July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Different patterns of anti-VEGF loading phase for diabetic macular edema (DME) treatment: data analysis from the UK Aflibercept Users Group.
Author Affiliations & Notes
  • Hussein Almuhtaseb
    Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
    Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
  • Irene Stratton
    Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
  • Peter Henry Scanlon
    Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
  • Andrew Lotery
    Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
    Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
  • Footnotes
    Commercial Relationships   Hussein Almuhtaseb, Bayer (R), Novartis (R); Irene Stratton, Bayer (F); Peter Scanlon, Bayer (F); Andrew Lotery, Bayer (R), Roche (R)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 3608. doi:
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      Hussein Almuhtaseb, Irene Stratton, Peter Henry Scanlon, Andrew Lotery; Different patterns of anti-VEGF loading phase for diabetic macular edema (DME) treatment: data analysis from the UK Aflibercept Users Group.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3608.

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

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Abstract

Purpose : To audit the number of loading intravitreal injections (IVIs) for diabetic macular edema (DME) in routine clinical care in UK centres. The United Kingdom National Institute for Health and Care Excellence (NICE) issued guidance in July 2015 for the use of aflibercept for treating visual impairment caused by diabetic macular edema in those eyes with a central retinal thickness of 400 micrometres or more. This advised that aflibercept be given as a single 2 mg intravitreal injection every month for 5 consecutive months followed by 1 injection every 2 months with no requirement for monitoring between visits.

Methods : Retrospective data analysis from an electronic medical record (Medisoft®) extracted from 16 centres in the UK in August 2017. The first treated eyes of people with DME treated with either or both of aflibercept and ranibizumab were included in sites with at least 20 patients. The number of loading injections in the loading phase was defined as the number of injections received until an inter-injection break of more than 6 weeks was observed.

Results : 873 treatment naïve eyes in 16 UK centres contributed to the data set. Eyes had at least one year of follow-up. In the loading phase, the median number of aflibercept IVIs received was 3 (range 2-6) [median (25th to 75th centile)]. Significant inter-centre heterogeneity was observed regarding the median number of IVIs given during the loading phase. In 3 centres only, >/= 5 IVIs were given in the loading phase.

Conclusions : Considerable inter-centre differences were observed regarding implementing NICE guidelines. In the centres audited here, most eyes with diabetic macular edema were receiving fewer injections in the loading phase than recommended. The heterogeneity is unexplained but gives an opportunity to examine the efficacy of different loading doses on visual outcomes.

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

 

Figure 1: The proportion of eyes in each centre (16 UK centres) stratified based on the number of IVIs received during the loading phase showing significant inter-centre heterogeneity regarding adherence to DRCR.net Protocol T and NICE recommendations.

Figure 1: The proportion of eyes in each centre (16 UK centres) stratified based on the number of IVIs received during the loading phase showing significant inter-centre heterogeneity regarding adherence to DRCR.net Protocol T and NICE recommendations.

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