Inexpensive HIV Med Improves Vision in Diabetic Eye Disease

TOPLINE:

Oral lamivudine, an inflammasome inhibitor originally approved for suppressing HIV, was a relatively safe and effective treatment for improving visual acuity in adults with center-involving diabetic macular edema, a serious complication of diabetic retinopathy.

METHODOLOGY:

• Researchers conducted a clinical trial to assess the effectiveness of oral lamivudine vs placebo in improving visual acuity in 24 adults (mean age, 62.7 years; 55% women) with type 2 diabetes and center-involving diabetic macular edema from a tertiary center in São Paulo, Brazil.
• Best-corrected visual acuity was less than 69 letters in this cohort.
• The participants were randomly assigned to receive either oral lamivudine (150 mg twice daily; 10 participants; 16 eyes) or placebo (14 participants; 21 eyes) for 8 weeks, with intravitreous bevacizumab (1.25 mg) administered at week 4.
• Primary outcomes were the mean changes in best-corrected visual acuity from baseline to weeks 4 and 8, and secondary outcomes included changes in retinal thickness and adverse events.
• Outcomes in the lamivudine group were compared with those in a historical cohort of individuals who received aflibercept, bevacizumab, or ranibizumab.

TAKEAWAY:

• Participants who received lamivudine experienced a significant improvement in visual acuity as early as week 4, with a mean gain of 9.8 letters on the eye chart, whereas those on placebo had a mean loss of 1.8 letters (P < .001) ; 94% of eyes in the lamivudine group showed an improvement in best-corrected visual acuity compared with just 24% in the placebo group.
• Following injection of bevacizumab at week 4, patients in the lamivudine group showed greater improvement in visual acuity than those who received placebo (16.9 vs 5.3 letters; P < .001) at week 8.
• When compared with drugs in the historical cohort, lamivudine was at least as effective as aflibercept and more effective than bevacizumab or ranibizumab.
• No significant differences were observed in retinal thickness or adverse events between the lamivudine and placebo groups; no serious systemic adverse events such as lactic acidosis or hepatic or renal toxicity were reported during the study period.

IN PRACTICE:

Continual intravitreous administration of anti–vascular endothelial growth factor drugs, “which requires frequent visits to doctors’ offices, imposes a substantial burden on patients and healthcare systems,” the researchers reported. “Repurposing existing drugs such as lamivudine enables potentially immediate translation to practice and could obviate the aforementioned challenges by reducing medication costs and eliminating intravitreous injection costs. Such an oral medication would also avoid the potentially blinding complications of intravitreous injections.”

“These findings open the door to a more accessible and less invasive treatment approach for DME [diabetic macular edema], with the potential to benefit millions of patients globally,” they added.

SOURCE:

This study was led by Felipe Pereira of the Universidade Federal de São Paulo, São Paulo, Brazil. It was published online on May 27, 2025, in Med.

LIMITATIONS:

The relatively small number of participants was a major limitation. The 8-week duration of the study — imposed because of safety concerns over lamivudine’s potential toxicity — precluded assessment of its long-term efficacy and safety. This study took place at a single center in Brazil and involved participants whose characteristics differed from those from the historical cohort who were based in the United States.

DISCLOSURES:

This study received support from the Universidade Federal de São Paulo, Latinofarma, the National Institutes of Health, and other sources. Some authors declared receiving consultancy fees, were named as inventors on matter-related patent applications, served as scientific consultants, and had other ties with many sources, including the funding agencies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.