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Dexamethasone best for persistent, recurrent uveitic macular edema
For patients with minimally active or inactive uveitis and persistent or recurrent uveitic macular edema (ME), dexamethasone is significantly better for treatment than methotrexate or ranibizumab, according to a study published online June 13 in Ophthalmology.
Nisha R. Acharya, M.D., from the University of California in San Francisco, and colleagues evaluated patients with minimally active or inactive uveitis and persistent or recurrent uveitic ME in one or both eyes from 33 centers. A total of 194 participants with 225 eligible eyes were randomly assigned (1:1:1) to receive at least one injection of dexamethasone (65 participants; 77 eyes), methotrexate (65 participants; 79 eyes), or ranibizumab (64 participants; 69 eyes).
The researchers found that each group showed a significant reduction in central subfield thickness relative to baseline at the 12-week primary outcome point: 35, 11, and 22 percent for dexamethasone, methotrexate, and ranibizumab, respectively. Compared with methotrexate or ranibizumab, the reduction of ME was significantly greater in the dexamethasone group. During follow-up, a significant improvement in best-corrected visual acuity (BCVA) was only seen for the dexamethasone group (4.86 letters). The dexamethasone group commonly had elevations of intraocular pressure (IOP) of 10 mm Hg, to 24 mm Hg or more, or both; IOP spikes to 30 mm Hg or more were uncommon, with no significant difference noted between the groups. In the methotrexate group, reductions in BCVA of 15 letters or more were more common and were attributable to persistent ME.
"These results suggest that intravitreal corticosteroid therapy, unless contraindicated, should be the preferred therapy for this indication," the authors write.
Several authors disclosed ties to the biopharmaceutical industry. Allergan and Genentech provided a portion of the dexamethasone implants and ranibizumab, respectively, for the study.
More information: Nisha R. Acharya et al, Intravitreal Therapy for Uveitic Macular Edema—Ranibizumab versus Methotrexate versus the Dexamethasone Implant, Ophthalmology (2023). DOI: 10.1016/j.ophtha.2023.04.011
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