Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review

Abstract

ObjectivesTo characterize diabetic macular edema (DME) treatment patterns in Taiwan and examine their impact on health care resource utilization and visual and anatomic outcomes.MethodsRetrospective, observational cohort study of longitudinal data from medical records of five hospital ophthalmology clinics. Patients with type 2 diabetes and DME who received ≥1 laser treatment or pharmacotherapy (intravitreal/subtenon corticosteroids and/or intravitreal anti-vascular endothelial growth factor [VEGF] agents) between January 2012 and December 2013 (index period) and attended ≥1 follow-up visit after the first treatment during that period were identified (prevalent population, N=431). In addition, a subset that received no anti-VEGFs before 2012 (anti-VEGF-naïve population, N=77) was analyzed. Outcome measures were change in DME treatment distribution between January 2009 and December 2014 and health care resource utilization over up to 3 years from the first DME treatment received in the index period (prevalent population), mean number of anti-VEGF injections and change from baseline in visual acuity and central macular thickness over 12 months (anti-VEGF-naïve population).ResultsBetween 2009 and 2014, laser treatment use declined, overall use of anti-VEGFs increased, and bevacizumab use decreased proportionately as ranibizumab use increased. Patients receiving corticosteroids and anti-VEGFs in the first 6 months post-index had greater health care resource utilization than those treated with laser, corticosteroids, or anti-VEGF alone (P<0.0001, cross-cohort comparison). Among anti-VEGF-naïve patients, 69% received one to four anti-VEGF injections in the first year post-index. Overall, visual acuity improvement from baseline was minimal at 1 year (0.4 letters, observed data; 0.1 letters, last observation carried forward), and modest central macular thickness reduction (28 µm [last observation carried forward]) was detected.ConclusionIn Taiwanese clinics, DME treatment patterns have shifted from use of laser to anti-VEGFs (with higher health care resource utilization); however, few patients receive anti-VEGF injections at the frequency reported in landmark trials, consistent with poorer visual outcomes. Effective alternative treatments with lower treatment burden should be considered.

One-year outcomes of the treat-and-extend regimen using aflibercept for the treatment of diabetic macular edema

“…These results indicated that our TAE protocol is feasible in routine practice to reduce treatment burden and clinic visits, particularly when poor compliance and/or limited insurance reimbursement may lead to undertreatment in real-world practice. 14,15,17 Although differences in study design and patient characteristics made it difficult to compare our findings with previous studies, a similar trend in visual and anatomical improvement was still observed. A retrospective cross-trial analysis of nine phase 2 and 3 randomized clinical trials of 0.5 mg ranibizumab and 2 mg aflibercept revealed the mean baseline VA was inversely correlated to VA gains, and mean VA plateaued at approximately 70 (68.5-73.0) letters at 12 months regardless of trial design (agents, regimens, and number of injections).…”

“…12,13 In real-world practice, however, patient compliance/adherence and financial concern are potential issues affecting monthly visits and injections in long-term management. [14][15][16][17] Treatment burden can be reduced when less frequent injections and/or clinic visits yield equivalent efficacy. The RETAIN study supported the feasibility of a TAE regimen using ranibizumab for DME.…”

Therapeutic effect of simultaneous intravitreal dexamethasone and aflibercept on diabetic macular edema

“…Laser photocoagulation was first recommended for treating DME in the 1985 Early Treatment Diabetic Retinopathy Study [ 17 , 33 ] and represented the standard of care for the treatment of DME prior to the advent of anti-VEGF injections [ 34 , 35 ]. Although no longer the standard treatment, macular laser therapy may still act as an adjuvant treatment because of its ability to reduce macular thickness and lower the required number of injections [ 36 ].…”

Risk of dialysis in patients receiving intravitreal anti–vascular endothelial growth factor treatment: a population-based cohort study

“…As the number of intravitreal anti-VEGF treatments has expanded in recent years [10][11][12], ophthalmologists are becoming aware of the associated adverse effects. Previous reports showed that hypertension is one of the adverse effects [13,14], and risks of mortality and cerebrovascular accidents were found to be elevated in patients with poorer overall conditions [15,16].…”