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JOHN W HINKLE, Amee Deepak Azad, Evan Chen, Nadim Rayess, Prithvi Mruthyunjaya, Ravi Parikh; Proliferative diabetic retinopathy treatment trends following the Diabetic Retinopathy Clinical Research Network Protocol S trial: A US claims-based analysis. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4858.
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To characterize the management of proliferative diabetic retinopathy (PDR) with and without diabetic macular edema (DME) before and after the publication of DRCR Protocol S.
This retrospective analysis used a nationally representative claims based cohort, Clinformatics™ Data Mart Database (OptumInsight, Eden Prairie, MN), to identify patients newly diagnosed with PDR with or without DME and no prior treatment history from 1/2013-11/2015 (period 1) and 11/2015-12/2017 (period 2). Patients with tractional retinal detachments or coexisting retinal, choroidal, or vascular pathology were excluded. Patients were identified using both international classification of disease codes as well as common procedure terminology codes.
A cohort of 7,093 patients (52.4% male, mean age 69.3 years (SD 10.6)) with previously untreated PDR was identified. Overall, the most common first line treatment was anti-vascular endothelial growth factor (VEGF), and the percent of patients for whom it was used increased from period 1 to period 2 (period 1: 51.1% vs. period 2: 65.2%, p<0.001). Bevacizumab was the most commonly used anti-VEGF in both periods (38.8 vs. 40.8%, p<0.001). Focal laser, as first line therapy, decreased between time periods (31.9% vs. 11.8%, p<0.001). Similarly pan retinal photocoagulation (PRP) use modestly declined (14.5% vs. 9.3%, p=0.018). Pars plana vitrectomy (PPV) as the first line treatment increased from 2.5% of patients in period 1 to 4.6% in period 2 (p<0.001). When comparing the entire treatment pathway for PDR patients in period 1 to 2, respectively, anti-VEGF (44.2% vs. 56.5%, p<0.001) and PPV (4.0% vs 7.3% p<0.001) were both used more frequently in period 2, while PRP (18.5% vs. 16.2%, p<0.001) and focal laser (33.3% vs. 20.0%, p<0.001) significantly declined over time.
From 2013-2017, the use of intravitreal anti-VEGF, specifically bevacizumab and aflibercept, and PPV as initial treatments for PDR with and without DME has increased. Over the same time period, the use of PRP has modestly decreased. These trends for these specific treatment modalities correlate with the timing of publication and the conclusions of the Protocol S trial. Factors outside clinical trial recommendations may influence physician practice patterns.
This is a 2020 ARVO Annual Meeting abstract.
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