June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Long-term clinical impact of intravitreal anti-VEGF therapy for severe non-proliferative diabetic retinopathy (NPDR): Analyses through a discrete event simulation model
Author Affiliations & Notes
  • Jennifer I Lim
    Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
  • Andrew A Moshfeghi
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Quan Dong Nguyen
    Ophthalmology, Stanford University School of Medicine, Stanford, California, United States
  • Ekaterina Ponomareva
    Axtria Inc, New Jersey, United States
  • Ankita Chauhan
    Axtria Inc, New Jersey, United States
  • Samir Tari
    Regeneron Pharmaceuticals Inc, Tarrytown, New York, United States
  • Steve Sherman
    Regeneron Pharmaceuticals Inc, Tarrytown, New York, United States
  • Footnotes
    Commercial Relationships   Jennifer Lim, Aldyera (F), Allergan (C), Aura Biosciences (C), Chengdu (F), Cognition (C), Genentech (C), Genentech (F), Graybug (F), Iveric Bio (R), Luxa (C), NGM (F), Novartis (C), Opthea (C), Quark (C), Regeneron (F), Regeneron (R), Santen (C), Stealth (F); Andrew Moshfeghi, Alimera (C), Allegro (F), Allergan (C), Allergan (R), Allergro (C), Bausch (C), Clearside (C), EyePoint (C), Genentech (C), Genentech (F), Graybug (C), Novartis (C), Novartis (F), OptiSTENT (I), Pr3vent (I), Regeneron (C), Regenron (F), Visunex (I); Quan Nguyen, Bausch & Lomb (C), Genentech (C), Regeneron (C), Santen (C); Ekaterina Ponomareva, Regeneron (C); Ankita Chauhan, Regeneron (C); Samir Tari, Regeneron (E); Steve Sherman, Regeneron (E)
  • Footnotes
    Support  Core Grant NIH Ey01792, RPB Unrestricted Grant
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1116. doi:
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      Jennifer I Lim, Andrew A Moshfeghi, Quan Dong Nguyen, Ekaterina Ponomareva, Ankita Chauhan, Samir Tari, Steve Sherman; Long-term clinical impact of intravitreal anti-VEGF therapy for severe non-proliferative diabetic retinopathy (NPDR): Analyses through a discrete event simulation model. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1116.

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

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Purpose : To model the impact of treating severe NPDR with anti-VEGF therapy on PDR progression and blindness compared with delayed treatment.

Methods : A discrete event simulation (DES) model was used to assess the impact of treating patients with severe NPDR (DRSS 47-53) instead of delaying treatment until PDR development. A retrospective cohort of patients with untreated NPDR was identified in the IBM Explorys™ EMR database. Cox multivariable regression was used to model risk of PDR progression. Treatment impact (aflibercept and ranibizumab) was estimated based on data from clinical trials (PANORAMA, RISE/RIDE) and averaged by weighted US market share. The DES examined PDR progression rates for a sampled set of 2 million patients scaled to US NPDR disease prevalence over 5 years using age- and gender-adjusted sampling weights, aggregating yearly progression events. Simulated PDR event rates were compared for two simulated cohorts with severe NPDR: untreated (no anti-VEGF treatment until they developed PDR), or treated (clones of the untreated patients modeled to receive early anti-VEGF treatment). Blindness (visual acuity <20/200) rates following PDR progression were obtained from literature. The probability of blindness was applied to all patients who progressed to PDR, and simulated events were compared over 10 years for treated vs untreated cohorts.

Results : A total of 1,174 patients with severe NPDR were identified in the database. The final Cox model included age, gender, baseline DR severity, diabetes control regimen, HbA1c, DME status, and other factors. The simulated cohort included 86,671 severe NPDR patients. Patients with severe NPDR had a 5-year risk of PDR of 37.5% (untreated) and 18.1% (treated); anti-VEGF therapy avoided 16,784 (51.7%) of PDR events for a 19.4% absolute risk reduction. The 10-year risk of blindness was 4.4% (untreated) and 1.9% (treated); treatment was associated with a 57.7% reduction blindness cases for a 2.6% absolute risk reduction.

Conclusions : The DES model suggests that severe NPDR treatment with intravitreal anti-VEGF therapy would significantly decrease PDR progression rates over 5 years and reduce incidence of blindness over 10 years.

This is a 2021 ARVO Annual Meeting abstract.


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