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Szilard Kiss, Ying Liu, Joseph Brown, Nancy Holekamp, Arghavan Almony, Joanna Campbell, Jonathan Kowalski; Real-World Utilization of Anti-VEGFs in Diabetic Macular Edema and Retinal Vein Occlusion: Injection Frequency, Patient Monitoring, and Concomitant Therapy Use. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2172.
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© ARVO (1962-2015); The Authors (2016-present)
Randomized controlled trials (RCTs) suggest that efficacy of anti-VEGF therapies increases with more frequent treatment in branch or central retinal vein occlusion (BRVO, CRVO) and diabetic macular edema (DME). This retrospective analysis assesses real-world utilization of bevacizumab and ranibizumab in these conditions.
A large national insurance database of medical claims from approximately 80 health plans was analyzed. The sample consisted of newly diagnosed patients who initiated anti-VEGF therapies in 2008, 2009, or 2010 with at least 12-month follow-up. The numbers of anti-VEGF injections, ophthalmologist visit days, and ocular coherence tomography (OCT) exams in the first 12 months of anti-VEGF treatment were studied. The association between laser or intravitreal triamcinolone (IVTA) use and the number of anti-VEGF treatments was also assessed.
675 (BRVO), 480 (CRVO), and 1,907 (DME) bevacizumab-treated patients met all inclusion/exclusion criteria, with too few ranibizumab-treated patients for meaningful analysis. For the 2008, 2009 and 2010 cohorts, mean numbers of bevacizumab injections over 12 months remained low despite a slight increase over time (BRVO: 2.5, 3.1, and 3.3; CRVO: 3.1, 3.1, and 3.5; DME: 2.2, 2.5, and 3.6). Mean ophthalmologist visit days were similarly low, ranging between 5.1 and 5.6 (BRVO), 5.9 and 6.5 (CRVO), and 4.4 and 5.3 (DME); while mean OCT exams ranged from 3.7 to 3.9 (BRVO), 3.4 to 3.8 (CRVO), and 3.1 to 3.8 (DME). Across all year cohorts, 44.4% (BRVO), 18.5% (CRVO), and 61.2% (DME) patients received laser and/or IVTA. Patients treated with laser received greater number of bevacizumab injections over 12 months in both BRVO and DME cohorts (BRVO: 3.3 vs. 2.9; DME: 3.3 vs. 2.7; p<0.05). Treatment with IVTA was positively associated with the mean number of bevacizumab injections in DME (3.3 vs. 3.0, p=0.04).
The numbers of bevacizumab injections BRVO, CRVO and DME patients received in clinical practice were well below those administered in major anti-VEGF RCTs, as were the number of ophthalmologist visit days and OCT exams. Further research is necessary to confirm these findings in larger ranibizumab samples and to evaluate the impact of these real-world treatment patterns on visual acuity outcomes.
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