The RESTORE Study Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema

Centre for Vision Research (Westmead Millennium Institute), University of Sydney, Sydney, Australia.
Ophthalmology (Impact Factor: 6.14). 04/2011; 118(4):615-25. DOI: 10.1016/j.ophtha.2011.01.031
Source: PubMed


To demonstrate superiority of ranibizumab 0.5 mg monotherapy or combined with laser over laser alone based on mean average change in best-corrected visual acuity (BCVA) over 12 months in diabetic macular edema (DME).
A 12-month, randomized, double-masked, multicenter, laser-controlled phase III study.
We included 345 patients aged ≥18 years, with type 1 or 2 diabetes mellitus and visual impairment due to DME.
Patients were randomized to ranibizumab + sham laser (n = 116), ranibizumab + laser (n = 118), or sham injections + laser (n = 111). Ranibizumab/sham was given for 3 months then pro re nata (PRN); laser/sham laser was given at baseline then PRN (patients had scheduled monthly visits).
Mean average change in BCVA from baseline to month 1 through 12 and safety.
Ranibizumab alone and combined with laser were superior to laser monotherapy in improving mean average change in BCVA letter score from baseline to month 1 through 12 (+6.1 and +5.9 vs +0.8; both P<0.0001). At month 12, a significantly greater proportion of patients had a BCVA letter score ≥15 and BCVA letter score level >73 (20/40 Snellen equivalent) with ranibizumab (22.6% and 53%, respectively) and ranibizumab + laser (22.9% and 44.9%) versus laser (8.2% and 23.6%). The mean central retinal thickness was significantly reduced from baseline with ranibizumab (-118.7 μm) and ranibizumab + laser (-128.3 μm) versus laser (-61.3 μm; both P<0.001). Health-related quality of life, assessed through National Eye Institute Visual Function Questionnaire (NEI VFQ-25), improved significantly from baseline with ranibizumab alone and combined with laser (P<0.05 for composite score and vision-related subscales) versus laser. Patients received ∼7 (mean) ranibizumab/sham injections over 12 months. No endophthalmitis cases occurred. Increased intraocular pressure was reported for 1 patient each in the ranibizumab arms. Ranibizumab monotherapy or combined with laser was not associated with an increased risk of cardiovascular or cerebrovascular events in this study.
Ranibizumab monotherapy and combined with laser provided superior visual acuity gain over standard laser in patients with visual impairment due to DME. Visual acuity gains were associated with significant gains in VFQ-25 scores. At 1 year, no differences were detected between the ranibizumab and ranibizumab + laser arms. Ranibizumab monotherapy and combined with laser had a safety profile in DME similar to that in age-related macular degeneration.

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Available from: Paul Mitchell, Nov 11, 2015
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    • "Anti-VEGF therapy A Cochrane review of anti-angiogenic therapy for DMO identified strong evidence of a clinical benefit in maintaining and improving vision using anti-VEGF drugs versus laser photocoagulation [Querques et al. 2009; Mitchell et al. 2011; Do et al. 2012; Rajendram et al. 2012; Virgili et al. 2014] "
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    • "In this study, we recruited patients from routine clinical care at two medium-sized county hospitals. Overall, the patient demographics, clinical characteristics, and visual functioning in the present clinical study were comparable with baseline characteristics in large pivotal clinical trials with ranibizumab for DME (Bressler et al., 2014; Mitchell et al., 2011). In the present study, we found a wide range in several baseline variables, such as age, glycosylated hemoglobin, weight, and blood pressure, which suggests heterogeneity among the included patients. "
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