title: Anti-VEGF treatment of diabetic macular edema in clinical practice: effectiveness and patterns of use (ECHO Study Report 1).
abstract: OBJECTIVE
  To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) inhibitors as used in clinical practice for the treatment of diabetic macular edema.
  
  
  METHODS
  Multicenter (10 sites), retrospective chart review in patients (n=156) who received ≥3 anti-VEGF injections. Data collected for ≥6 months after the first injection included Snellen best-corrected visual acuity (BCVA) and central retinal thickness (CRT) by time-domain or spectral-domain optical coherence tomography (TD-OCT or SD-OCT).
  
  
  RESULTS
  Mean number of anti-VEGF injections (627 bevacizumab, 594 ranibizumab, 1 aflibercept) was 5.8 (year 1), 5.0 (year 2), and 3.4 (year 3). Percentage of patients with BCVA of 20/40 or better and CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT at the same visit (primary endpoint) ranged from 16.4% to 38.9% after the first 10 injections; 51.9%-62.3% achieved ≥20/40 BCVA and 26.2%-48.0% met CRT criteria. Therapy was well tolerated with 19 treatment-related adverse events (all ocular) reported.
  
  
  CONCLUSIONS
  Anti-VEGF injections were administered less frequently and were less effective than those in the ranibizumab registration trials. After each of the first 9 injections, <25% of patients achieved both BCVA of 20/40 or better and a dry macula. A substantial proportion of patients are suboptimal responders to anti-VEGF therapy; these patients may be candidates for other therapies, including intravitreal corticosteroid and laser therapy.
authors.affiliation: The Retina Institute, St Louis, MO.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Blinder
authors.affiliation: Retinal Consultants of Arizona, Phoenix, AZ; USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles.
authors.forename: Pravin U
authors.initials: PU
authors.lastname: Dugel
authors.affiliation: Orange County Retina, Santa Ana.
authors.forename: Sanford
authors.initials: S
authors.lastname: Chen
authors.affiliation: West Coast Retina Medical Group, San Francisco.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Jumper
authors.affiliation: Allergan plc, Irvine, CA, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Walt
authors.affiliation: Allergan plc, Irvine, CA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Hollander
authors.affiliation: Allergan plc, Irvine, CA, USA.
authors.forename: Lanita C
authors.initials: LC
authors.lastname: Scott
keywords: bevacizumab; diabetic retinopathy; drug administration schedule; ranibizumab; vascular endothelial growth factor; visual acuity