Abstract
Purpose :
Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are the standard of care for neovascular age-related macular degeneration (nAMD). A retrospective, observational study was performed to examine real-world anti-VEGF treatment frequency and visual acuity (VA) outcomes among patients with nAMD.
Methods :
Data from an electronic medical records (EMR) system covering 58 retina practices across the US were extracted. Patients considered treatment-naïve (no anti-VEGF treatment for >180 days before first treatment), aged ≥50 years, diagnosed with nAMD and initiating anti-VEGF treatment between January 2012 and December 2015 were included. Treatment frequency and VA outcomes were analyzed in a pooled manner (aflibercept, ranibizumab, unlicensed bevacizumab) at baseline and during a maximum follow up period of 4 years. Reported below are long-term outcomes of the sub-cohort with maximum 4 years of follow-up (first anti-VEGF injection between January 2012 and December 2012).
Results :
Of 13,024 eyes identified in 2012, 8,501 (65.3%), 6,021 (46.2%), 4,725 (36.3%) and 2,926 (22.5%) eyes received continuous treatment for at least 1, 2, 3 and 4 years. From year 1 to 4, the respective mean±SD number of injections were 7.2±2.0, 6.5±2.1, 6.5±2.3 and 6.4±2.3 and the respective mean number of total retina practice visits were 8.9±3.3, 8.3±3.6, 8.4±3.9 and 8.2±4.0. At the end of year 1, 2, 3 and 4, 32.4%, 31.3%, 29.3% and 45.4% eyes, respectively, were treated more frequently than every 8 weeks. Mean VA decreased by -0.4 letters in year 1, followed by further decline of -1.9, -3.6, and -5.2 ETDRS letters in years 2, 3 and 4, respectively.
Conclusions :
Current management of nAMD is associated with a substantial treatment and monitoring burden. In this real word study, a high proportion of patients with long-term follow-up received injections frequently (at less than 8-week intervals) but VA continued to decrease over time. These results highlight the need for therapeutic solutions that enable extended injection intervals while improving and maintaining long-term vision.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.