July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Five-year progression of newly diagnosed untreated diabetic retinopathy in a real-world setting from a large US claims database
Author Affiliations & Notes
  • Andrew A Moshfeghi
    USC Roski Eye Institute , Los Angeles, California, United States
  • Avanti Ghanekar
    Genentech, Inc., South San Francisco , California, United States
  • Ibrahim Abbass
    Genentech, Inc., South San Francisco , California, United States
  • Daniel Sheinson
    Genentech, Inc., South San Francisco , California, United States
  • Carlos Quezada-Ruiz
    Genentech, Inc., South San Francisco , California, United States
  • Vincent Garmo
    Genentech, Inc., South San Francisco , California, United States
  • Footnotes
    Commercial Relationships   Andrew Moshfeghi, Allergan (C), Genentech, Inc. (C), Genentech, Inc. (F), OptiSTENT (C), OptiSTENT (I), Regeneron (C), Regeneron (F), Valeant (C), Visunex (C), Visunex (I); Avanti Ghanekar, Genentech, Inc. (E), Genentech, Inc. (I); Ibrahim Abbass, Genentech, Inc. (E), Genentech, Inc. (I); Daniel Sheinson, Genentech, Inc. (E), Genentech, Inc. (I); Carlos Quezada-Ruiz, Genentech, Inc. (E), Genentech, Inc. (I); Vincent Garmo, Genentech, Inc. (E), Genentech, Inc. (I)
  • Footnotes
    Support  Genentech, Inc., South San Francisco, CA, provided support for the study and participated in the study design; conducting the study; and data collection, management, and interpretation.
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 2599. doi:https://doi.org/
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      Andrew A Moshfeghi, Avanti Ghanekar, Ibrahim Abbass, Daniel Sheinson, Carlos Quezada-Ruiz, Vincent Garmo; Five-year progression of newly diagnosed untreated diabetic retinopathy in a real-world setting from a large US claims database. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2599. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Diabetic retinopathy (DR) progresses from nonproliferative DR (NPDR) to proliferative DR (PDR), with severe NPDR and PDR having the highest risk of severe vision loss. Diabetic macular edema (DME), which also impairs vision, occurs in both NPDR and PDR. In general, patients (pts) with mild-moderate NPDR are considered to have non–vision-threatening DR (NVTDR) while pts with severe NPDR and PDR have vision-threatening DR (VTDR). The purpose of this study was to examine, over 5 years (y): 1) distribution of disease severity stage of newly diagnosed DR; 2) DR worsening from NVTDR to VTDR; 3) risk of progression to DME; 4) median days to DR worsening; and 5) baseline (BL) characteristics of pts whose DR worsened vs pts whose DR did not.

Methods : This longitudinal cohort study of US claims included all pts aged ≥18 y with newly diagnosed DR as defined by ICD-9 diagnosis codes with 5 y of follow-up, ≥2 outpatient claims of initial DR diagnosis between 7/1/2007 and 4/30/2012 (to allow 5-y follow-up), no diagnosis of DR, DME, or other retinal diseases in the prior 18 months, and no treatment for DR prior to or during follow-up. BL demographic and clinical characteristics, including age, sex, health plan type, geography, and Elixhauser Comorbidity Index (ECI), were measured. Median time to worsening DR was calculated; DR worsening defined as a change from NVTDR to VTDR status.

Results : At BL, 8639 of 14,490 (59.6%) pts were classified with NVTDR, including mild (47.5%, n=6878) or moderate (12.2%, n=1761) NPDR; and 5851 (40.4%) with VTDR (excluding DME), including severe NPDR (3.0%, n=439) or PDR (37.3%, n=5412) at BL. Over a 5-y period, of pts starting with NVTDR, 2250 (26.0%) worsened to VTDR (median time 757 days), 532 (6.2%) pts’ DR stage worsened (median time 863 days), 1926 (22.3%) developed DME (median time 776 days), and 208 (2.4%) pts had both worsened DR and developed DME. Pts who developed DME or DR worsening had more comorbidities at BL (ECI 1.67 vs 1.55, P=0.007). Over a 5-y period, a greater proportion of pts starting with VTDR developed DME (33.4% [n=1957]) compared with pts with NVTDR (22.3% [n=1926]) (P<0.001).

Conclusions : Over a 5-y period, ~25% of pts progressed to VTDR or developed DME (26.0% and 22.3%, respectively); progression occurred within a median time of ~2 y, suggesting that pts should be closely monitored and intervention may be warranted.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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