Sustained Delivery Fluocinolone Acetonide Vitreous Inserts Provide Benefit for at Least 3 Years in Patients with Diabetic Macular Edema
To assess long-term efficacy and safety of intravitreal inserts releasing 0.2 μg/d (low dose) or 0.5 μg/d (high dose) fluocinolone acetonide (FAc) in patients with diabetic macular edema (DME). Two randomized, sham injection-controlled, double-masked, multicenter clinical trials. Subjects with persi...
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Published in | Ophthalmology (Rochester, Minn.) Vol. 119; no. 10; pp. 2125 - 2132 |
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Main Authors | , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York, NY
Elsevier Inc
01.10.2012
Elsevier |
Subjects | |
Online Access | Get full text |
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Abstract | To assess long-term efficacy and safety of intravitreal inserts releasing 0.2 μg/d (low dose) or 0.5 μg/d (high dose) fluocinolone acetonide (FAc) in patients with diabetic macular edema (DME).
Two randomized, sham injection-controlled, double-masked, multicenter clinical trials.
Subjects with persistent DME despite ≥1 macular laser treatment were randomized 1:2:2 to sham injection (n = 185), low-dose insert (n = 375), or high-dose insert (n = 393).
Subjects received study drug or sham injection and after 6 weeks were eligible for rescue laser. Based on retreatment criteria, additional study drug or sham injections could be given after 1 year.
Percentage of patients with improvement of ≥15 letters from baseline. Secondary outcomes included other parameters of visual function and foveal thickness.
At month 36, the percentage of patients who gained ≥15 in letter score using the last observation carried forward method was 28.7% (low dose) and 27.8% (high dose) in the FAc insert groups compared with 18.9% (P = 0.018) in the sham group, and considering only those patients still in the trial at month 36, it was 33.0% (low dose) and 31.9% (high dose) compared with 21.4% in the sham group (P = 0.030). Preplanned subgroup analysis demonstrated a doubling of benefit compared with sham injections in patients who reported duration of DME ≥3 years at baseline; the percentage who gained ≥15 in letter score at month 36 was 34.0% (low dose; P<0.001) or 28.8% (high dose; P = 0.002) compared with 13.4% (sham). An improvement ≥2 steps in the Early Treatment Diabetic Retinopathy Study retinopathy scale occurred in 13.7% (low dose) and 10.1% (high dose) compared with 8.9% in the sham group. Almost all phakic patients in the FAc insert groups developed cataract, but their visual benefit after cataract surgery was similar to that in pseudophakic patients. The incidence of incisional glaucoma surgery at month 36 was 4.8% in the low-dose group and 8.1% in the high-dose insert group.
In patients with DME FAc inserts provide substantial visual benefit for up to 3 years and would provide a valuable addition to the options available for patients with DME.
Proprietary or commercial disclosure may be found after the references. |
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AbstractList | Objective To assess long-term efficacy and safety of intravitreal inserts releasing 0.2 μg/d (low dose) or 0.5 μg/d (high dose) fluocinolone acetonide (FAc) in patients with diabetic macular edema (DME). Design Two randomized, sham injection-controlled, double-masked, multicenter clinical trials. Participants Subjects with persistent DME despite ≥1 macular laser treatment were randomized 1:2:2 to sham injection (n = 185), low-dose insert (n = 375), or high-dose insert (n = 393). Methods Subjects received study drug or sham injection and after 6 weeks were eligible for rescue laser. Based on retreatment criteria, additional study drug or sham injections could be given after 1 year. Main Outcome Measures Percentage of patients with improvement of ≥15 letters from baseline. Secondary outcomes included other parameters of visual function and foveal thickness. Results At month 36, the percentage of patients who gained ≥15 in letter score using the last observation carried forward method was 28.7% (low dose) and 27.8% (high dose) in the FAc insert groups compared with 18.9% ( P = 0.018) in the sham group, and considering only those patients still in the trial at month 36, it was 33.0% (low dose) and 31.9% (high dose) compared with 21.4% in the sham group ( P = 0.030). Preplanned subgroup analysis demonstrated a doubling of benefit compared with sham injections in patients who reported duration of DME ≥3 years at baseline; the percentage who gained ≥15 in letter score at month 36 was 34.0% (low dose; P <0.001) or 28.8% (high dose; P = 0.002) compared with 13.4% (sham). An improvement ≥2 steps in the Early Treatment Diabetic Retinopathy Study retinopathy scale occurred in 13.7% (low dose) and 10.1% (high dose) compared with 8.9% in the sham group. Almost all phakic patients in the FAc insert groups developed cataract, but their visual benefit after cataract surgery was similar to that in pseudophakic patients. The incidence of incisional glaucoma surgery at month 36 was 4.8% in the low-dose group and 8.1% in the high-dose insert group. Conclusions In patients with DME FAc inserts provide substantial visual benefit for up to 3 years and would provide a valuable addition to the options available for patients with DME. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. To assess long-term efficacy and safety of intravitreal inserts releasing 0.2 μg/d (low dose) or 0.5 μg/d (high dose) fluocinolone acetonide (FAc) in patients with diabetic macular edema (DME).OBJECTIVETo assess long-term efficacy and safety of intravitreal inserts releasing 0.2 μg/d (low dose) or 0.5 μg/d (high dose) fluocinolone acetonide (FAc) in patients with diabetic macular edema (DME).Two randomized, sham injection-controlled, double-masked, multicenter clinical trials.DESIGNTwo randomized, sham injection-controlled, double-masked, multicenter clinical trials.Subjects with persistent DME despite ≥1 macular laser treatment were randomized 1:2:2 to sham injection (n = 185), low-dose insert (n = 375), or high-dose insert (n = 393).PARTICIPANTSSubjects with persistent DME despite ≥1 macular laser treatment were randomized 1:2:2 to sham injection (n = 185), low-dose insert (n = 375), or high-dose insert (n = 393).Subjects received study drug or sham injection and after 6 weeks were eligible for rescue laser. Based on retreatment criteria, additional study drug or sham injections could be given after 1 year.METHODSSubjects received study drug or sham injection and after 6 weeks were eligible for rescue laser. Based on retreatment criteria, additional study drug or sham injections could be given after 1 year.Percentage of patients with improvement of ≥15 letters from baseline. Secondary outcomes included other parameters of visual function and foveal thickness.MAIN OUTCOME MEASURESPercentage of patients with improvement of ≥15 letters from baseline. Secondary outcomes included other parameters of visual function and foveal thickness.At month 36, the percentage of patients who gained ≥15 in letter score using the last observation carried forward method was 28.7% (low dose) and 27.8% (high dose) in the FAc insert groups compared with 18.9% (P = 0.018) in the sham group, and considering only those patients still in the trial at month 36, it was 33.0% (low dose) and 31.9% (high dose) compared with 21.4% in the sham group (P = 0.030). Preplanned subgroup analysis demonstrated a doubling of benefit compared with sham injections in patients who reported duration of DME ≥3 years at baseline; the percentage who gained ≥15 in letter score at month 36 was 34.0% (low dose; P<0.001) or 28.8% (high dose; P = 0.002) compared with 13.4% (sham). An improvement ≥2 steps in the Early Treatment Diabetic Retinopathy Study retinopathy scale occurred in 13.7% (low dose) and 10.1% (high dose) compared with 8.9% in the sham group. Almost all phakic patients in the FAc insert groups developed cataract, but their visual benefit after cataract surgery was similar to that in pseudophakic patients. The incidence of incisional glaucoma surgery at month 36 was 4.8% in the low-dose group and 8.1% in the high-dose insert group.RESULTSAt month 36, the percentage of patients who gained ≥15 in letter score using the last observation carried forward method was 28.7% (low dose) and 27.8% (high dose) in the FAc insert groups compared with 18.9% (P = 0.018) in the sham group, and considering only those patients still in the trial at month 36, it was 33.0% (low dose) and 31.9% (high dose) compared with 21.4% in the sham group (P = 0.030). Preplanned subgroup analysis demonstrated a doubling of benefit compared with sham injections in patients who reported duration of DME ≥3 years at baseline; the percentage who gained ≥15 in letter score at month 36 was 34.0% (low dose; P<0.001) or 28.8% (high dose; P = 0.002) compared with 13.4% (sham). An improvement ≥2 steps in the Early Treatment Diabetic Retinopathy Study retinopathy scale occurred in 13.7% (low dose) and 10.1% (high dose) compared with 8.9% in the sham group. Almost all phakic patients in the FAc insert