Abstract
Purpose :
This study aimed to characterize long-term treatment patterns among patients with diabetic macular edema (DME) from a large ophthalmology registry.
Methods :
A retrospective analysis was performed among treatment-naïve DME patients (no prior anti-vascular endothelial growth factor (anti-VEGF) intravitreal therapy [IVT] in the past 12 months) initiating IVT from 1/1/2015-12/31/2019 using de-identified electronic medical records (IRIS® Registry). Anti-VEGF agent utilization patterns, including agent type, switches (defined as ≥3 consecutive injections of a different anti-VEGF agent from the original agent), and discontinuations (defined as no anti-VEGF IVT for ≥12 months). Results were stratified by baseline visual acuity (VA) and initial anti-VEGF agent including on-label (ranibizumab and aflibercept) and off-label agent (bevacizumab).
Results :
Of 190,345 eyes (147,687 patients), 147,336 eyes (77%) received only 1 anti-VEGF agent over a mean follow-up of 2.3 years, with bevacizumab being the most commonly used agent (53% of eyes). Bevacizumab use decreased by a mean of 5.6% each year and on-label agent use increased by a mean of 6.9% each year (Figure 1). 15% of eyes switched anti-VEGF agents after a mean of 53 weeks, of which 74% switched from bevacizumab to an on-label agent. 52% of eyes discontinued anti-VEGF treatment after a mean of 24 weeks, of which 33% reinitiated after a mean of 91 weeks. Rates of discontinuation, switching, and reinitiation were mostly similar regardless of baseline VA, though discontinuation with no reinitiation of IVT during follow-up was highest in patients with VA ≤20/200 at baseline (Figure 2).
Conclusions :
Although a majority of patients with DME discontinue IVT therapy after a mean of 6 months, a third reinitiated. 58% patients initially received bevacizumab, but its use decreased over time with an increased use of on-label agents. Reasons for switching and discontinuation should be further explored.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.