www.diabeticretinopathy.org.uk

Drugs to treat diabetic retinopathy

David Kinshuck

Anti-VEGF drugs

AntiVEGF drugs
  • Avastin (Bevacizumab) ~£60, lasts 4 weeks
  • Lucentis (Ranibizumab) ~£650, lasts 4 weeks
  • Eylea (aflibercept) ~£700, lasts ~2 months

There are 3 drugs. Eylea is new and longer lasting and is likely to be the best for the moment, Avastin is the cheapest and almost certainly just as good as Lucentis which is in popular use.  The procedure is discussed.

The drugs reduce macular oedema and proliferation (blood vessel growth) in diabetic retinopathy, but their effect usually wears off. To keep good sight in the long term, the diabetes and blood pressure (BP) must be controlled: the drugs are very useful for use whilst patients are trying to control their diabetes and BP

The risk of anti-VEGF treatment is small

How are AntiVEGFs given

The AntiVEGFs are given by injection into the vitreous cavity of the eyeball details. The drugs last 4-8 weeks. There are different protocols.

Funding for AntiVEGF

Repeated AntiVEGF injections

Unfortunately the effect of these drugs is just weeks. Here is my interpretation of Macugen's (an older drug now withdrawn) results:

the benefits of macugen may be temporary

Visual acuity improved whilst the injections are given, but starts to deteriorate when they are stopped. However, if the blood pressure is lowered aggressively and diabetic control improves, ophthalmologists hope for much longer benefit.

 

Steroid injections

All these are injections in the eyeball itself, all with a rrisk of glaucoma. Triamcinolone is a regular fluid injection, heOsardex and illuvian are slow-release inserts.

 

Somatostatin in retinopathy

Previous reports indicated that this drug would be helpful see , but there are few reports other than case reports. More recent reports indicate no long term benefit. They have been replaced by AntiVEGFs.

 

Good control of diabetes

This is essential even with the new drugs. See targets