Abstract
Purpose :
The purpose of this retrospective chart review was to identify trends of intravitreal injections (IVI) of anti-Vascular Endothelial Growth Factor (VEGF) and between off/on label medications in a large retinal practice. Medications utilized in Ophthalmology change rapidly and it’s necessary to explore prescribing trends to better understand factors driving drug utilization.
Methods :
Data was collected using the Practice Management System of Retina Associates of Cleveland, Inc. from 2019-2023 for patients treated with 8 anti-VEGF IVIs. Anti-VEGF IVIs utilized were aflibercept (ALF) bevacizumab (BEVA), faricimab-svoa (FAR), ranibizumab 0.5 milligrams (mg) (RAN 0.5), ranibizumab 0.3 mg (RAN 0.3) ranibizumab-eqrn (RANe), ranibizumab-nuna (RANn) and brolucizumab (BROL). Data collected was analyzed for total usage, percentage of anti-VEGF IVIs, and annual growth rates (AGR).
Results :
In total, 294,587 anti-VEGF IVIs were performed, representing 95% of all IVIs. ALF had the highest total of IVIs (166,847) with a large growth in utilization from 2019-2020 (85%). After 2020, ALF AGR rose steadily at 12% with its yearly percentage among IVIs at 47-65%. BEVA totaled 76,553 IVIs, with an AGR of 3.2%, and constituted 39-24% of all IVIs each year. FAR , which was implemented in 2022, totaled 11,322 IVIs. FARs AGR was 120%, and it represented 5-13% of all IVIs per year. RAN 0.5 (17,228 IVI total) and RAN 0.3mg (1,797 IVI total) use declined, with RAN 0.3 declining at a faster rate (-22% vs -11% annually). RAN 0.3mg represented approximately 2-<1% of all IVIs per year, while RAN 0.5mg ranged from 12-2%. BROL’s AGR declined at -25%, and ranged from <1-3% of total IVIs. RANe and RANn use began in 2023, had small counts (11IVI, 56 IVI) and were not eligible for an AGR.
Conclusions :
Approved for treatment of diabetic retinopathy in May 2019, ALF has become the most used anti-VEGF IVI. ALF displayed an 85% increase in usage from 2019-2020, it steadily rose after. BEVA, the only off label anti-VEGF, usage percentage dropped over the 5 years. Three new agents were approved recently RANe (8/2022), RANn (9/2021), and FAR (1/2022). FAR experienced a large growth over its 2 years of use, however the new ranibizumab biosimilars did not experience similar adoption. RAN use declined. BROL sharply declined after unexpected complications, namely, severe intraocular inflammation reported by American Society of Retinal Specialists (6/2020).
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.