groups developed cataract, but their visual benefit after cataract surgery was similar to that in pseudophakic patients. The incidence of incisional glaucoma surgery at month 36 was 4.8% in the low-dose group and 8.1% in the high-dose insert group.In patients with DME FAc inserts provide substantial visual benefit for up to 3 years and would provide a valuable addition to the options available for patients with DME.CONCLUSIONSIn patients with DME FAc inserts provide substantial visual benefit for up to 3 years and would provide a valuable addition to the options available for patients with DME. To assess long-term efficacy and safety of intravitreal inserts releasing 0.2 μg/d (low dose) or 0.5 μg/d (high dose) fluocinolone acetonide (FAc) in patients with diabetic macular edema (DME). Two randomized, sham injection-controlled, double-masked, multicenter clinical trials. Subjects with persistent DME despite ≥1 macular laser treatment were randomized 1:2:2 to sham injection (n = 185), low-dose insert (n = 375), or high-dose insert (n = 393). Subjects received study drug or sham injection and after 6 weeks were eligible for rescue laser. Based on retreatment criteria, additional study drug or sham injections could be given after 1 year. Percentage of patients with improvement of ≥15 letters from baseline. Secondary outcomes included other parameters of visual function and foveal thickness. At month 36, the percentage of patients who gained ≥15 in letter score using the last observation carried forward method was 28.7% (low dose) and 27.8% (high dose) in the FAc insert groups compared with 18.9% (P = 0.018) in the sham group, and considering only those patients still in the trial at month 36, it was 33.0% (low dose) and 31.9% (high dose) compared with 21.4% in the sham group (P = 0.030). Preplanned subgroup analysis demonstrated a doubling of benefit compared with sham injections in patients who reported duration of DME ≥3 years at baseline; the percentage who gained ≥15 in letter score at month 36 was 34.0% (low dose; P<0.001) or 28.8% (high dose; P = 0.002) compared with 13.4% (sham). An improvement ≥2 steps in the Early Treatment Diabetic Retinopathy Study retinopathy scale occurred in 13.7% (low dose) and 10.1% (high dose) compared with 8.9% in the sham group. Almost all phakic patients in the FAc insert groups developed cataract, but their visual benefit after cataract surgery was similar to that in pseudophakic patients. The incidence of incisional glaucoma surgery at month 36 was 4.8% in the low-dose group and 8.1% in the high-dose insert group. In patients with DME FAc inserts provide substantial visual benefit for up to 3 years and would provide a valuable addition to the options available for patients with DME. Proprietary or commercial disclosure may be found after the references. To assess long-term efficacy and safety of intravitreal inserts releasing 0.2 μg/d (low dose) or 0.5 μg/d (high dose) fluocinolone acetonide (FAc) in patients with diabetic macular edema (DME). Two randomized, sham injection-controlled, double-masked, multicenter clinical trials. Subjects with persistent DME despite ≥1 macular laser treatment were randomized 1:2:2 to sham injection (n = 185), low-dose insert (n = 375), or high-dose insert (n = 393). Subjects received study drug or sham injection and after 6 weeks were eligible for rescue laser. Based on retreatment criteria, additional study drug or sham injections could be given after 1 year. Percentage of patients with improvement of ≥15 letters from baseline. Secondary outcomes included other parameters of visual function and foveal thickness. At month 36, the percentage of patients who gained ≥15 in letter score using the last observation carried forward method was 28.7% (low dose) and 27.8% (high dose) in the FAc insert groups compared with 18.9% (P = 0.018) in the sham group, and considering only those patients still in the trial at month 36, it was 33.0% (low dose) and 31.9% (high dose) compared with 21.4% in the sham group (P = 0.030). Preplanned subgroup analysis demonstrated a doubling of benefit compared with sham injections in patients who reported duration of DME ≥3 years at baseline; the percentage who gained ≥15 in letter score at month 36 was 34.0% (low dose; P<0.001) or 28.8% (high dose; P = 0.002) compared with 13.4% (sham). An improvement ≥2 steps in the Early Treatment Diabetic Retinopathy Study retinopathy scale occurred in 13.7% (low dose) and 10.1% (high dose) compared with 8.9% in the sham group. Almost all phakic patients in the FAc insert groups developed cataract, but their visual benefit after cataract surgery was similar to that in pseudophakic patients. The incidence of incisional glaucoma surgery at month 36 was 4.8% in the low-dose group and 8.1% in the high-dose insert group. In patients with DME FAc inserts provide substantial visual benefit for up to 3 years and would provide a valuable addition to the options available for patients with DME. |
