The Effect of Sample Medication Use on Subsequent Anti-VEGF Agent Selection for Neovascular Age-Related Macular Degeneration

Abstract

Purpose: To examine the effect of medication sample use (ranibizumab or aflibercept) on future anti-vascular endothelial growth factor (VEGF) agent selection in neovascular age-related macular degeneration (nvAMD).Design: Retrospective cohort study.Methods: nvAMD patients who underwent an initial anti-VEGF injection with a sample medication were compared to nvAMD control patients who never received a medication sample. Charts from 2017 through 2020 were reviewed for data regarding demographics, anti-VEGF agent selection, and visual acuity outcomes for both groups.Anti-VEGF agent selection for the first four injections and at one year were examined in both the sample and control groups.Results: Adherence to the initial agent was high between first and subsequent injections (2 nd , 3 rd , 4 th injection, and 1 year) in both sample (96.2%, 95.9%, 91.9%, 93.4%, respectively) and control groups (98.1%, 94.2%, 94.9%, 87.8%, respectively).Bevacizumab usage was significantly lower among eyes receiving samples relative to controls at the second (1.9% vs. 38.7%, p<0.001), third (3.1% vs. 41.3%, p<0.001), fourth injections (4.7% vs. 40.4%, p<0.001), and at 1 year (0% vs. 33.8%, p<0.001).Aflibercept usage was significantly higher in sample eyes relative to controls at the second (78.3% vs. 43.4%, p<0.001), third (76.3% vs. 41.5%, p<0.001), and fourth injections (76.7% vs. 43.4%, p<0.001), and at 1 year (77.0% vs. 52.7%, p<0.001). Conclusions: Eyes receiving a sample anti-VEGF agent (ranibizumab or aflibercept)for their initial injection were less likely to receive bevacizumab at future visits relative to eyes that did not receive an anti-VEGF sample, even after one year of treatment.

Long Term Use of Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration

“…Most of our patients received ranibizumab at their first injection, followed by a smaller proportion receiving aflibercept and a minority receiving bevacizumab. In line with the previous work, 20 most eyes were maintained on the same treatment as the initial agent throughout the study period. There is evidence from Comparison of Age-Related Macular Degeneration Treatments Trials that ranibizumab may accelerate GA growth in the first 2 years.…”

Anti-VEGF Pharmaceutical Prior Authorization in Retina Practices

“…In an effort to initiate treatment in a timely manner, some retina clinicians may be forced to use sample medications while pursuing the insurance authorization process, and some university-based and other practices preclude use of sample medications out of concerns for unintended bias in choosing medications. A recent study noted that the mean (SD) time to first injection among patients who received a sample medication was shorter compared with those who did not (0.31 [1.84] vs 1.19 [3.38] days [mean difference, 0.88 days]). The authors also noted that once a patient began receiving a more expensive sample medication such as aflibercept, they were less likely to switch to a less expensive option such as bevacizumab, which paradoxically may lead to overall greater costs .…”

“…A recent study noted that the mean (SD) time to first injection among patients who received a sample medication was shorter compared with those who did not (0.31 [1.84] vs 1.19 [3.38] days [mean difference, 0.88 days]). The authors also noted that once a patient began receiving a more expensive sample medication such as aflibercept, they were less likely to switch to a less expensive option such as bevacizumab, which paradoxically may lead to overall greater costs . Sampling medications is also an unsustainable approach to address the delay in care associated with PA. Another potential concern is that the authors have noted pharmaceutical companies have stopped providing sample medications for therapeutics they are phasing out.…”