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Mushtaq B, Bhatnagar A, Palmer H. Real-World Outcomes in Diabetic Macular Edema for the 0.2 µg/Day Fluocinolone Acetonide Implant: Case Series from the Midlands, UK. Clin Ophthalmol 2021; 15:2935-2943. [PMID: 34262254 PMCID: PMC8274235 DOI: 10.2147/opth.s283561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/09/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To investigate real-world effectiveness and safety of fluocinolone acetonide (FAc) implant over three years of treatment in eyes with diabetic macular edema (DME) in a population with large ethnic diversity. Methods This audit of three large treatment centres in the UK involved retrospective collection of outcome data (best recorded visual acuity [BRVA] by Early Treatment Diabetic Retinopathy Study [ETDRS] letters, central retinal thickness [CRT], intraocular pressure [IOP] and use of supplementary treatments) from patients with DME treated with 0.2 µg/day FAc intravitreal implant with three-year follow-up expected. Results A total of 96 eyes were included. Ninety (93.8%) eyes had received prior intravitreal treatment. Increases in mean BRVA were significant at one, two and three years (p<0.05). Overall, 78.1% of eyes gained or maintained BRVA; just over 50% gained ≥5 letters, representing a functional response. Eleven (11.6%) patients lost ≥10 letters by year three. Decreases in central retinal thickness (CRT) nearing 200 µm in the first year were sustained to three years (p < 0.0001). Patients with baseline VA ≥60 letters maintained their BRVA throughout follow-up, while significant improvements at month 12 (p<0.0001) in those with baseline BRVA <60 letters were maintained through month 36 (p < 0.005). Fifty-three (55.2%) eyes required no supplementary therapy during follow-up. Increases in IOP to ≥30 mmHg and ≥25 mmHg were seen in 12 (12.5%) and 23 (24.0%) eyes, respectively. Conclusion This study confirms the effectiveness and tolerability of FAc implant up to 36 months in a real-world setting, highlighting the importance of early treatment for sustaining functional vision for patients.
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Affiliation(s)
- Bushra Mushtaq
- Birmingham Midland Eye Centre, City Hospital SWBH NHS Trust, Birmingham, UK
| | - Ajay Bhatnagar
- Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Helen Palmer
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Minnella AM, Picardi SM, Maceroni M, Albanesi F, De Siena E, Placidi G, Caputo CG, De Vico U, Rizzo S, Falsini B. Retinal Morpho-Functional Changes Following 0.19 mg Fluocinolone Acetonide Intravitreal Implant for Chronic Diabetic Macular Edema. Adv Ther 2021; 38:3143-3153. [PMID: 33948926 PMCID: PMC8096132 DOI: 10.1007/s12325-021-01751-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022]
Abstract
Purpose To evaluate morpho-functional outcomes of the intravitreal fluocinolone acetonide (FAc) implant. Methods Retrospective, observational, single-center study. Primary endpoint was the mean change in central macular thickness (CMT) from baseline to month 1–3. Secondary endpoints included mean CMT change from baseline to month 4–8 and 9–14 and mean best corrected visual acuity (BCVA), photopic negative response (PhNR) and b-wave of flash full-field electroretinogram (ERG) changes from baseline to month 1–3, 4–8, and 9–14. Results Fourteen patients (18 eyes) were included. Mean (standard deviation) CMT decreased from 473 (196) µm at baseline to 371 (163) µm at month 1–3 (mean difference − 102.3 ± 98.35 µm, 95% CI ± 46.4 µm; p < 0.0001) and this decrease tended to endure up to month 9–14. BCVA did not change significantly. There was an improvement in mean PhNR amplitude from 2.76 (1.65) µV at baseline to 3.73 (2.32) µV at month 1–3 (mean difference 0.91 (1.14) µV, 95% CI ± 0.54 µV, p = 0.003); b-wave amplitude improved from 8.83 (4.52) µV at baseline versus 10.05 (5.04) µV at month 1–3 (mean difference 1.22 (2.23) µV, 95% CI ± 1.08 µV, p = 0.0384). These ERG positive changes tended to endure up to month 9–14, although they did not reach statistical significance after month 3. Conclusions Intravitreal FAc implant significantly improved anatomic as well as functional outcomes related to middle and inner retinal layers, known to be altered in diabetic retinopathy. Our findings support the hypothesis that intravitreal FAc implant may exert a protective effect in diabetic retinas with diabetic macular edema.
