Abstract
Purpose :
Aflibercept is an anti-vascular endothelial growth factor (VEGF) therapy that effectively treats diabetic retinopathy (DR). Due to the high cost of aflibercept, DR patients are commonly started on a more affordable anti-VEGF therapy like bevacizumab. In this retrospective, observational clinical study, we evaluated clinical and sociodemographic factors associated with switching to aflibercept therapy.
Methods :
Medical records of 178 consecutive patients were reviewed from two hospitals in Los Angeles County: 92 patients from Los Angeles General Medical Center and 86 patients from Keck Hospital of the University of Southern California. Demographic and longitudinal data was collected for patients age 18 and older who had been diagnosed with DR warranting anti-VEGF therapy between 2016 and 2021. Primary outcomes were assessed based on the administration of aflibercept therapy within 2 years of initial anti-VEGF therapy. Multivariate logistic regression analysis was used for statistical analysis, including the presence of comorbid conditions, insurance status, ethnicity, sex, age, baseline best-corrected visual acuity (BCVA), and income. This research was deemed exempt by the University of Southern California Institutional Review Board.
Results :
In total, 25.3% of the cohort received aflibercept therapy. The average number of bevacizumab injections prior to switching to aflibercept was 4.94 ± 1.35. Controlling for insurance status and income, our multivariate regression analysis demonstrated that the odds of receiving aflibercept therapy within two years of initial treatment increase by 1.083 times (95% CI=1.033, 1.133, p<0.001) per every one-year increase in age. Among patients with poorer baseline BCVA measured in logMAR, the odds ratio of receiving aflibercept therapy was 0.42 (95% CI=0.178, 0.979, p=0.04). Hypertension status, hyperlipidemia status, sex, and ethnicity were not independent predictors of receiving aflibercept therapy.
Conclusions :
Our results demonstrate that age positively predicted, while worse baseline visual acuity negatively predicted the likelihood of transitioning to aflibercept therapy. Notably, hypertension, hyperlipidemia, sex, and ethnicity did not independently predict the administration of aflibercept therapy. Further research is warranted to validate these findings and explore the underlying factors contributing to these treatment patterns.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.