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 inOphthalmology (Rochester, Minn.) Vol. 119; no. 10; pp. 2125 - 2132
Main Authors Campochiaro, Peter A., Brown, David M., Pearson, Andrew, Chen, Sanford, Boyer, David, Ruiz-Moreno, Jose, Garretson, Bruce, Gupta, Amod, Hariprasad, Seenu M., Bailey, Clare, Reichel, Elias, Soubrane, Gisele, Kapik, Barry, Billman, Kathleen, Kane, Frances E., Green, Kenneth
Format Journal Article
LanguageEnglish
Published New York, NY Elsevier Inc 01.10.2012
Elsevier
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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.
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
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  surname: Campochiaro
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  organization: Wilmer Eye Institute, Baltimore, Maryland
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  givenname: David M.
  surname: Brown
  fullname: Brown, David M.
  organization: Vitreoretinal Consultants, Houston, Texas
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  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
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  surname: Boyer
  fullname: Boyer, David
  organization: Retina Vitreous Associates Medical Group, Beverly Hills, California
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  surname: Ruiz-Moreno
  fullname: Ruiz-Moreno, Jose
  organization: Institut Oflalmologico Alicante, Spain
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  fullname: Gupta, Amod
  organization: Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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  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
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  givenname: Gisele
  surname: Soubrane
  fullname: Soubrane, Gisele
  organization: Intercommunal Hospital of Creteil, Creteil, France
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  surname: Kapik
  fullname: Kapik, Barry
  organization: Alimera Sciences, Atlanta, Georgia
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  givenname: Kathleen
  surname: Billman
  fullname: Billman, Kathleen
  organization: Alimera Sciences, Atlanta, Georgia
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  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
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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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Issue 10
Keywords Endocrinopathy
Human
Corticosteroid
Retinopathy
Steroid hormone
Diabetes mellitus
Vitreous body
Retinal edema
Eye disease
Fluocinolone acetonide
Adrenal hormone
Delivery
Ophthalmology
Language English
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PublicationTitle Ophthalmology (Rochester, Minn.)
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References Campochiaro, Brown, Pearson (bib2) 2011; 118
Campochiaro, Hafiz, Shah (bib1) 2010; 117
(bib3) 1985; 103
Nguyen, Brown, Marcus (bib4) 2012; 119
(10.1016/j.ophtha.2012.04.030_bib3) 1985; 103
Nguyen (10.1016/j.ophtha.2012.04.030_bib4) 2012; 119
Campochiaro (10.1016/j.ophtha.2012.04.030_bib1) 2010; 117
Campochiaro (10.1016/j.ophtha.2012.04.030_bib2) 2011; 118
References_xml – volume: 118
  start-page: 626
  year: 2011
  end-page: 635
  ident: bib2
  article-title: Long-term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema
  publication-title: Ophthalmology
– volume: 119
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  year: 2012
  end-page: 801
  ident: bib4
  article-title: Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE
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– volume: 103
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  ident: bib3
  article-title: Photocoagulation for diabetic macular edema
  publication-title: Arch Ophthalmol
– volume: 117
  start-page: 1393
  year: 2010
  end-page: 1399
  ident: bib1
  article-title: Sustained ocular delivery of fluocinolone acetonide by an intravitreal insert
  publication-title: Ophthalmology
– volume: 119
  start-page: 789
  year: 2012
  ident: 10.1016/j.ophtha.2012.04.030_bib4
  article-title: Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE
  publication-title: Ophthalmology
  doi: 10.1016/j.ophtha.2011.12.039
– volume: 117
  start-page: 1393
  year: 2010
  ident: 10.1016/j.ophtha.2012.04.030_bib1
  article-title: Sustained ocular delivery of fluocinolone acetonide by an intravitreal insert
  publication-title: Ophthalmology
  doi: 10.1016/j.ophtha.2009.11.024
– volume: 103
  start-page: 1796
  year: 1985
  ident: 10.1016/j.ophtha.2012.04.030_bib3
  article-title: Photocoagulation for diabetic macular edema
  publication-title: Arch Ophthalmol
  doi: 10.1001/archopht.1985.01050120030015
– volume: 118
  start-page: 626
  year: 2011
  ident: 10.1016/j.ophtha.2012.04.030_bib2
  article-title: Long-term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema
  publication-title: Ophthalmology
  doi: 10.1016/j.ophtha.2010.12.028
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Snippet 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...
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...
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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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