Link between DME, different anti-VEGF therapies and renal function

nvestigators found that renal function might affect the response to IVBI treatment in patients with DME

A team of researchers from the Republic of Korea have found that renal function may have an impact on the efficacy of different anti-vascular endothelial growth factor treatments for diabetic macular edema (DME).

Tae Hwan Moon, MD, from First Eye Clinic, Cheongju, and colleagues conducted a retrospective study to investigate an association between responses to intravitreal bevacizumab injection (IVBI) (Avastin, Genentech Inc.) and renal function in patients diagnosed with DME.

The medical records of 104 treatment-naïve patients with DME who had been treated with IVBI were analyzed and the patients were classified into 3 groups according to the degree of renal impairment based on the value of the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2).

The best-corrected visual acuity (BCVA) and central subfield retinal thickness (CST) changes were compared among the groups after the patients had received an IVBI on 3 consecutive months. In the groups with decreased renal function, the response to further treatment with a different drug was investigated, the investigators explained.

The 104 patients who were included in the study were classified as follows: 60 had preserved renal function with an eGFR of 60 mL/ min/1.73 m2 or higher; 25 had moderate chronic kidney disease (CKD) with an eGFR ranging from 30 mL/ min/1.73 m2 to less than 60 mL/min/1.73 m2; and 19 had severe CKD with an eGFR below 30 mL/min/1.73 m2).

The data showed that after the 3 injections of IVBI, the BCVA and CST improved significantly (p < 0.001 for both comparisons) only in the patients who had preserved renal function.

In the patients who had moderate and severe renal function and were treated with other drugs, the results were significantly better in the patients who were switched to aflibercept (Eylea, Regeneron) or dexamethasone implant (Ozurdex, Allergan) compared with those who remained on IVBI.

“In this preliminary study, we found that renal function might affect the response to IVBI treatment in patients with DME,” he said. “In the case of a poor response to initial IVBI treatment for DME in patients with moderate to severe CKD, our study supports switching to the aflibercept or dexamethasone implant.”

The researchers also suggested that the eGFR might be considered a reference biomarker to predict treatment responsiveness in patients with DME.

Reference

Moon TH, Jo GH, Seo EJ, et al. Preliminary study of different treatment responses between bevacizumab, aflibercept and dexamethasone implant according to renal function in diabetic macular edema patients. J Clin Med. 2022;11:7047; https://doi.org/10.3390/jcm11237047