An inexpensive HIV drug can improve vision for patients with diabetic macular edema (DME), a common complication of diabetes that can lead to blindness, an initial clinical trial suggests.
The drug, lamivudine, could become an important new option for millions of people living with DME. The oral medication could be particularly important for people who do not have access to or are unable to afford monthly visits to eye specialists for injections into their eyes.
“A $20-a-month or even cheaper oral pill that improves vision as much as or more than therapy with injections into the eye that cost up to $2,000 per month could be transformative both for patients and the healthcare system,” said ophthalmologist Jayakrishna Amabati, MD, the founding director of our Center for Advanced Vision Science.
To test lamivudine's effects on DME, Dr. Ambati and colleagues enrolled two dozen people in a small clinical trial. Participants randomly received either lamivudine or a harmless placebo, in addition to bevacizumab injections into their eyes starting at four weeks.
Lamivudine recipients showed significant improvement even before their first injections. Their ability to read letters on an eye chart increased by about two lines at four weeks, while the participants receiving placebo saw their ability decrease slightly. A month after the bevacizumab injections, the lamivudine recipients had improved by more than three lines, while the placebo group, receiving bevacizumab alone, had increased by only about one.
The results suggest that lamivudine may improve vision in patients with DME both by itself or in conjunction with bevacizumab. The researchers are urging larger, longer trials that are needed to bear out the findings.
“This trial demonstrates that blocking [immune cells called] inflammasomes can improve vision in DME," Dr. Ambati said. "We have developed a safer version of lamivudine called K9, which blocks inflammasomes without the potential side effects of lamivudine. So we are excited by the ongoing and planned clinical trials of K9 in DME as well.”