Older Age May Significant Affect Diabetic Macular Edema Treatment

Credit: Unsplash / Christian Langballe

Older patients with diabetic macular edema (DME) experienced poorer response to anti-vascular endothelial growth factor (VEGF) treatment, according to analysis of multiple trials from the DRCR Retina Network. The findings are especially concerning both the higher likelihood of older patients developing the retina disease—and anti-VEGF therapy being among the standard treatment options for this form of vision loss.

These new data showed older eyes with DME experienced a suboptimal response specifically in visual acuity (VA) and central subfield thickness (CST) after treatment with three different anti-VEGF agents compared with younger patients.

“We found that the older the patient, the smaller the increase in VA and the smaller the decrease in CST,” Maureen Maguire, PhD, DRCR Retina Network, said about the study. “This finding was consistent when using other definitions of suboptimal treatment response for all 3 anti-VEGF agents, for all three trials, and after adjustment for baseline differences in age groups.”

A previous post hoc analysis of a DRCR Retina Network randomized trial found older age was correlated with a higher risk for meeting criteria for switching anti-VEGF agents due to suboptimal response.

Within this exploratory analysis, Maguire and colleagues assessed data across the DRCR Retina Network to investigate the link between age and response in VA and CST after anti-VEGF treatment.

The analysis combined eyes with DME assigned to aflibercept, bevacizumab, or ranibizumab in three randomized clinical trials: Protocols I, T, and AC. Baseline age was categorized as younger than 50, 50 to 59, 60 to 69, and at least 70 years old.

Regression and Cox proportional hazards models were used to evaluate the connection between age with change in VA or CST and suboptimal treatment response, respectively.

Baseline characteristics showed 119 patients were aged younger than 50; 306 were aged 50 to 59; 387 were aged 60 to 69; and 194 were aged at least 70. The youngest age group had a lower percentage of White, female, and type 2 diabetes diagnsoes, as well as a shorter duration of diabetes and higher median HbA1c.

At the two-year mark, the adjusted mean VA increase from baseline decreased with older age, from +17.9 in the youngest cohort to +9.0 in the oldest. The adjusted mean CST reductions also decreased with older age, from –183 in the youngest cohort to –158 in the oldest.

Notably, Maguire and colleagues found these trends present for all anti-VEGF agents, including aflibercept (Eylea) , bevacizumab (Avastin), and ranibizumab (Lucentis). Analyses were then performed to determine the two-year adjusted proportion of patients with suboptimal response to these anti-VEGF agents.

These data showed suboptimal VA response increased with older age, from 60 percent in the youngest cohort to 84 percent in the oldest. Suboptimal CST response also increased with older age, from 42 percent in the youngest cohort to 62 percent in the oldest.

Once more, investigators found these trends apparent for all three anti-VEGF agents, without an agent-to-age interaction.

“These results may be helpful to refine expectations regarding treatment outcomes when initiating therapy for DME with anti-VEGF drugs,” Maguire added.

An original version of this article was published on sister site HCPLive.