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Adán A, Cabrera F, Figueroa MS, Cervera E, Ascaso FJ, Udaondo P, Abraldes M, Reyes MÁ, Pazos M, Pessoa B, Armadá F. Clinical-Decision Criteria to Identify Recurrent Diabetic Macular Edema Patients Suitable for Fluocinolone Acetonide Implant Therapy (ILUVIEN ®) and Follow-Up Considerations/Recommendations. Clin Ophthalmol 2020; 14:2091-2107. [PMID: 32801618 PMCID: PMC7398681 DOI: 10.2147/opth.s252359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/21/2020] [Indexed: 12/26/2022] Open
Abstract
Current management of diabetic macular edema (DME) predominantly involves treatment with short-acting intravitreal injections of anti-vascular endothelial growth factors (anti-VEGFs) and/or corticosteroids; however, short-acting therapies (lasting between 1 and 6 months) require frequent injections to maintain efficacy, meaning a considerable treatment burden for diabetic patients with multiple comorbidities. Continuous injections needed in some cases are an economic burden for patients/healthcare system, so real-life clinical practice tends to adopt a reactive approach, ie, watch and wait for worsening symptoms, which consequently increases the risk of undertreatment and edema recurrence. On March 7th 2019, a group of experts in retinal medicine and surgery held a roundtable meeting in Madrid, Spain to discuss how to (1) optimize clinical outcomes through earlier use of fluocinolone acetonide (FAc) implant (ILUVIEN®) in patients with persistent or recurrent DME despite therapy; and, (2) to provide guidance to assist physicians in deciding which patients should be treated with ILUVIEN. In this regard, a 36-month follow-up consensus protocol is presented. In conclusion, patients that achieve a complete or partial anatomical, and preferably functional, response following one or two intravitreal dexamethasone implants, but with recurrence of edema after 3-4 months, are deemed by the authors most likely to benefit from ILUVIEN, and the switch to FAc implant should not be delayed more than 12 months after the initiation of at least the first dexamethasone implant.
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Affiliation(s)
| | - Francisco Cabrera
- Complejo Hospitalario Universitario Insular Materno-Lnfantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Francisco J Ascaso
- Hospital Clínico Universitario Lozano Blesa de Zaragoza, Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Patricia Udaondo
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Maximino Abraldes
- Complexo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain
| | - Miguel Ángel Reyes
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Pazos
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Bernardete Pessoa
- Centro Hospitalar e Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
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Pochopien M, Beiderbeck A, McEwan P, Zur R, Toumi M, Aballéa S. Cost-effectiveness of fluocinolone acetonide implant (ILUVIEN®) in UK patients with chronic diabetic macular oedema considered insufficiently responsive to available therapies. BMC Health Serv Res 2019; 19:22. [PMID: 30626376 PMCID: PMC6327492 DOI: 10.1186/s12913-018-3804-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic macular oedema (DMO) may lead to visual loss and blindness. Several pharmacological treatments are available on the National Health Service (NHS) to United Kingdom patients affected by this condition, including intravitreal vascular endothelial growth factor inhibitors (anti-VEGFs) and two types of intravitreal steroid implants, releasing dexamethasone or fluocinolone acetonide (FAc). This study aimed to assess the value for money (cost-effectiveness) of the FAc 0.2 μg/day implant (ILUVIEN®) in patients with chronic DMO considered insufficiently responsive to other therapies. METHODS We developed a Markov model with a 15-year time horizon to estimate the impact of changes in best-corrected visual acuity in DMO patients on costs and quality-adjusted life years. The model considered both eyes, designated as the "study eye", defined at model entry as phakic with an ongoing cataract formation or pseudophakic, and the "fellow eye". The model compared the FAc 0.2 μg/day implant with a 700 μg dexamethasone implant (pseudophakic patients only) or with usual care, defined as a mixture of laser photocoagulation and anti-VEGFs (phakic and pseudophakic patients). Costs were estimated from the perspective of the NHS and Personal Social Services; full NHS prices were used for drugs. RESULTS In patients who were pseudophakic at baseline, at 36 months, the FAc implant provided an additional gain of 4.01 and 3.64 Early Treatment Diabetic Retinopathy Study (ETDRS) letters compared with usual care and the dexamethasone implant, respectively. Over the 15-year time horizon, this translated into 0.185 additional quality-adjusted life years (QALYs) at an extra cost of £3066 compared with usual care, and 0.126 additional QALYs at an extra cost of £1777 compared with dexamethasone. Thus, incremental cost-effectiveness ratios (ICERs) were £16,609 and £14,070 per QALY gained vs. usual care and dexamethasone, respectively. In patients who were phakic at baseline, the FAc 0.2 μg/day implant provided an additional gain of 2.96 ETDRS letters at 36 months compared with usual care, which, over 15 years, corresponded to 0.11 additional QALYs at an extra cost of £3170, resulting in an ICER of £28,751 per QALY gained. CONCLUSION The FAc 0.2 μg/day implant provided good value for money compared with other established treatments, especially in pseudophakic patients.
