Faculty Collaboration Database

Ranibizumab for edema of the macula in diabetes study: 3-year outcomes and the need for prolonged frequent treatment. JAMA Ophthalmol 2013 Feb;131(2):139-45

Date

04/02/2013

Pubmed ID

23544200

DOI

10.1001/2013.jamaophthalmol.91

Scopus ID

2-s2.0-84874080959 (requires institutional sign-in at Scopus site)   147 Citations

Abstract

OBJECTIVE: To assess the benefit of increased follow-up and treatment with ranibizumab between months 24 and 36 in the Ranibizumab for Edema of the Macula in Diabetes (READ-2) Study.

DESIGN: Prospective, interventional, multicenter follow-up of a randomized clinical trial.

METHODS: Patients who agreed to participate between months 24 and 36 (ranibizumab, 28 patients; laser, 22; and ranibizumab + laser, 24) returned monthly and received ranibizumab, 0.5 mg, if foveal thickness (FTH, center subfield thickness) was 250 μm or greater. Main outcome measures were improvement in best-corrected visual acuity (BCVA) and reduction in FTH between months 24 and 36.

RESULTS: Mean improvement from the baseline BCVA in the ranibizumab group was 10.3 letters at month 36 vs 7.2 letters at month 24 (ΔBCVA letters = 3.1, P = .009), and FTH at month 36 was 282 μm vs 352 μm at month 24 (ΔFTH = 70 μm, P = .006). Changes in BCVA and FTH in the laser group (-1.6 letters and -36 μm, respectively) and the ranibizumab + laser group (+2.0 letters and -24 μm) were not statistically significant. The mean number of ranibizumab injections was significantly greater in the ranibizumab group compared with the laser group (5.4 vs 2.3 injections, P = .008) but not compared with the ranibizumab + laser group (3.3, P = .11).

CONCLUSIONS: More aggressive treatment with ranibizumab during year 3 resulted in a reduction in mean FTH and improvement in BCVA in the ranibizumab group. More extensive focal/grid laser therapy in the other 2 groups may have reduced the need for more frequent ranibizumab injections to control edema.

APPLICATION TO CLINICAL PRACTICE: Long-term visual outcomes for treatment of diabetic macular edema with ranibizumab are excellent, but many patients require frequent injections to optimally control edema and maximize vision.

TRIAL REGISTRATION: clinicaltrials.gov Identifier:NCT00407381

Author List

Do DV, Nguyen QD, Khwaja AA, Channa R, Sepah YJ, Sophie R, Hafiz G, Campochiaro PA, READ-2 Study Group

MESH terms used to index this publication - Major topics in bold

Adolescent
Angiogenesis Inhibitors
Antibodies, Monoclonal, Humanized
Combined Modality Therapy
Diabetes Mellitus, Type 1
Diabetes Mellitus, Type 2
Diabetic Retinopathy
Fluorescein Angiography
Follow-Up Studies
Fovea Centralis
Humans
Intravitreal Injections
Laser Coagulation
Macular Edema
Prospective Studies
Ranibizumab
Retreatment
Tomography, Optical Coherence
Treatment Outcome
Vascular Endothelial Growth Factor A
Visual Acuity