Recent research from Brazil has highlighted the potential of lamivudine, a cost-effective and widely-used oral drug for HIV, as a treatment for diabetic macular edema (DME). The study suggests that lamivudine could offer an alternative to the frequent, often monthly, intravitreal injections currently used to treat DME.
Lamivudine, a first-generation nucleoside reverse transcriptase inhibitor (NRTI), was first approved for HIV-1 treatment in 1995 and for hepatitis B in 1998. It has been the primary treatment option for HIV since 2002. Administered orally, lamivudine reaches maximum serum levels within 1 to 1.5 hours after dosing.
Dr. Jayakrishna Ambati, a leading ophthalmologist and director of UVA Health’s Center for Advanced Vision Science, described the potential benefits of an oral DME treatment. “An oral medication that improves vision in DME would be a game changer, offering greater convenience for patients compared to frequent injections,” he said. “Moreover, lamivudine’s mechanism is different from existing treatments, opening the door for combination therapies.”
In the trial, 24 DME patients were randomly assigned to receive either lamivudine or a placebo, alongside monthly intravitreal bevacizumab injections. After just four weeks, participants receiving lamivudine showed a significant improvement in vision, with a gain of 9.8 letters on the eye chart, compared to a loss of 1.8 letters in the placebo group.
One month after receiving bevacizumab injections, the lamivudine group saw a total improvement of 16.9 letters, compared to 5.3 letters in the placebo group, attributed to the bevacizumab injections. These results suggest that lamivudine is effective both on its own and in combination with bevacizumab, though the researchers caution that further studies are needed for confirmation.
Ambati and his team believe that lamivudine’s effectiveness in treating DME stems from its ability to block inflammasome activity. Inflammasomes, while crucial for detecting infections, have also been linked to the development of DME.
While larger and longer trials are necessary, the study’s early results are promising. Vision improvement was noted not only in the first four weeks—when most DME improvements typically occur—but also in the following month.
If further research supports these findings, lamivudine could become a breakthrough treatment, particularly for patients in remote areas with limited access to specialized care. The drug’s affordability—at approximately $20 per month—makes it a potential alternative to injectable therapies that can cost up to $2,000 per month.
“A cheap oral pill that improves vision as effectively as or more than expensive eye injections could have a transformative impact, both for patients and the healthcare system,” Dr. Ambati concluded.
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