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Vincent Garmo, Parisa Emami-Naeini, Nicholas Boucher, Rusirini Fernando, Alicia Menezes; 5-year treatment patterns in patients with DME following intravitreal (IVT) anti-VEGF therapy. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1060.
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To describe the long-term impact of treatment (tx) regimens on vision outcomes in patients (pts) with diabetic macular edema (DME) who received IVT anti-vascular endothelial growth factor (VEGF) therapy from a large US electronic health record (EHR) database.
EHR data (Vestrum Health; 01-01-2014 to 06-30-2020) were analyzed. Tx naïve pts were followed for 5 yrs from first tx (i.e. index) with IVT anti-VEGF. Pts were stratified by baseline visual acuity (VA) and also evaluated for other DME-related tx, including IVT steroids, focal laser, and pan-retinal photocoagulation (PRP).
1657 eyes were stratified and analyzed by index VA. On average, pts received 6.8 anti-VEGF injections in yr 1, and ~4 injections per yr in following yrs. Overall, pts gained 4.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters from baseline to 5 yrs (65.6 vs 69.6 letters; ~ 20/40 Snellen), though pts lost roughly 3 letters from their peak of 72.5 letters at yr 1. 80% of pts with ≥20/40 index VA were able to maintain VA of ≥20/40 at 5 yrs, while only 58%, 31%, and 30% of pts with 20/40–20/100, 20/100–20/200 and <20/200 index VA, respectively, were able to reach ≥ 20/40 at 5 yrs (Fig 1). At the end of yr 1, pts who received 1–4 (28%), 5–6 (17%), 7–8 (20%), and ≥9 (35%) injections in the first yr gained 2.9, 7.6, 7.9, and 9.4 letters, respectively. Pts receiving 1-4 injections in yr 1 had the highest baseline VA (67.0 vs. 64.3 letters in ≥9 group), but had the lowest VA at yr 5 (68.1 vs. 70.7 letters in 9+ group) (Fig 2). More injections correlated with improved VA (P < 0.001). In subsequent yrs, VA was mostly lost or unchanged (−1.2, −0.9, 1.1, and −0.8 letters at yr 3; −1.7, −0.5, −0.4, and 0.2 at yr 5). 33% of pts received laser tx (focal or PRP) in yr 1, dropping to 16%,11%, 7% and 5% in yrs 2,3,4 and 5, respectively.
Overall, pts with DME gained vision through 5 yrs, but were not able to maintain peak vision following yr 1 of tx. More injections were associated with improved VA gains at yr 1 and beyond, suggesting increased injections could result in lasting improved vision. Pts with ≥20/40 index vision, and pts receiving more injections at baseline maintained better overall vision throughout the study, suggesting that early and frequent tx is likely to result in optimal long-term vision.
This is a 2021 ARVO Annual Meeting abstract.
Fig 1. Mean VA over 5 yrs by index vision
Fig 2. Mean VA over 5 yrs by yr 1 injection frequency
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