Is Anti-VEGF Therapy in Eyes with PDR Associated

Transcript:Is Anti-VEGF Therapy in Eyes with PDR Associated:
Is Anti-VEGF Therapy in Eyes with PDR Associated with Increased Risk of Traction Retinal Detachment? A Secondary Analysis of Five DRCR.net Clinical Trials Presenter on Behalf of the DRCR Network: Hani Salehi-Had, MD DRCR Retina Network Financial and Other Disclosures No relevant financial disclosures 2 Background – The Avastin “Crunch” Bevacizumab Therapy for the Treatment of ROP – R.V. Paul Chan (Retina Today, September 2011) “…intravitreal bevacizumab may decrease neovascularization but promote progression to retinal detachment. This progression to retinal detachment, often termed “ROP crunch”, can occur rather quickly...” 3 Clinical chart review at 6 centers TRD noted in 25 of 698 eyes (3.5%) receiving bevacizumab prior to vitrectomy for TRD Risk factors identified: >15-year duration of diabetes (~3-fold increase) >13 days from injection to vitrectomy (~7-fold increase) 2.5-mg dose of bevacizumab (~2-fold increase) Background: More Concerns of Avastin “Crunch” Letter to the Editor: Retinal Detachment after Bevacizumab – Arevalo et al (Ophthalmology, November 2011;118:2304.e3) 4 Study Objective To determine whether rates of traction retinal detachment and vitrectomy for traction retinal detachment, among study eyes with PDR in DRCR Network protocols, are higher when treating with anti-VEGF versus not treating with anti-VEGF Limited to events occurring in first year because previously-reported cases of TRD after anti-VEGF were noted soon after initial exposure Eyes with macular-threatening traction have generally been excluded from enrolling in DRCR.net anti-VEGF studies 5 Original Protocol of Eyes Analyzed 6 * Includes focal/grid laser (I, J), PRP (J, S), and intravitreous saline (N) ** Includes aflibercept (6%), bevacizumab (8%), and ranibizumab (86%) *** Protocol S eyes with baseline DME and 20/32 or worse vision were excluded because ranibizumab was required in both groups Participant Characteristics 7 Ocular Characteristics 8 *Time-domain (Stratus) equivalent Time to Retinal Detachment 9 * Adjusted for Protocol Time to Vitrectomy for Retinal Detachment 10 * Adjusted for Protocol Traction Retinal Detachment by DR Severity 11 Vitrectomy for TRD by DR Severity 12 Summary Among eyes with PDR at baseline enrolled in these protocols, anti-VEGF therapy was NOT associated with an increased rate of traction retinal detachment or associated vitrectomy compared with management in control arm Rates were numerically lower in the anti-VEGF group Caveat: these trials do not include eyes with TRD involving the macula or TRD for which vitrectomy was imminent or planned Conclusion: These findings do not support the hypothesis that anti-VEGF therapy for DME or PDR increases the risk of