Proliferative Diabetic Retinopathy Events in Patients With Diabetic Macular Edema: Post Hoc Analysis of VISTA and VIVID Trials

Diana V Do; Carmelina Gordon; Ivan J Suñer; Kimberly Reed; Hadi Moini; Andrea Gibson; Weiming Du; Chirag P Shah

doi:10.1177/24741264221093914

Proliferative Diabetic Retinopathy Events in Patients With Diabetic Macular Edema: Post Hoc Analysis of VISTA and VIVID Trials

J Vitreoretin Dis. 2022 Jun 4;6(4):295-301. doi: 10.1177/24741264221093914. eCollection 2022 Jul-Aug.

Authors

Diana V Do¹, Carmelina Gordon², Ivan J Suñer³, Kimberly Reed⁴, Hadi Moini⁴, Andrea Gibson⁴, Weiming Du⁴, Chirag P Shah⁵

Affiliations

¹ Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
² Specialty Eye Institute, Jackson, MI, USA.
³ Retina Associates of Florida, PA, Tampa, FL, USA.
⁴ Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA.
⁵ Ophthalmic Consultants of Boston, Boston, MA, USA.

Abstract

Purpose: This work aimed to assess the incidence of proliferative diabetic retinopathy (PDR) events and improvement to mild non-PDR (NPDR) or better after intravitreal aflibercept injection (IAI) or laser treatment (control) in diabetic macular edema (DME).

Methods: PDR events in the VISTA (NCT01363440) and VIVID (NCT01331681) phase 3 clinical trials were evaluated in a combined IAI-treated group (IAI 2 mg every 4 weeks or 2 mg every 8 weeks after 5 initial monthly doses; n = 475) and a macular laser control group (n = 235) through week 100 in eyes without PDR at baseline (Diabetic Retinopathy Severity Scale [DRSS] score ≤ 53). Improvement in the DRSS score to 35 or better was evaluated in those with a baseline DRSS score of 43 or greater.

Results: A lower proportion of eyes in the IAI group than in the laser group developed a PDR event through week 100 (4.4% vs 11.1%; adjusted difference, -6.7%; 97.5% CI, -11.7 to -1.6; nominal P = .0008). All PDR events occurred in eyes with a baseline DRSS score of 43, 47, or 53 and not in those with a score of 35 or less. A greater proportion of eyes in the IAI group than in the control group achieved a DRSS score of 35 or less (20.0% vs 3.8%; nominal P < .0001).

Conclusions: Fewer eyes with NPDR and DME treated with IAI than eyes treated with a laser had a PDR event. More eyes treated with IAI improved to mild NPDR or better (DRSS score ≤ 35) through 100 weeks.

Keywords: VISTA; VIVID; anti-VEGF therapy; diabetic macular edema; diabetic retinopathy; intravitreal aflibercept; proliferative diabetic retinopathy.