Management of Neovascular Age-Related Macular Degeneration Treatment in France from 2008–2018: The Nationwide LANDSCAPE Study

Abstract

Introduction The aim of this study was to describe the management of neovascular age-related macular degeneration (nAMD) in French patients between 2008 and 2018. Methods This was a retrospective longitudinal cohort study using exhaustive nationwide health records from the French National Health Information database. Enrollment criteria were adults aged ≥ 50 years, nAMD diagnosis, or reimbursement for nAMD treatments (anti-vascular epithelial growth factor [VEGF] injection or dynamic phototherapy with verteporfin). Exclusion criteria were high myopia, diagnosis of other retinal diseases, and treatments for other macular diseases (dexamethasone implant, laser). Main outcome measures were consumption of medical care and nAMD treatments per calendar year and number of years of follow-up. Results Between 2008 and 2018, we identified 342,961 patients who have been treated for nAMD. Median duration of ophthalmological follow-up exceeded 7 years (90 months). The median annual number of ophthalmology consultations decreased from nine visits in year 1 after treatment initiation to four visits from year 7 onwards. The median duration of nAMD treatment was 10.1 months for all patients, with 48.5% of patients undergoing treatment for < 1 year. Only 24.4% of patients had maintained treatment at year 11. Patients remaining under treatment had a median of four anti-VEGF treatments per year throughout the 10-year study period. Ranibizumab was the more common first-line treatment (67.5% of patients) compared to aflibercept (32.4%). About 20% of patients who initiated treatment switched treatment at least once. Conclusions LANDSCAPE provides exhaustive nationwide data on the real-world management of nAMD in France over a 10-year period. Further investigation into short treatment duration is required, especially in terms of understanding its relation to visual outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-023-00772-3.

Management of diabetic macular oedema in France from 2012 to 2018: The nationwide LANDSCAPE study

“…Patients appeared to be under‐treated, in relation to French DME guidelines recommending 7–9 anti‐VEGF injections in the first year (Creuzot‐Garcher & Massin, 2016). Under‐treatment has been previously reported (Billioti de Gage et al., 2022; Jiang et al., 2015; Kodjikian et al., 2021; Korobelnik et al., 2022; Massin et al., 2021) (Creuzot‐Garcher et al., 2023).…”