An inexpensive HIV antiviral may offer an alternative to intravitreal injections for diabetic macular edema, according to findings from a randomized study.

“An oral drug that improves vision in diabetic macular edema (DME) would be a game changer because it would be more convenient for patients than frequent, often monthly, injections into the eye,” study leader Jayakrishna Ambati, MD, of the University of Virginia, said in a statement.

In the study, 24 patients with DME in Brazil were randomized to receive oral lamivudine (Epivir) or placebo daily for 4 weeks. This treatment period was followed by a standard intravitreal injection of bevacizumab (Avastin).

At week 4, mean best-corrected visual acuity in the lamivudine group improved by 9.8 letters on the ETDRS chart—approximately 2 lines—while the placebo group experienced a decline of 1.8 letters. Four weeks after receiving bevacizumab, participants who had also received lamivudine improved by 16.9 letters, compared to a 5.3-letter gain in the group receiving bevacizumab alone.

The study authors noted that lamivudine inhibits an early step in the inflammatory cascade associated with DME pathogenesis. That mechanism of action is different from existing treatments, “so we could also develop combination therapies,” Dr. Ambati said.

While the results suggest lamivudine may be effective both as monotherapy and in conjunction with anti-VEGF therapy, Dr. Ambati noted its potential clinical utility in underserved populations.

“An oral pill that improves vision as much as or more than therapy with injections into the eye that cost up to $2000 per month could be transformative both for patients and the healthcare system,” he said. “A $20 a month or even cheaper oral pill ... could be life changing for patients in regions with limited access to specialty doctors or who are unable to afford or travel to monthly eye appointments.”

Source: Med (Cell Press)