Patterns of ranibizumab and aflibercept treatment of central retinal vein occlusion in routine clinical practice in the USA

Abstract

BackgroundThe intravitreal anti-vascular endothelial growth factor treatments ranibizumab and aflibercept have proven efficacy in clinical trials, but their real world usage in central retinal vein occlusion (CRVO) has not been assessed. We therefore evaluated the treatment patterns of both drugs in a US claims database.MethodsThe IMS Integrated Data Warehouse was used to identify the patients with CRVO in the USA with claims for ranibizumab or aflibercept between 24 September 2012 and 31 March 2014 with at least 12 months follow-up. Patients were required to have had no anti-VEGF treatment code for 6 months before index (‘treatment-naive'). Mean numbers of injections and non-injection visits to a treating physician were compared with patients receiving these treatments.ResultsPatient characteristics were similar for patients receiving ranibizumab (n=206) or aflibercept (n=79) at index. The mean (±SD) numbers of injections received by patients treated with ranibizumab or aflibercept were 4.4±2.8 and 4.7±2.9 (P=0.38), respectively; the total number of patient visits to their treating physician was 7.3±3.7 and 7.0±2.9 (P=0.52), respectively. For patients receiving one or more injections (n=238), the mean interval between injections was 55.1 days (ranibizumab) and 54.2 days (aflibercept; P=0.44).ConclusionsOur results suggest that, in routine clinical practice, patients receive a comparable number of injections in the first year of treatment with ranibizumab or aflibercept. This may have implications for commissioning and service development of CRVO care pathways.

Treatment of Retinal Vein Occlusion with Ranibizumab in Clinical Practice: Longer-Term Results and Predictive Factors of Functional Outcome

“…One reported average bevacizumab injections of 2.5, 3.1 and 3.3 in BRVO, and 3.1, 3.1 and 3.5 in CRVO across the years 2008, 2009 and 2010, respectively. Another reported mean numbers of injections of 4.4 ± 2.8 and 4.7 ± 2.9 in patients treated with ranibizumab or aflibercept, respectively, for CRVO in the 1st year [17,18]. This picture is much different from the above-mentioned clinical trials and very similar to our own experience.…”

“…An important aspect of anti-VEGF treatments, however, is the drug delivery protocol used in real-life clinical practice, which can be significantly different from that used in well-controlled clinical trials. Few reports exist on this matter in RVO, and none of them evaluated the associated long-term outcomes [17,18]. Also, some debate has been raised about the role of anti-VEGF agents in promoting retinal nonperfusion (RNP) or, on the contrary, in reducing retinal ischemia by promoting retinal reperfusion [1,19,20,21].…”

Response to Comment on: Treatment patterns of ranibizumab intravitreal injection and dexamethasone intravitreal implant for retinal vein occlusion in the USA

“…5 Comparing treatment frequency was a secondary objective in our study, with the resulting estimate of ranibizumab treatment frequency being consistent with that previously observed by Lotery and Regnier. 2 We agree with Dan and Mihai Călugăru that the observed treatment patterns in our analysis should not be interpreted as the optimal treatment frequency. The frequency of treatment administration neither reflects the treatment frequency observed in clinical trials 6,7 nor provides data on visual acuity outcomes attained by the treated cohort.…”

“…The subject of optimal intensity of anti-VEGF treatment has been discussed previously following the publication of a similar claims data study, which described real-world treatment patterns of ranibizumab and aflibercept for macular oedema secondary to central retinal vein occlusion. [2][3][4] Our study aimed to understand whether the frequency of ophthalmology visits for patients treated with ranibizumab (Lucentis) and dexamethasone implant (Ozurdex) differed in routine clinical practice in the United States for the treatment of macular oedema secondary to retinal vein occlusion (RVO). 5 Comparing treatment frequency was a secondary objective in our study, with the resulting estimate of ranibizumab treatment frequency being consistent with that previously observed by Lotery and Regnier.…”

Canadian preference and trends survey results for anti-VEGF treatment of macular edema

“…A recent review comparing ranibizumab and aflibercept in the treatment of macular edema secondary to RVO found that both groups had a similar interval between injections and received a similar number of injections. 46…”