Treatment Patterns of Anti-Vascular Endothelial Growth Factor and Laser Therapy Among Patients with Diabetic Macular Edema

Jiang, Shan; Barner, Jamie C.; Park, Chanhyun; Ling, You-Li

doi:10.18553/jmcp.2015.21.9.735

Cited by 13 publications

(12 citation statements)

References 17 publications

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“…Studies suggest that intervention may occur earlier in the course of the disease. 33,34 However, we do not think that this change in practice would impact the conclusions of this study. A strength of the study was the use of ocular interventions as the end point, because structural changes alone are imperfect in the prediction of vision loss.…”

Section: Discussionmentioning

confidence: 84%

Enhancing Risk Assessment in Patients with Diabetic Retinopathy by Combining Measures of Retinal Function and Structure

Brigell

Chiang

Maa

et al. 2020

Trans. Vis. Sci. Tech.

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To determine whether combining measures of retinal structure and function predicts need for intervention for diabetic retinopathy (DR) better than either modality alone. Methods: The study sample consisted of 279 diabetic patients who participated in an earlier cross-sectional study. Patients were excluded if they were previously treated for macular edema or proliferative DR or if they had other retinopathies. Medical records were reviewed for ocular interventions including vitrectomy, intravitreal injection, and laser treatment. Need for intervention was analyzed using Kaplan-Meier analyses and Cox proportional hazards. Baseline electroretinograms and fundus photographs were obtained. Two definitions of structural positive findings were as follows: 1. Early Treatment of Diabetic Retinopathy Study diabetic retinopathy severity scale (ETDRS-DR) severity ≥ level 53 (ETDRS-DR+) and 2. ETDRS-DR+ or clinically significant macular edema (VTDR+). A positive function finding corresponded to a RETeval DR Score >23.5 (RETeval+). Results: For patients with VTDR+ the incidence of intervention was 19%, 31%, and 53% after 1, 2, and 3 years of follow-up. In these patients, intervention incidence increased to 34%, 54%, and 74% the subsequent 1, 2, and 3 years if function was above criterion (RETeval+), whereas RETeval− results reduced the risk to 3%, 4%, and 29%, respectively, reducing risk to similar levels seen for patients with VTDR− results at baseline. Conclusions: Prediction of subsequent intervention was best when combining structural and functional information. Translational Relevance: This study demonstrates that clinical management of diabetic retinopathy is improved by adding electroretinography to fundus photographic information in assessing the risk of the need for intervention.

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Section: Discussionmentioning

confidence: 84%

Enhancing Risk Assessment in Patients with Diabetic Retinopathy by Combining Measures of Retinal Function and Structure

Brigell

Chiang

Maa

et al. 2020

Trans. Vis. Sci. Tech.

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“…An investigation using Medicare claims data from 2008 to 2012 similarly reported that 42.2% of patients with DME who were treated with anti-VEGF received laser therapy within 1 year after their initial anti-VEGF injection. 20 …”

Section: Discussionmentioning

confidence: 99%

Anti-VEGF treatment of diabetic macular edema in clinical practice: effectiveness and patterns of use (ECHO Study Report 1)

Blinder¹,

Dugel²,

Chen³

et al. 2017

OPTH

114

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PurposeTo evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) inhibitors as used in clinical practice for the treatment of diabetic macular edema.MethodsMulticenter (10 sites), retrospective chart review in patients (n=156) who received ≥3 anti-VEGF injections. Data collected for ≥6 months after the first injection included Snellen best-corrected visual acuity (BCVA) and central retinal thickness (CRT) by time-domain or spectral-domain optical coherence tomography (TD-OCT or SD-OCT).ResultsMean number of anti-VEGF injections (627 bevacizumab, 594 ranibizumab, 1 aflibercept) was 5.8 (year 1), 5.0 (year 2), and 3.4 (year 3). Percentage of patients with BCVA of 20/40 or better and CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT at the same visit (primary endpoint) ranged from 16.4% to 38.9% after the first 10 injections; 51.9%–62.3% achieved ≥20/40 BCVA and 26.2%–48.0% met CRT criteria. Therapy was well tolerated with 19 treatment-related adverse events (all ocular) reported.ConclusionAnti-VEGF injections were administered less frequently and were less effective than those in the ranibizumab registration trials. After each of the first 9 injections, <25% of patients achieved both BCVA of 20/40 or better and a dry macula. A substantial proportion of patients are suboptimal responders to anti-VEGF therapy; these patients may be candidates for other therapies, including intravitreal corticosteroid and laser therapy.

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“… 12 , 13 , 15 , 27 , 28 However, it is consistent with other real-world studies that reported a mean of two to four injections during the first year of treatment. 21 , 26 , 29 – 31 This low frequency of anti-VEGF injections is likely due to the already high treatment burden experienced by diabetic patients with DME. 32 – 34 A claims database study in the United States showed that patients with DME had significantly more comorbidities, as well as greater health care utilization and treatment burden, compared with diabetic patients with no DME.…”

Section: Discussionmentioning

confidence: 99%

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

Sheu¹,

Cheng²,

Kuo³

et al. 2018

OPTH

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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.

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Treatment Patterns of Anti-Vascular Endothelial Growth Factor and Laser Therapy Among Patients with Diabetic Macular Edema

Abstract: Although anti-VEGF use is increasing, laser use is still more prevalent. Over 40% of patients who initiated on anti-VEGF injections switched to laser surgery. Additional research should be conducted to determine factors associated with this high rate of switching.

Cited by 13 publications

References 17 publications

Enhancing Risk Assessment in Patients with Diabetic Retinopathy by Combining Measures of Retinal Function and Structure

Enhancing Risk Assessment in Patients with Diabetic Retinopathy by Combining Measures of Retinal Function and Structure

Anti-VEGF treatment of diabetic macular edema in clinical practice: effectiveness and patterns of use (ECHO Study Report 1)

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

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