The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy

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Abstract

Diabetes is a major cause of visual impairment among workingage adults in the United States. The proliferative form of diabetic retinopathy is associated with severe vision loss (acuity <5/200). The standard treatment in proliferative diabetic retinopathy (PDR) is panretinal photocoagulation (PRP), which is effective but has established side effects such as peripheral visualfield constraints. Vascular endothelial growth factor (VEGF) is thought to drive the process of vascular proliferation. Drugs targeting VEGF (anti-VEGF) have been studied extensively in diabetic macular edema (DME), and results have shown that diabetic retinopathy regresses with anti-VEGF treatment. Recent studies show that anti-VEGF is not inferior to PRP for PDR while treatment is maintained, though recurrence rate when anti- VEGF treatment is stopped is unclear. In vitreous hemorrhage where PRP cannot be performed, use of anti-VEGF medications can treat underlying PDR and delay or reduce need for vitrectomy. Limitations of anti-VEGF treatment, however, require careful patient selection and monitoring. This review discusses recent clinical trials and guidelines for anti-VEGF use in PDR.

Keywords: aflibercept, angiogenesis inhibitors, antibodies, monoclonal, humanized antibodies, bevacizumab, diabetic retinopathy, intravitreal injection, ranibizumab, vascular endothelial growth factor A.

Citation: Zhao Y, Singh RP. The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy. Drugs in Context 2018; 7: 212532. DOI: 10.7573/dic.212532

Contributions: Both authors actively participated in the preparation of the manuscript.

Disclosure and potential conflicts of interest: YZ reports no conflicts of interest. RPS reports grants and personal fees from Regeneron, grants and personal fees from Genentech, grants and personal fees from Alcon, personal fees from Zeiss, and personal fees from Optos during the conduct of the study. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at https://www.drugsincontext.com/wp-content/uploads/2018/07/dic.212532-COI.pdf

Funding declaration: There was no funding for this manuscript.

Copyright: Copyright © 2018 Zhao Y, Singh RP. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Zhao Y, Singh RP. https://doi.org/10.7573/dic.212532. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/the-role-of-anti-vascular-endothelial-growth-factor-anti-vegf-in-the-management-of-proliferative-diabetic-retinopathy

Correspondence: Rishi P Singh, 9500 Euclid Avenue, i32, Cleveland, OH 44195, USA. singhr@ccf.org

Provenance: invited; externally peer reviewed.

Submitted: 4 April 2018; Peer review comments to author: 2 July 2018; Revised manuscript received: 19 July 2018; Accepted: 20 July 2018; Publication date: 13 August 2018.

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