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Sajjad Mahmood, Irene Mary Stratton, Raj Mukherjee, James S Talks, Clare Bailey, Andrew Lotery, Shahram Kashani, Faruque Ghanchi, Salim Natha, Peter Henry Scanlon; Aflibercept in the real world – an EPR based clinical audit of patients with diabetic macular edema from 21 UK hospitals. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2626.
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© ARVO (1962-2015); The Authors (2016-present)
Aflibercept was licenced in UK for use as treatment for diabetic macular edema in 2015. Here we report on real life experience in 21 UK hospitals.
Anonymised data of patients undergoing anti-VEGF injections for diabetic macular edema was exported from a dedicated ophthalmology electronic patient record system. Those who had aflibercept injections only were included. For those who had both eyes treated, only the first eye to be treated was included and for those who had both eyes treatment started simultaneously, the better eye was included. Linear regression was used to relate change in visual acuity (VA) over 12 months from the first injection with age (grouped <65 years, 65 to 74, 75 and above) , baseline letter score (<50 letters, 50 to 59, 60 to 69, 70 to 79, 80 or more) and number of injections.
Data was available for 1566 patients who could have had 12 months follow-up from first injection. Of these 142 had no baseline VA in the 8 weeks prior to the first injection, 181 had no 12-month anniversary VA within 8 weeks of the 12-month anniversary, 40 had no baseline or 12-month data. Thus 363 patients (23%) were excluded from the analysis. The 1153 patients with complete data were of age 64 (57 to 73) years (median (25th to 75th centile)), with the baseline VA of 64 (54 to 72) ETDRS letters and had received 6 (5 to 8) injections. Over 12 months the VA improved by 5 (0 to 12) letters.Worse baseline VA was associated with greatest improvement (p<0.001), those with fewer than 50 letters at baseline having improvement of 15 (18.7) (mean (s.d.)) letters and those with 80 letters or more losing 2.2 (5.7) letters. Older patients had smaller improvement (p=0.0002), patients aged 75 years and above gaining 4.6 (13.8) letters and those under 65 gaining 6.6 (14.3) letters.The number of injections was of borderline significance (p=0.051) with each additional injection giving improvement of 0.4 letters.
Despite the high level of missing data the results concur with previous reports. The efficacy of anti-VEGF demonstrated a 5 letter gain similar to previous real life studies, possibly affected by a ceiling and floor effect on VA outcomes, with a somewhat lower mean injection count (n=6).
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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