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Date of preparation: June 2020 INT-OZU-1950046

This is a promotional material. This data visualisation was created and funded by Allergan, an AbbVie company.

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DEX implants in DME:

Results from a real-life 24-month study

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This multicentre international retrospective study investigated efficacy and safety of repeated DEX implants over 24 months in DME eyes that were treatment naïve compared with eyes refractory to anti-VEGF treatment, in a real-life environment.
This is the largest real-life study comparing functional and anatomical outcomes in DME patients.

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130 eyes of 125 patients

Naïve (n=71)

vs

anti-VEGF Refractory eyes (n=59)

BCVA in logMAR
  • 0.9
  • 0.8
  • 0.7
  • 0.6
  • 0.5
  • 0.4
  • 0.3
  • 0.2
    • 0
    • 6
    • 12
    • 24
    • months

Fig. 1. Best-corrected visual acuity (logMAR) in naïve and refractory eyes over 24-month follow-up. Data are presented as mean ± SD.

Visual acuity improved in both arms, but improvement was greater in naïve eyes:
+11.3 ± 10.0 letters vs
+7.3 ± 2.7 letters (p=0.01)

Central Subfield Thickness
Central Subfield Thickness

Naïve (n=71)

Central Subfield Thickness over 24 months

  • Baseline 583 ± 94 µm
  • 6 months 325 ± 67 µm
  • 12 months 268 ± 60 µm
  • 24 months 279 ± 61 µm

Refractory (n=59)

Central Subfield Thickness over 24 months

  • Baseline 565 ± 107 µm
  • 6 months 370 ± 136 µm
  • 12 months 326 ± 131 µm
  • 24 months 313 ± 125 µm
CST decreased in both arms, but CST was lower in naïve eyes:
279 ± 61mm vs 313 ± 125 mm (p=0.10)

DEX implants have an established safety profile

In this study, 38 eyes (29.2%) were phakic at baseline. Of them, 22/38 (57.9%) underwent cataract surgery within 24 months follow-up.

Nine patients (9/38) underwent cataract surgery within the first year and 13 (13/38) within the second year of follow-up.

Among the phakic eyes, 93.8% (15/16) in the naïve group vs 31.8% (7/22) in the refractory group underwent cataract surgery (p=0.002)

18/127 (14.2%) required intraocular pressure-lowering drops at 24 months.

5 out of 70 blue dots
7.1% (5/70) of naïve eyes

13 out of 57 yellow dots
22.8% (13/57) of refractory eyes

required intraocular pressure-lowering drops (p=0.033)

Three eyes already had glaucoma at baseline. None underwent glaucoma surgery during 24-month follow-up.

Central Subfield Thickness

Visual Acuity

Over 24-month follow-up, vision improved in DME eyes after treatment with DEX implant, both in eyes that were treatment naïve and eyes refractory to anti-VEGF treatment.

DEX implant therapy demonstrated substantial anatomical and functional improvement in both naïve and refractory DME patients.

Treatment-naïve DME patients benefit more from DEX implants than those with refractory DME.

Licences and indications may vary by country, please refer to your local Summary of Product Characteristics.
Adverse events should be reported to your Ministry of Health and local Allergan office.

OZURDEX® (Dexamethasone 700 micrograms intravitreal implant in applicator)

