A Pharmacoepidemiological study of intravitreal drug consumption in the first 12 months of treatment. The EPIdemiology and SAFEty collaboration.

Abstract

Purpose : To report the 12-month consumption of intravitreal therapies with vascular endothelial growth factor (VEGF) inhibitors (aflibercept or ranibizumab) and dexamethasone implants in a region of France.

Methods : The study sample consisted of 2814 adults, assessed from the medico-administrative database which includes 2.7 million inhabitants from Languedoc Roussillon, a region of the South-East of France (Données de consommation inter-régimes [DCIR]). Patients were included in this study if they had not received any intravitreal therapy for at least 18 months, were treated for one eye, and if they received > 1 intravitreal injection after inclusion in the study, over a 12-month period between 1^st July 2014 and 31^st of August 2016.

Results : Mean (standard deviation) age of the population was 76.1 (11) years, 57.6% were female, 26.6% were being treated for diabetes, 65.5% for hypertension, 32.7% for dyslipidemia and 5.8% had a history of cardiovascular disease.
Among 748 diabetic patients, 86.4% received only VEGF inhibitors, 2.7% only dexamethasone implants and 10.8% a combination of dexamethasone implants and VEGF inhibitors over the 12-month period. Among diabetic patients treated exclusively with VEGF inhibitors, the median (interquartile range [IQR]) number of delivered drugs in the 12 first months was 5 (4-7) while in those treated only with dexamethasone implants, it was 3 (2-4).
Among 2066 non-diabetic patients, 90.7% received only VEGF inhibitors drugs, 4.3% only dexamethasone implants and 5.0% and combination of dexamethasone implants and VEGF inhibitors; the median (IQR) number of VEGF inhibitor agents delivered in the first 12 months of therapy was 5 (3-7).

Conclusions : A median number of 5 delivered VEGF inhibitors in the 12 first months of therapy observed from medico-administrative database was in the range of the number of intravitreal injections from previous observational studies. This is lower than the number of intravitreal drug delivered in the 12 first months in randomized controlled trials for diabetic macular edema (between 9 and 10) and nAMD (between 7 and 12) where best outcomes were achieved. Analysis of the medico-administrative database appears to be a useful way to assess the consumption of intravitreal drugs in real world clinical practice in France. Patients with retinal disease may be undertreated in real world practice.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.