Thicker Baseline CST Linked to Longer DME Resolution in Aflibercept-Treated Eyes

Katherine Talcott, MD

New research reported the median time to diabetic macular edema (DME) resolution was 33 weeks among eyes treated with intravitreal aflibercept injection.

Eyes with a thicker baseline central subfield thickness (CST) and better baseline best-corrected visual acuity (BCVA) in the intravitreal aflibercept injection group were associated with a longer time to and a lower rate of DME resolution.

Led by study author Katherine Talcott, MD, Department of Ophthalmology, Cleveland Clinic, investigators aimed to assess the relationship between baseline factors and time to DME resolution in a post-hoc analysis of the VISTA and VIVID trials.

Participants in the trials had eyes with baseline central subfield thickness (CST) of ≥290mm. Eyes were treated with intravitreal aflibercept injection 2 mg (n = 558; every 4 weeks or every 8 weeks after 5 monthly doses) or laser control (n = 274).

Investigators assessed the effect of baseline factors on the time to DME resolution (CST <290µ) in univariable and multivariable models and further evaluated by the Kaplan-Meier method. Main outcomes for the trials were the time to and cumulative incidence of DME resolution.

The findings suggest eyes treated with intravitreal aflibercept injection had a 2.5-fold higher DME resolution rate, with a median time of 33.0 weeks (95% confidence interval [CI], 28.1 – 40.0), compared with DME resolution not being achieved in 50% of eyes treated with laser control.

In multivariable analysis, they found a lower DME resolution rate was associated with a thicker baseline CST (hazard ratio [HR] per 100µm CST increase, 0.79 [95% CI, 0.72 - 0.86]) and better baseline BCVA (HR per 5-letter increase, 0.87 [95% CI, 0.83 - 0.92]) with aflibercept.

Data show tertiles of increasing CST (T1 ≤ 419 μm; T2CST >419 to ≥541; T3 >541) were associated with longer median times to DME resolution (20.1, 39.1, and 49.1 weeks, respectively; P <.001 for T2 and T3 versus T1). They additionally saw a lower cumulative incidence of events with aflibercept injection (HR, 1.0, 0.6, and 0.6, respectively; P <.001 for T2 and T3 versus T1).

Results show tertiles of increasing BCVA (T1 ≤57 letters; T2 >57 to ≤66; T3 >66) were associated with longer median times to DME resolution (28.4, 31.7, and 44.1 weeks, respectively; P <.05 for T3 versus T1), as well as a lower cumulative incidence of events (HR, 1.0, 0.9, and 0.8, respectively; P <.05 for T3 versus T1) with aflibercept.

There were no other baseline factors associated with the time to DME resolution, according to investigators.

The study, “Time to Resolution of Diabetic Macular Edema after Treatment with Intravitreal Aflibercept Injection or Laser in VISTA and VIVID,” was published in Ophthalmology.