Treatment of diabetic macular edema with sustained-release glucocorticoids

Intravitreal triamcinolone acetonide, dexamethasone implant, and fluocinolone acetonide implant

Thomas A. Ciulla, Alon Harris, Nathaniel McIntyre, Christian Jonescu-Cuypers

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Introduction: Diabetic macular edema (DME) can be treated with intravitreal glucocorticoids, particularly triamcinolone acetonide, dexamethasone (DEX), and fluocinolone acetonide (FA). Areas covered: The pathophysiology of DME includes multiple growth factors such as VEGF and also inflammatory mediators. Glucocorticoids act on DME through multiple pathways, and current research into their efficacy, safety, and therapeutic potential when administered intravitreally is discussed. Conclusion: The intravitreal route of administration minimizes systemic side effects of glucocorticoids. Furthermore, sustained-release low-dose delivery via the DEX implant or the FA implant will limit frequent intravitreal injection and possibly some cost associated with intravitreal anti-VEGF therapy. In addition, the durable action of these treatments facilitates combination therapy. Patients can receive these implants as foundational therapy, and then receive additional treatment with laser or intravitreal anti-VEGF agents as combination therapy, which may conceivably provide some synergistic benefit. While the FA implant lasts much longer than the DEX implant, potentially decreasing the visit and treatment burden on patients and their families, the FA implant appears to have a greater risk of inducing ocular hypertension and cataract. However, these modalities have not been directly compared in a clinical trial and there is insufficient evidence to draw more elaborate conclusions.

Original languageEnglish
Pages (from-to)953-959
Number of pages7
JournalExpert Opinion on Pharmacotherapy
Volume15
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Fluocinolone Acetonide
Triamcinolone Acetonide
Macular Edema
Dexamethasone
Glucocorticoids
Vascular Endothelial Growth Factor A
Therapeutics
Ocular Hypertension
Intravitreal Injections
Cataract
Intercellular Signaling Peptides and Proteins
Lasers
Clinical Trials
Safety
Costs and Cost Analysis

Keywords

  • Dexamethasone
  • Diabetes
  • Fluocinolone acetonide
  • Macular edema

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology

Cite this

Treatment of diabetic macular edema with sustained-release glucocorticoids : Intravitreal triamcinolone acetonide, dexamethasone implant, and fluocinolone acetonide implant. / Ciulla, Thomas A.; Harris, Alon; McIntyre, Nathaniel; Jonescu-Cuypers, Christian.

In: Expert Opinion on Pharmacotherapy, Vol. 15, No. 7, 2014, p. 953-959.

Research output: Contribution to journalArticle

@article{cdf2b25d53fc4084914de43f0f319538,
title = "Treatment of diabetic macular edema with sustained-release glucocorticoids: Intravitreal triamcinolone acetonide, dexamethasone implant, and fluocinolone acetonide implant",
abstract = "Introduction: Diabetic macular edema (DME) can be treated with intravitreal glucocorticoids, particularly triamcinolone acetonide, dexamethasone (DEX), and fluocinolone acetonide (FA). Areas covered: The pathophysiology of DME includes multiple growth factors such as VEGF and also inflammatory mediators. Glucocorticoids act on DME through multiple pathways, and current research into their efficacy, safety, and therapeutic potential when administered intravitreally is discussed. Conclusion: The intravitreal route of administration minimizes systemic side effects of glucocorticoids. Furthermore, sustained-release low-dose delivery via the DEX implant or the FA implant will limit frequent intravitreal injection and possibly some cost associated with intravitreal anti-VEGF therapy. In addition, the durable action of these treatments facilitates combination therapy. Patients can receive these implants as foundational therapy, and then receive additional treatment with laser or intravitreal anti-VEGF agents as combination therapy, which may conceivably provide some synergistic benefit. While the FA implant lasts much longer than the DEX implant, potentially decreasing the visit and treatment burden on patients and their families, the FA implant appears to have a greater risk of inducing ocular hypertension and cataract. However, these modalities have not been directly compared in a clinical trial and there is insufficient evidence to draw more elaborate conclusions.",
keywords = "Dexamethasone, Diabetes, Fluocinolone acetonide, Macular edema",
author = "Ciulla, {Thomas A.} and Alon Harris and Nathaniel McIntyre and Christian Jonescu-Cuypers",
year = "2014",
doi = "10.1517/14656566.2014.896899",
language = "English",
volume = "15",
pages = "953--959",
journal = "Expert Opinion on Pharmacotherapy",
issn = "1465-6566",
publisher = "Informa Healthcare",
number = "7",

