Clinical Ophthalmology (May 2021)

Factors Influencing Response to Aflibercept in Diabetic Macular Oedema Patients in a Diverse North West London Population: A Real-World Study

  • Sim SY,
  • Ghulakhszian A,
  • Minocha A,
  • Ramcharan D,
  • Nokhostin S,
  • Cheong-Leen R,
  • George S,
  • Posner E,
  • Dinah C

Journal volume & issue
Vol. Volume 15
pp. 2089 – 2097

Abstract

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Sing Yue Sim,1 Arevik Ghulakhszian,2 Amal Minocha,1 Dhannie Ramcharan,2 Soroush Nokhostin,3 Richard Cheong-Leen,1 Sheena George,1 Esther Posner,3 Christiana Dinah2 1Department of Ophthalmology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK; 2Department of Ophthalmology, London North West University Healthcare NHS Trust, London, UK; 3Department of Ophthalmology, Imperial College Healthcare NHS Trust, London, UKCorrespondence: Christiana Dinah Email [email protected]: Diabetic macular oedema (DMO) is the leading cause of sight impairment in working age populations in developed countries. Current first line treatment for centre-involving DMO involves intravitreal anti-VEGF but treatment response can be variable. In this retrospective, real world, multi-centre cohort study, we aim to identify ocular and systemic characteristics that correlate with anatomical and functional outcomes for treatment-naive DMO patients treated with intravitreal aflibercept.Methods: Retrospective multicentre cohort study of treatment-naive DMO patients initiated on aflibercept at three North West London hospitals between 2016 and 2018. Baseline systemic and ocular factors, best corrected visual acuity (BCVA) and central macular thickness (CMT) at 12 months were determined and statistically analysed.Results: A total of 270 eyes of 221 DMO patients met inclusion criteria. Mean age was 62.8 ± 12.1, mean baseline HbA1c was 67 ± 20 mmol/mol, and mean eGFR was 72 mL/min/1.7m2. Mean number of aflibercept injections at 12 months was 6.2. Better baseline BCVA, lower baseline CMT, and absence of epiretinal membrane (ERM) were associated with better BCVA at 12 months whilst lower baseline CMT and proliferative retinopathy status were associated with lower CMT at 12 months.Conclusion: Our study is the largest real-world dataset examining factors influencing functional and anatomical response to aflibercept in DMO in the UK. Older age, lower baseline BCVA, higher baseline CMT and more severe diabetic retinopathy were associated with poorer visual acuity at 12 months and prioritisation of these patients within a pressured healthcare setting is recommended.Keywords: diabetic macular oedema, functional and anatomical response to Aflibercept

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