July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
High-Dose Statins and Progression of Age-Related Macular Degeneration in Commercially Insured Patients, 2007 to 2016
Author Affiliations & Notes
  • Cassie A. Ludwig
    Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
  • Nitya Rajeshuni
    Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
  • Daniel Vail
    School of Medicine, Stanford University, Stanford, California, United States
  • Natalia F. Callaway
    Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
  • Darius Moshfeghi
    Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
  • Footnotes
    Commercial Relationships   Cassie Ludwig, None; Nitya Rajeshuni, None; Daniel Vail, None; Natalia Callaway, None; Darius Moshfeghi, None
  • Footnotes
    Support  NEI P30-EY026877, and Research to Prevent Blindness, Inc
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 60. doi:
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      Cassie A. Ludwig, Nitya Rajeshuni, Daniel Vail, Natalia F. Callaway, Darius Moshfeghi; High-Dose Statins and Progression of Age-Related Macular Degeneration in Commercially Insured Patients, 2007 to 2016. Invest. Ophthalmol. Vis. Sci. 2019;60(9):60.

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

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Abstract

Purpose : Age-related macular degeneration (AMD) is hypothesized to have comparable pathophysiology to atherosclerosis given similar composition of drusen and arteriosclerotic deposits. Therefore, statins have been researched as a potential therapy for AMD though results have been conflicting. A prospective trial showed a reduction in drusen volume with the use of high-dose atorvastatin in a subset of dry AMD patients, but larger studies specifically assessing high-dose statins have not been performed. So, we explored a large database of commercially insured patients to determine whether patients with dry AMD on high-dose statins had a lower risk of progression to choroidal neovascularization (CNV) development.

Methods : A retrospective cohort study was performed using the MarketScan Research Databases from 2007 to 2016. The MarketScan Databases include privately insured medical and prescription drug claims from 350 payers. ICD9 and 10 codes were used to identify diagnoses and National Drug Codes to identify drugs filled. Patients diagnosed with dry AMD and enrolled for at least one year were included. Patients with alternative pathology known to be complicated by CNV were excluded.

Results : ICD9 and ICD10 codes revealed 254,887 patients diagnosed with dry AMD. Of these, 174,716 met inclusion criteria (mean age 54.6 +/- 7.9 years, 58.8% female). In total, 0.46% (797) had filled a high-dose statin (atorvastatin 40 mg or greater or an equivalent statin) within 6 months of diagnosis of dry AMD, while 99.5% (173,919) had no record of statin use. Progression to wet AMD occurred in 13,484 (7.7%) patients (mean time to diagnosis of wet AMD 585 +/- 769 days). Patients taking high-dose statins had no significant difference in odds of progressing to wet AMD as compared to patients not taking statins before (OR 1.098, 95% CI 0.854 – 1.411) or after controlling for age, sex, smoking, and obesity (OR 0.982, 95% CI, 0.764 – 1.263). Kaplan-Meier estimates demonstrated no significant difference between conversion to wet AMD over time by high-dose statin use as compared to no statin use (p = 0.1425).

Conclusions : We found no significant association between the use of high-dose statins and the progression of dry to wet AMD. Given the devastating effects of wet AMD and limited options for prevention, further exploration of subgroups for whom statins may be effective in preventing progression is warranted.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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