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Affiliation(s)
| | - Annette Beiderbeck
- Alimera Sciences Ophthalmologie GmbH, Cicerostraße 21, Handelsregister Amtsgericht Berlin, (Charlottenburg) HRB 165580 B, 10709, Berlin, Germany.
| | - Phil McEwan
- Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, Cardiff, CF23 8RS, UK
| | - Richard Zur
- Creativ-Ceutical, The Monadnock Building, Suite 73553 W Jackson, blvd Chicago, Chicago, IL, 60604, USA
| | - Mondher Toumi
- Creativ-Ceutical, 215, rue du Faubourg St Honoré, 75008, Paris, France.,Aix-Marseille University, Jardin du Pharo, 58 Boulevard Charles Livon, 13007, Marseille, France
| | - Samuel Aballéa
- Creativ-Ceutical, 215, rue du Faubourg St Honoré, 75008, Paris, France.,Aix-Marseille University, Jardin du Pharo, 58 Boulevard Charles Livon, 13007, Marseille, France
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Fusi-Rubiano W, Blow RR, Lane M, Morjaria R, Denniston AK. Iluvien™ (Fluocinolone Acetonide 0.19 mg Intravitreal Implant) in the Treatment of Diabetic Macular Edema: A Review. Ophthalmol Ther 2018; 7:293-305. [PMID: 30229441 PMCID: PMC6258573 DOI: 10.1007/s40123-018-0145-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Indexed: 12/21/2022] Open
Abstract
Diabetic macular edema (DMO) is a leading cause of blindness in the working age population. Although anti-vascular endothelial growth factor (VEGF) therapy provided a major advance in treatment of DMO for many patients, there is a significant proportion of patients who maintain persistent DMO and have minimal response to anti-VEGF treatment. Iluvien (fluocinolone acetonide 0.19 mg [FAc]) is an important additional treatment option for DMO. In this review we describe the clinical context and the evidence for the use of the FAc implant in treating DMO, from pilot to randomized controlled studies, to later phase real world data. These studies indicate that the FAc implant is effective, well tolerated and a cost-effective option in the treatment of insufficiently responsive DMO.
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Affiliation(s)
| | - Rebecca R Blow
- Lion Health Medical Centre, Lowndes Road, Stourbridge, UK
| | - Mark Lane
- Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, UK
| | - Rupal Morjaria
- Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, UK.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. .,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. .,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
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Fusi-Rubiano W, Mukherjee C, Lane M, Tsaloumas MD, Glover N, Kidess A, Denniston AK, Palmer HE, Manna A, Morjaria R. Treating Diabetic Macular Oedema (DMO): real world UK clinical outcomes for the 0.19mg Fluocinolone Acetonide intravitreal implant (Iluvien™) at 2 years. BMC Ophthalmol 2018; 18:62. [PMID: 29486754 PMCID: PMC6389097 DOI: 10.1186/s12886-018-0726-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 02/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare visual function and structural improvements in pseudophakic eyes with diabetic macular oedema (DMO) treated with the 0.19mg Fluocinolone Acetonide (FAc) intravitreal implant (IluvienTM) in a 'real world' setting. METHODS A single centre retrospective evaluation of patients with DMO unresponsive to conventional treatment treated with the FAc implant according to UK guidelines. Primary efficacy endpoint was best corrected visual acuity (BCVA); secondary endpoints included optical coherence tomography evaluations of the macula (a) central retinal and (b) peak macular thickness collected at annual time points. Primary safety endpoint was new rise in IOP >27mmHg or glaucoma surgery. Patients with <1 year follow-up were excluded. RESULTS Twenty-nine eyes were included, with mean(SD) follow up of 792(270) days. Improvement in BCVA and reduction in macular oedema was noted at all timepoints. Mean improvement in BCVA from baseline was 6 ETDRS letters at year 1(n=29), 6.5L at year 2(n=22) and 11L at year 3(n=6). Mean central retinal thickness at baseline was 451 microns, 337 microns at year 1, 342 microns at year 2 and 314 microns at year 3. Two eyes required IOP-lowering drops post implant. Supplementary treatment for persistence or recurrence of DMO was necessary in 18 eyes over the total study period of 3 years with mean time to supplementary treatment being 12 months. CONCLUSIONS Our evaluation of the 0.19mg FAc implant delivered in a real-world setting, provides additional evidence that it is effective and safe in the treatment of patients with DMO, and can provide sustained benefit for patients with previously refractory disease.
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Affiliation(s)
- William Fusi-Rubiano
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom.,Sandwell & West Birmingham NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Chandoshi Mukherjee
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom.,Sandwell & West Birmingham NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Mark Lane
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom.,Sandwell & West Birmingham NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Marie D Tsaloumas
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom
| | - Nicholas Glover
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom
| | - Andrej Kidess
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom
| | - Alastair K Denniston
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom. .,Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Helen E Palmer
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom
| | - Avinash Manna
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom
| | - Rupal Morjaria
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom.,Sandwell & West Birmingham NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
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