Fluocinolone Acetonide Implant Shows Reduced Injection Frequency for Diabetic Macular EdemaFluocinolone Acetonide Implant May Reduce Injection Frequency for DME

PURPOSE: The NEW DAY (ClinicalTrials.gov identifier, NCT04469595) study assessed the efficacy and safety of the fluocinolone acetonide (FAc; 0.19 mg) intravitreal implant as baseline therapy in diabetic macular edema (DME). DESIGN: Prospective, randomized, single-masked, active-controlled, multicenter, 18-month, phase 4 study. PARTICIPANTS: Adults with type 1 or 2 diabetes and center-involving DME confirmed by central subfield thickness (CST). METHODS: Treatment regimens were FAc implant followed by rescue supplemental injections of aflibercept if needed (2 mg/0.05 ml) for 17 months versus aflibercept loading dose (2 mg every 4 weeks for 5 consecutive doses) followed by rescue supplemental injections of aflibercept if needed (2 mg/0.05 ml) for 13 months. MAIN OUTCOME MEASURES: The primary end point was mean rescue supplemental injections of aflibercept needed during the study by treatment group. Additional outcomes included time to first rescue supplemental injection, best-corrected visual acuity (BCVA), CST, rates of cataract procedures, and increases in intraocular pressure (IOP). RESULTS: Five hundred seventeen participants were screened, and 306 participants randomized. Mean (standard deviation [SD]) rescue supplemental injections were 2.4 (3.2) with FAc and 2.5 (3.1) with aflibercept (P = 0.76; primary end point). Counting both protocol-mandated and rescue supplemental injections, the FAc group received fewer injections compared with the aflibercept group (mean [SD], 3.4 [3.2] vs. 7.2 [3.4] injections; nominal P < 0.001). Time to first rescue supplemental injection was longer with FAc than with aflibercept (mean [SD], 185.4 [97.9] days vs. 132.8 [94.0] days; nominal P < 0.001). Proportions of participants who did not receive rescue supplemental injections were similar (32.5% vs. 30.3%; nominal P = 0.68). Mean change in BCVA was similar between groups (1.8 letters vs. 5.5 letters; nominal P = 0.08), as was the change in CST (mean [SD], -119 [112] μm vs. -114 [103] μm; nominal P = 0.71). In the FAc group, 27.9% underwent a cataract procedure versus 6.6% in the aflibercept group. Increased IOP occurred in 15.6% and 3.3% of participants in the FAc and aflibercept groups, respectively. CONCLUSIONS: Although the primary end point of rescue supplemental injection superiority was not met, FAc-treated participants achieved similar visual and anatomic improvements as those receiving aflibercept with fewer than half the number of total injections throughout the study. Safety data results were consistent with previous FAc implant studies. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.