Evidence for Step Therapy in Diabetic Macular Edema

This editorial discusses the application of step therapy, a cost control strategy where lower cost medications like bevacizumab are used before switching to higher cost alternatives like aflibercept, for treating diabetic macular edema (DME). The authors reference a multicenter clinical trial involving 312 eyes with DME, which demonstrated similar visual acuity outcomes between the two treatment groups over two years. However, concerns are raised about the feasibility of frequent follow up visits in real world practice and the potential for irreversible vision loss if timely switches to aflibercept are missed. The editorial highlights the need for further research using large clinical registries to evaluate the long term benefits and risks of this approach.

This editorial discusses the application of step therapy, a cost control strategy where lower cost medications like bevacizumab are used before switching to higher cost alternatives like aflibercept, for treating diabetic macular edema (DME). The authors reference a multicenter clinical trial involving 312 eyes with DME, which demonstrated similar visual acuity outcomes between the two treatment groups over two years. However, concerns are raised about the feasibility of frequent follow up visits in real world practice and the potential for irreversible vision loss if timely switches to aflibercept are missed. The editorial highlights the need for further research using large clinical registries to evaluate the long term benefits and risks of this approach.