}

TY - JOUR

T1 - Treatment of diabetic macular edema with sustained-release glucocorticoids

T2 - Intravitreal triamcinolone acetonide, dexamethasone implant, and fluocinolone acetonide implant

AU - Ciulla, Thomas A.

AU - Harris, Alon

AU - McIntyre, Nathaniel

AU - Jonescu-Cuypers, Christian

PY - 2014

Y1 - 2014

N2 - Introduction: Diabetic macular edema (DME) can be treated with intravitreal glucocorticoids, particularly triamcinolone acetonide, dexamethasone (DEX), and fluocinolone acetonide (FA). Areas covered: The pathophysiology of DME includes multiple growth factors such as VEGF and also inflammatory mediators. Glucocorticoids act on DME through multiple pathways, and current research into their efficacy, safety, and therapeutic potential when administered intravitreally is discussed. Conclusion: The intravitreal route of administration minimizes systemic side effects of glucocorticoids. Furthermore, sustained-release low-dose delivery via the DEX implant or the FA implant will limit frequent intravitreal injection and possibly some cost associated with intravitreal anti-VEGF therapy. In addition, the durable action of these treatments facilitates combination therapy. Patients can receive these implants as foundational therapy, and then receive additional treatment with laser or intravitreal anti-VEGF agents as combination therapy, which may conceivably provide some synergistic benefit. While the FA implant lasts much longer than the DEX implant, potentially decreasing the visit and treatment burden on patients and their families, the FA implant appears to have a greater risk of inducing ocular hypertension and cataract. However, these modalities have not been directly compared in a clinical trial and there is insufficient evidence to draw more elaborate conclusions.

AB - Introduction: Diabetic macular edema (DME) can be treated with intravitreal glucocorticoids, particularly triamcinolone acetonide, dexamethasone (DEX), and fluocinolone acetonide (FA). Areas covered: The pathophysiology of DME includes multiple growth factors such as VEGF and also inflammatory mediators. Glucocorticoids act on DME through multiple pathways, and current research into their efficacy, safety, and therapeutic potential when administered intravitreally is discussed. Conclusion: The intravitreal route of administration minimizes systemic side effects of glucocorticoids. Furthermore, sustained-release low-dose delivery via the DEX implant or the FA implant will limit frequent intravitreal injection and possibly some cost associated with intravitreal anti-VEGF therapy. In addition, the durable action of these treatments facilitates combination therapy. Patients can receive these implants as foundational therapy, and then receive additional treatment with laser or intravitreal anti-VEGF agents as combination therapy, which may conceivably provide some synergistic benefit. While the FA implant lasts much longer than the DEX implant, potentially decreasing the visit and treatment burden on patients and their families, the FA implant appears to have a greater risk of inducing ocular hypertension and cataract. However, these modalities have not been directly compared in a clinical trial and there is insufficient evidence to draw more elaborate conclusions.

KW - Dexamethasone

KW - Diabetes

KW - Fluocinolone acetonide

KW - Macular edema

UR - http://www.scopus.com/inward/record.url?scp=84899447918&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899447918&partnerID=8YFLogxK

U2 - 10.1517/14656566.2014.896899

DO - 10.1517/14656566.2014.896899

M3 - Article

VL - 15

SP - 953

EP - 959

JO - Expert Opinion on Pharmacotherapy

JF - Expert Opinion on Pharmacotherapy

SN - 1465-6566

IS - 7

ER -