Abbreviated Prescribing Information

Presentation: Intravitreal implant in applicator. One implant contains 700 micrograms of dexamethasone. Disposable injection device, containing a rod-shaped implant which is not visible. The implant is approximately 0.46 mm in diameter and 6 mm in length. Indications: Treatment of adult patients: with macular oedema following either Branch Retinal Vein Occlusion (BRVO) or Central Retinal Vein Occlusion (CRVO), inflammation of the posterior segment of the eye presenting as non-infectious uveitis and visual impairment due to diabetic macular oedema (DME) who are pseudophakic or who are considered insufficiently responsive to, or unsuitable for non- corticosteroid therapy. Dosage and Administration: Please refer to the Summary of Product Characteristics before prescribing for full information. OZURDEX must be administered by a qualified ophthalmologist experienced in intravitreal injections. The recommended dose is one OZURDEX implant to be administered intra-vitreally to the affected eye. Administration to both eyes concurrently is not recommended. Repeat doses should be considered when a patient experiences a response to treatment followed subsequently by a loss in visual acuity and in the physician’s opinion may benefit from retreatment without being exposed to significant risk. Patients who experience and retain improved vision should not be retreated. Patients who experience a deterioration in vision, which is not slowed by OZURDEX, should not be retreated. In RVO and uveitis there is only very limited information on repeat dosing intervals less than 6 months. There is currently no experience of repeat administrations in posterior segment non-infectious uveitis or beyond 2 implants in Retinal Vein Occlusion. In DME there is no experience of repeat administration beyond 7 implants. Patients should be monitored following the injection to permit early treatment if an infection or increased intraocular pressure occurs. Single-use intravitreal implant in applicator for intravitreal use only. The intravitreal injection procedure should be carried out under controlled aseptic conditions as described in the Summary of Product Characteristics. The patient should be instructed to self-administer broad spectrum antimicrobial drops daily for 3 days before and after each injection. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Active or suspected ocular or periocular infection including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases. Advanced glaucoma which cannot be adequately controlled by medicinal products alone. Aphakic eyes with ruptured posterior lens capsule. Eyes with Anterior Chamber Intraocular Lens (ACIOL), iris or transscleral fixated intraocular lens and ruptured posterior lens capsule. Warnings/Precautions: Intravitreous injections, including OZURDEX can be associated with endophthalmitis, intraocular inflammation, increased intraocular pressure and retinal detachment. Proper aseptic injection techniques must always be used. Patients should be monitored following the injection to permit early treatment if an infection or increased intraocular pressure occurs. Monitoring may consist of a check for perfusion of the optic nerve head immediately after the injection, tonometry within 30 minutes following the injection, and biomicroscopy between two and seven days following the injection. Patients must be instructed to report any symptoms suggestive of endophthalmitis or any of the above mentioned events without delay. All patients with posterior capsule tear, such as those with a posterior lens (e.g. due to cataract surgery), and/or those who have an iris opening to the vitreous cavity (e.g. due to iridectomy) with or without a history of vitrectomy, are at risk of implant migration into the anterior chamber. Implant migration to the anterior chamber may lead to corneal oedema. Persistent severe corneal oedema could progress to the need for corneal transplantation. Other than those patients contraindicated where OZURDEX should not be used, OZURDEX should be used with caution and only following a careful risk benefit assessment. These patients should be closely monitored to allow for early diagnosis and management of device migration. Use of corticosteroids, including OZURDEX, may induce cataracts (including posterior subcapsular cataracts), increased IOP, steroid induced glaucoma and may result in secondary ocular infections. The rise in IOP is normally manageable with IOP lowering medication. Corticosteroids should be used cautiously in patients with a history of ocular herpes simplex and not be used in active ocular herpes simplex. OZURDEX is not recommended in patients with macular oedema secondary to RVO with significant retinal ischemia. OZURDEX should be used with caution in patients taking anti-coagulant or anti-platelet medicinal products. OZURDEX administration to both eyes concurrently is not recommended. Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, consider evaluating for possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids. Interactions: No interaction studies have been performed. Systemic absorption is minimal and no interactions are anticipated. Pregnancy: There are no adequate data from the use of intravitreally administered dexamethasone in pregnant women. OZURDEX is not recommended during pregnancy unless the potential benefit justifies the potential risk to the foetus. Lactation: Dexamethasone is excreted in breast milk. No effects on the child are anticipated due to the route of administration and the resulting systemic levels. However OZURDEX is not recommended during breast-feeding unless clearly necessary. Driving/Use of Machines: Patients may experience temporarily reduced vision after receiving OZURDEX by intravitreal injection. They should not drive or use machines until this has resolved. Adverse Effects: In clinical trials the most frequently reported adverse events were increased intraocular Pressure (IOP), cataract and conjunctival haemorrhage*. Increased IOP with OZURDEX peaked at day 60 and returned to baseline levels by day 180. The majority of elevations of IOP either did not require treatment or were managed with the temporary use of topical IOP-lowering medicinal products. 1% of patients (4/347 in DME and 3/421 in RVO) had surgical procedures in the study eye for the treatment of IOP elevation. The following adverse events were reported: Very Common (≥ 1/10) : IOP increased, cataract, conjunctival haemorrhage*. Common (≥1/100 to <1/10) : headache, ocular hypertension, cataract subcapsular, vitreous haemorrhage*, visual acuity reduced*, visual impairment/disturbance, vitreous detachment*, vitreous floaters*, vitreous opacities*, blepharitis, eye pain*, photopsia*, conjunctival oedema*, conjunctival hyperaemia. Uncommon (≥1/1,000 to <1/100) : migraine, necrotizing retinitis, endophthalmitis*, glaucoma, retinal detachment*, retinal tear*, hypotony of the eye*, anterior chamber inflammation*, anterior chamber cells/flares*, abnormal sensation in eye*, eyelids pruritus, scleral hyperaemia*, device dislocation* (migration of implant) with or without corneal oedema , complication of device insertion resulting in ocular tissue injury* (implant misplacement). (*Adverse reactions considered to be related to the intravitreous injection procedure rather than the dexamethasone implant). Please refer to Summary of Product Characteristics for full information on side effects. Marketing Authorisation Number: EU/1/10/638/001. Marketing Authorisation Holder: Allergan Pharmaceuticals Ireland, Castlebar Road, Westport, Co. Mayo, Ireland. Legal Category: Prescription. Date of Preparation: May 2019. IR/0027/2019

Further information is available from: Allergan Limited, Marlow International, The Parkway, Marlow, Bucks, SL7 1YL.

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