Author | Chen, Sanford Hariprasad, Seenu M. Kapik, Barry Boyer, David Billman, Kathleen Gupta, Amod Kane, Frances E. Garretson, Bruce Ruiz-Moreno, Jose Reichel, Elias Soubrane, Gisele Campochiaro, Peter A. Green, Kenneth Brown, David M. Pearson, Andrew Bailey, Clare |
Author_xml | – sequence: 1 givenname: Peter A. surname: Campochiaro fullname: Campochiaro, Peter A. email: pcampo@jhmi.edu organization: Wilmer Eye Institute, Baltimore, Maryland – sequence: 2 givenname: David M. surname: Brown fullname: Brown, David M. organization: Vitreoretinal Consultants, Houston, Texas – sequence: 3 givenname: Andrew surname: Pearson fullname: Pearson, Andrew organization: Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, Kentucky – sequence: 4 givenname: Sanford surname: Chen fullname: Chen, Sanford organization: Orange County Retina Medical Group, Santa Ana, California – sequence: 5 givenname: David surname: Boyer fullname: Boyer, David organization: Retina Vitreous Associates Medical Group, Beverly Hills, California – sequence: 6 givenname: Jose surname: Ruiz-Moreno fullname: Ruiz-Moreno, Jose organization: Institut Oflalmologico Alicante, Spain – sequence: 7 givenname: Bruce surname: Garretson fullname: Garretson, Bruce organization: Royal Oak Associates, Royal Oak, Michigan – sequence: 8 givenname: Amod surname: Gupta fullname: Gupta, Amod organization: Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India – sequence: 9 givenname: Seenu M. surname: Hariprasad fullname: Hariprasad, Seenu M. organization: Department of Ophthalmlogy, University of Chicago, Chicago, Illinois – sequence: 10 givenname: Clare surname: Bailey fullname: Bailey, Clare organization: Bristol Eye Hospital, Bristol, UK – sequence: 11 givenname: Elias surname: Reichel fullname: Reichel, Elias organization: Tufts Medical Center Hospital, Boston, Massachusetts – sequence: 12 givenname: Gisele surname: Soubrane fullname: Soubrane, Gisele organization: Intercommunal Hospital of Creteil, Creteil, France – sequence: 13 givenname: Barry surname: Kapik fullname: Kapik, Barry organization: Alimera Sciences, Atlanta, Georgia – sequence: 14 givenname: Kathleen surname: Billman fullname: Billman, Kathleen organization: Alimera Sciences, Atlanta, Georgia – sequence: 15 givenname: Frances E. surname: Kane fullname: Kane, Frances E. organization: Alimera Sciences, Atlanta, Georgia – sequence: 16 givenname: Kenneth surname: Green fullname: Green, Kenneth organization: Alimera Sciences, Atlanta, Georgia |
BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26818699$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/22727177$$D View this record in MEDLINE/PubMed |
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Cites_doi | 10.1016/j.ophtha.2011.12.039 10.1016/j.ophtha.2009.11.024 10.1001/archopht.1985.01050120030015 10.1016/j.ophtha.2010.12.028 |
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Keywords | Endocrinopathy Human Corticosteroid Retinopathy Steroid hormone Diabetes mellitus Vitreous body Retinal edema Eye disease Fluocinolone acetonide Adrenal hormone Delivery Ophthalmology |
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SubjectTerms | Antihypertensive Agents - therapeutic use Biological and medical sciences Cataract - etiology Cataract - therapy Delivery. Postpartum. Lactation Diabetes. Impaired glucose tolerance Diabetic Retinopathy - diagnosis Diabetic Retinopathy - drug therapy Double-Blind Method Drug Implants Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Fluocinolone Acetonide - administration & dosage Fluocinolone Acetonide - adverse effects Fluorescein Angiography Follow-Up Studies Glaucoma - etiology Glaucoma - surgery Glucocorticoids - administration & dosage Glucocorticoids - adverse effects Gynecology. Andrology. Obstetrics Humans Macular Edema - diagnosis Macular Edema - drug therapy Medical sciences Miscellaneous Ophthalmology Phacoemulsification Retinopathies Tomography, Optical Coherence Trabeculectomy Treatment Outcome Visual Acuity - physiology Vitreous Body |
Title | Sustained Delivery Fluocinolone Acetonide Vitreous Inserts Provide Benefit for at Least 3 Years in Patients with Diabetic Macular Edema |
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