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Anti-VEGF Treatment Provides Long-Term Treatment in Diabetic Macular Edema

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Although corticosteroids were found to immediately improve best-corrected visual acuity and central macular thickness, anti–vascular endothelial growth factor (anti-VEGF) therapies had significant long-term advantages when treating diabetic macular edema.

Anti–vascular endothelial growth factor (anti-VEGF) was found to have significant long-term advantages when treating diabetic macular edema (DME) that was associated with diabetic retinopathy compared with corticosteroids. According to a review published in Cureus, corticosteroids had immediate benefit to best-corrected visual acuity (BCVA) and central macular thickness (CMT) but dropped off after 6 months.

DME is caused primarily by fluid buildup in the macula, which itself is caused by leaking blood vessels. This can cause visual disability and blindness in extreme cases. Anti-VEGF has been used as the primary treatment of DME, as well as intravitreal injections of corticosteroids. The effectiveness of each of these treatments continues to be studied. This review aimed to evaluate and combine all data that compared using anti-VEGF therapy with corticosteroids when treating DME.

Close-up of blue eye | Image credit: Liudmila Dutko - stock.adobe.com

Close-up of blue eye | Image credit: Liudmila Dutko - stock.adobe.com

The researchers searched PubMed, EMBASE, the Cochrane Library, Web of Science, and Scopus to collect studies to use in the review. All articles needed to be published in English, and no specified timeframe was imposed on the search. Participants in the study needed to be 18 years and older with a diagnosis of DME. All changes in BCVA and CMT were evaluated as primary outcomes and comparisons between anti-VEGF and corticosteroids were included. Case reports, editorials, and reviews/studies that had low amounts of data or had a risk of bias were not included in the review. All demographic data and details of the intervention and comparison treatment were extracted from the studies as well.

There were 9 papers covering 877 participants that were ultimately included in the review. There were 2 groups formed for all participants based on their therapy: 453 in the corticosteroid group and 424 in the anti-VEGF group. A total of 290 eyes were affected by DME in the population; 153 eyes received corticosteroid treatment and 137 eyes received anti-VEGF. Intravitreal delivery was used for all medications. Exact dosages of the medications were used in 4 studies whereas 3 studies did not report information on dose quantities.

An improvement in visual acuity was found at the end of the treatment cycle based on BCVA logMAR scores. However, although these results were clinically significant, they were not statistically significant. A combined data analysis found there was a decrease in BCVA of –0.13 (95% CI, –0.41 to 0.16) whereas there was an improvement in baseline BCVA compared with the end point (pooled effect size, 0.03; 95% CI, –0.07 to 0.13). However, this was not statistically significant.

No significant changes were found in favor of corticosteroids when comparing them to anti-VEGF therapy (difference, –0.07; 95% CI, –0.29 to 0.15). All of these results had a high level of heterogeneity.

The researchers concluded that these results should encourage detailed consideration of each treatment before drug administration when treating DME, as both corticosteroids and anti-VEGF therapy were effective in treating DME.

Reference

Kumar A, Kumar A, Kumar J, et al. Comparative efficacy of anti-vascular endothelial growth factor (anti-VEGF) agents and corticosteroids in managing diabetic retinopathy-associated diabetic macular edema: a meta-analysis and comprehensive systematic review. Cureus. Published online January 8, 2024. doi:10.7759/cureus.51910

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