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S. Yalamanchi, A. S. Babiuch, P. J. Rosenfeld, A. A. Moshfeghi; Intravitreal Injection Trends in a Busy Academic Retina Practice. Invest. Ophthalmol. Vis. Sci. 2010;51(13):538.
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The introduction of anti-VEGF therapy has altered the clinical practice of ophthalmology in a variety of dimensions. The successful use of intravitreal bevacizumab to treat exudative AMD was first reported in 2005. The data from phase III randomized controlled clinical trials, MARINA and ANCHOR, ultimately led to the FDA approval of ranibizumab in 2006 for the treatment of all forms of neovascular AMD. In a recent survey of members of the American Society of Retina Specialists, the 389 responders were approximately equally split between bevacizumab and ranibizumab when choosing a drug for AMD treatment. The purpose of this study is to demonstrate the trends in intravitreal anti-VEGF injections in an academic ophthalmology practice.
Retrospective review of intravitreal anti-VEGF injection logs from August 2006 through November 2009 in a single academic practice to quantify the number of injections for bevacizumab and ranibizumab. The monthly and yearly totals were calculated for each drug for cross comparison and evaluation of distribution patterns.
From July 2006 through November 2009, a total of 11,398 intravitreal injections of anti-VEGF agents were administered at the Bascom Palmer Eye Institute-Palm Beach office. Data analysis overall demonstrated a greater than two-fold increase in the total number of annual injections from 2006 to 2008. Intravitreal ranibizumab injections accounted for 85% of the annual total in 2006, 40% in 2007, 25% in 2008, and 21% in 2009. Specifically, November of 2009 accounted for 20% of the annual total. Annual intravitreal bevacizumab injections increased from 22% of total anti-VEGF injections in 2006 to 80% in 2009. Demographic analysis indicated that the total number of both injections was highest between November through April of each year, having increased from 55% of total volume in 2006 to 64% in 2009.
Evaluation of intravitreal anti-VEGF injections patterns from 2006-2009 reflect that neovascular AMD is a disease state with an increasing case number. The initial effect of ranibizumab entry into the drug market in 2006 accounts for the high percentage of utilization of the drug during this year. The subsequent increased proportion of bevacizumab injections over the course of the following two years likely reflect the ongoing practice management issues involved with increased patient volume and direct drug costs. Recent potential reimbursement changes for bevacizumab was evident in the greater than three fold amount of ranibizumab utilized during this time period.
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