Language
English
Publication Date
7-1-2026
Journal
Ophthalmology
DOI
10.1016/j.ophtha.2026.03.019
PMID
41887289
Abstract
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.
Keywords
Humans, Fluocinolone Acetonide, Macular Edema, Diabetic Retinopathy, Drug Implants, Visual Acuity, Recombinant Fusion Proteins, Receptors, Vascular Endothelial Growth Factor, Female, Glucocorticoids, Prospective Studies, Male, Middle Aged, Intravitreal Injections, Single-Blind Method, Tomography, Optical Coherence, Vascular Endothelial Growth Factor A, Intraocular Pressure, Aged, Treatment Outcome, Diabetes Mellitus, Type 2, Diabetes Mellitus, Type 1, Angiogenesis Inhibitors/, Aflibercept, Anti-VEGF, Diabetic macular edema, Fluocinolone acetonide, Intravitreal implant
Published Open-Access
yes
Recommended Citation
Singer, Michael A; Wykoff, Charles C; Riemann, Christopher D; et al., "Fluocinolone Acetonide Implant as a Baseline Therapy for Diabetic Macular Edema: Results from the Randomized Phase 4 NEW DAY Study" (2026). Faculty, Staff and Students Publications. 7416.
https://digitalcommons.library.tmc.edu/baylor_docs/7416