This release was uncommonly thorough in explaining the results of the study and its implications. Benefits are accurately described in terms that are meaningful to readers. Costs for the different drugs are provided, and the study methodology is clearly communicated. Discussion of harms and the major alternative to these drugs (laser treatment) would have completed the picture for readers.
Vision problems are significant in both type I and type II diabetics and about 750,000 Americans with diabetic retinopathy have diabetic macular edema, which causes blurred vision. The finding that that three drugs work equally well for people with mild vision impairment has significant implications, because why would anyone pay $17,000 more for a drug that doesn’t work any better?
The costs of the three anti-VEGF drugs evaluated in the study were listed as about $1960 for aflibercept (Eylea), $1200 for ranibizumab (Lucentis) and $70 for bevacizumab (Avastin), per injection. This is satisfactory, although since a treatment course involves multiple injections, we’d like to have seen the total cost of treatment compared without having to do the math ourselves.
These drugs are already used for treatment of macular edema and the purpose of the study was to compare the three. In general, all three show good results, with aflibercept producing slightly better results for those initially exhibiting poorer vision. The release quantifies this clearly in terms of improved ability to read an eye chart.
Nothing is reported about adverse effects either locally in the eye or systemically. While these drugs are standard treatments, a line about potential for infection or other potential harms should have been included. Information about completion rates and reasons for dropouts would also have been welcome.
The release tells us that the results were published in the New England Journal of Medicine. And while the story does not include the statistical comparisons of the three drugs, it does show, by vision improvement, the outcomes. Also included are the numbers of patients and the general study methodology. It’s clear from the release that this was a well-conducted study that has important implications for practice.
Vision problems associated with diabetes are well known. There is no disease mongering in this story.
The funding sources and the donation of drugs from the pharmaceutical companies are clearly stated. The Joslin researchers quoted in the article don’t appear to have any direct conflicts of interest with companies involved in the research.
The release discusses three competing drug therapies, but there should have been some mention of the alternative to drugs — laser treatment. How do these results compare with laser outcomes?
Two of these drugs are available specifically for macular edema and the third, although used off label, is also available in proper form and dosage. The story makes this clear. Since availability also relates to cost and who will pay for it — especially this era of high deductible health plans — some comment about the increased availability of the lower-cost option would not have been inappropriate.
Novelty is established in the first line of the release, which states that this is “the first clinical trial directly comparing three drugs most commonly used to treat diabetic macular edema.”
No claims that do not appear in the original paper are made in the release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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