Clinical Practice Patterns Over 2 Years for Neovascular Age-related Macular Degeneration (nAMD) Patients Treated with Anti-Vascular Endothelial Growth Factors (aVEGFs)

Abstract

Purpose : Treatment burden in managing nAMD patients remains a significant problem. Prospective clinical trials on anti-VEGF (aVEGF) treat and extend (T&E) regimens have supported reduced treatment burden for nAMD, at the potential expense of clinical outcomes. We sought to describe aVEGF treatment patterns in clinical practice from a T&E perspective in using 2 years of electronic health record data.

Methods : This was a retrospective analysis of adult nAMD patients in the USRetina database, receiving ≥1 aVEGF (bevacizumab [BEV], ranibizumab [RAN], aflibercept [AFL]) between 10/1/16 and 12/1/17, and treated in practices contributing data ≥12 months pre- and ≥24 months post- the first recorded aVEGF. Patient-eyes had no record of aVEGF treatment in the 12 months pre-index. Numbers of aVEGF injections, agent switch, and duration between injections were descriptively assessed and compared to per-label dosing and T&E clinical trials (LUCAS, ATLAS).

Results : 2,244 patients contributing 2,401 eyes were identified. BEV was the most common index aVEGF (49% eyes), followed by AFL (28%) and RAN (23%). Overall, 1 in 5 eyes switched aVEGF therapy (20%) and >50% of eyes received ≤8 aVEGF injections over the 2-year period. Eyes receiving BEV had a higher switch rate (25%) and more eyes (58%) received <8 injections over 2 years. The mean number of injections per patient over 2 years was 8.8, and the mean number of injections in the first year was 5.4 injections. The median duration between injections was similar across agents at 55.2 days (mean 67.4 days), indicating a majority of intervals were <8 weeks. The average number of injections in the real-world were lower than expected over two years based on standard dosing or T&E protocols. Patients in LUCAS received on average 16.0 RAN injections and 18.2 BEV injections over 2 years, while in ATLAS, patients received on average 8.0 AFL injections in the 1^st year and 6.5 injections in the 2^nd year. The number of injections over 2 years in these studies with T&E protocols was much higher than the average number in our study over 2 years.

Conclusions : Based on two-year clinical practice data, patients received fewer injections than expected when compared to per-label dosing or prospective T&E clinical trials, which may translate to poorer visual acuity outcomes.

This is a 2020 ARVO Annual Meeting abstract.