title: Nonbiological pharmacotherapies for the treatment of diabetic macular edema.
abstract: BACKGROUND
  During the past decade, there have been significant advances in the pharmacotherapies for the treatment of diabetic macular edema (DME). Among the presently available treatment options, anti-vascular endothelial growth factors (anti-VEGF) agents are the most favored agents due to their efficacy and safety. The index review focuses on nonbiological therapies that have entered in phase 3 clinical trials for DME.
  
  
  METHODS
  An extensive review of the literature was performed to identify various nonbiological immunotherapies i.e., drugs other than '-mAbs' (monoclonal antibodies including anti-VEGF agents), '-mibs' (proteasome inhibitors), '-NAbs' (nanoparticle albumin-bound), and '-nibs' (small molecule inhibitor/tyrosine kinase inhibitors), among others. Extended-release low-dose corticosteroid devices have been recently approved for the treatment of DME. Other compounds such as non-steroidal anti-inflammatory drugs, antibody mimetic proteins, nonbiological growth factor inhibitors, and inhibitors of protein kinase C have been described.
  
  
  CONCLUSIONS
  A number of therapies are under development for the pharmacological management of DME. Due to the rising healthcare costs associated with anti-VEGF agents, a number of alternate treatment options have been explored recently. Some of these agents have reached phase 3 in clinical trials and appear to have a promising role in the management of DME. As further research is conducted, the role of each individual agent will become more defined, alone or in combination therapy.
authors.affiliation: a Ocular Imaging Research and Reading Center (OIRRC) , Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center , Omaha , NE , USA.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: b College of Medicine , University of Nebraska , Omaha , NE , USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Parriott
authors.affiliation: a Ocular Imaging Research and Reading Center (OIRRC) , Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center , Omaha , NE , USA.|c Department of Ophthalmology , Ankara University Faculty of Medicine , Ankara , Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Demirel
authors.affiliation: b College of Medicine , University of Nebraska , Omaha , NE , USA.
authors.forename: Colby
authors.initials: C
authors.lastname: Argo
authors.affiliation: a Ocular Imaging Research and Reading Center (OIRRC) , Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center , Omaha , NE , USA.
authors.forename: Yasir Jamal
authors.initials: YJ
authors.lastname: Sepah
authors.affiliation: a Ocular Imaging Research and Reading Center (OIRRC) , Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center , Omaha , NE , USA.
authors.forename: Diana V
authors.initials: DV
authors.lastname: Do
authors.affiliation: a Ocular Imaging Research and Reading Center (OIRRC) , Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center , Omaha , NE , USA.
authors.forename: Quan Dong
authors.initials: QD
authors.lastname: Nguyen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D042682:Angiopoietins / Q000037:antagonists & inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007167:Immunotherapy; D008269:Macular Edema / Q000188:drug therapy* / Q000276:immunology; D061988:Proteasome Inhibitors / Q000627:therapeutic use; D011493:Protein Kinase C / Q000037:antagonists & inhibitors; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D015398:Signal Transduction; D042442:Vascular Endothelial Growth Factors / Q000037:antagonists & inhibitors; D054460:rho-Associated Kinases / Q000037:antagonists & inhibitors
chemical_list: D000305:Adrenal Cortex Hormones; D042682:Angiopoietins; D000894:Anti-Inflammatory Agents, Non-Steroidal; D061988:Proteasome Inhibitors; D042442:Vascular Endothelial Growth Factors; D011505:Protein-Tyrosine Kinases; D054460:rho-Associated Kinases; D011493:Protein Kinase C
keywords: clinical trials; diabetic macular edema; nonbiological pharmacotherapy; nonsteroidal anti-inflammatory drugs; steroids