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Nancy M. Holekamp, Wei-Shi Yeh, Yifeng Chia, Szilárd Kiss, Arghavan Almony, Jonathan W. Kowalski; Real-world Utilization of Intravitreal Anti-Vascular Endothelial Growth Factor Agents in Common Retinal Diseases. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4179.
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Randomized controlled trials (RCTs) have demonstrated significant efficacy of anti-vascular endothelial growth factor (anti-VEGF) agents in retinal diseases. However, it is unclear whether treatment regimens in RCTs are implemented in actual practice. The purpose of this study is to examine real-world utilization patterns of anti-VEGF agents in common retinal diseases.
This retrospective study uses commercial and Medicare supplemental insurance claims from July 2005 to December 2010. The sample consists of patients receiving ≥1 intravitreal anti-VEGF injection (ranibizumab or bevacizumab) within 12 months from the initial diagnosis of neovascular age-related macular degeneration (AMD), branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), or diabetic macular edema (DME). The number of anti-VEGF injections per patient was examined for 12 months from the index date of first anti-VEGF treatment. Subgroup analyses were conducted to examine whether concurrent use of laser or triamcinolone influences the number of anti-VEGF treatments.
A total of 15,880, 900, 914, and 1,272 patients were identified as bevacizumab users for AMD, BRVO, CRVO, and DME, respectively. Another 4,119 AMD patients were identified as ranibizumab users. The number of ranibizumab users for BRVO, CRVO, or DME was too small to allow meaningful analysis. The mean number of bevacizumab treatments during 12-months of observation were 4.6, 2.8, 3.1, and 2.6 for AMD, BRVO, CRVO, and DME, respectively. In AMD, the mean number of ranibizumab treatments was 5.9. For AMD patients with at least 3 anti-VEGF treatments, the majority of ranibizumab (81.8%) and bevacizumab (75.2%) users received the first 3 injections within 3 months from the index date. The corresponding proportions for bevacizumab users were lower in BRVO (40.1%), CRVO (42.3%), and DME (37.7%). Concurrent use of laser or triamcinolone was not associated with the number of anti-VEGF injections.
Between 2005 and 2010, the number of anti-VEGF injections patients received in actual practice is lower than the number reported in RCTs for common retinal diseases. Therefore, under-treatment with anti-VEGF therapy in the real world may preclude patients from achieving the successful visual outcomes observed in RCTs.
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