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Comparative Study
. 2015 Sep;21(9):735-41.
doi: 10.18553/jmcp.2015.21.9.735.

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

Shan Jiang  1 , Jamie C Barner, Chanhyun Park, You-Li Ling
Affiliations
Comparative Study

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

Shan Jiang et al. J Manag Care Spec Pharm. 2015 Sep.

Abstract

Background: Diabetic macular edema (DME) is a form of diabetic retinopathy caused by continued leakage from retinal blood vessels. The use of anti-vascular endothelial growth factor (VEGF) injections has gained in popularity in the treatment of DME due to satisfactory efficacy, while laser photocoagulation is still the first-line therapy. Examining anti-VEGF treatment patterns may improve understanding of real-world medication-taking behaviors.

Objectives: To (a) compare demographic and clinical characteristics and treatment patterns of anti-VEGF (bevacizumab, ranibizumab, and pegaptanib) and laser therapies among DME patients and (b) determine predictors of switching and anti-VEGF therapy initiation.

Methods: A retrospective cohort analysis was conducted with Texas Medicaid medical and prescription claims (January 1, 2008-December 31, 2012) for patients who were aged 18-63 years, continuously enrolled 1 year pre- and post-index, diagnosed with DME and treated with anti-VEGF or laser therapies. Treatment patterns included treatment frequency and switching between anti-VEGF and laser therapies. Logistic regression and multinomial analysis were used to determine factors associated with switching and initiation of anti-VEGF therapy, while controlling for demographic and clinical characteristics.

Results: DME patients (N = 2,201) were aged 54.7 (SD ± 7.9) years; 63.1% were female; 59.1% were Hispanic; and 10.3% were visually impaired. CCI mean score was 6.5 (SD ± 3.1), and patients were on 2.6 (SD ± 3.3) unique prescription medications. Anti-VEGF users had significantly (P less than 0.0001) fewer prescriptions compared with laser users (1.9 [SD ± 3.1) vs. 2.8 [SD ± 3.3], respectively). Laser was the most commonly used (84.9%) therapy from 2009 to 2011; however, anti-VEGF use increased from 11.7% in 2009 to 21.8% in 2011 (P less than 0.0001). Patients received 1.5 (SD ± 0.7) laser surgeries compared with 1.7 (SD ± 1.1) anti-VEGF injections per eye annually. Switching from laser to anti-VEGF injections was 9.7%, while switching from anti-VEGF injections to laser surgery was 42.2%. Patients who switched from anti-VEGF injections to laser surgery were more likely to be Hispanic (OR = 1.415, 95% CI = 1.037-1.930); male (OR = 1.341, 95% CI = 1.053-1.709); have fewer prescriptions (OR = 0.944, 95% CI = 0.905-0.985); and less likely to have no visual impairment (OR = 0.641, 95% CI = 0.449-0.915). Multinomial regression results showed anti-VEGF users were more likely to remain on the same therapy if they had more prescriptions (OR = 1.094, 95% CI = 1.029-1.172) or were female (OR = 1.441, 95% CI = 1.024-2.041). Anti-VEGF initiators had fewer prescriptions (OR = 0.917, 95% CI = 0.868-0.947) and initiated in 2011 vs. 2009 (OR = 2.363, 95% CI = 1.777-3.141).

Conclusions: 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.

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Conflict of interest statement

Jiang, Barner, Park, and Ling declare no conflict of interest or financial interest in any therapy discussed in this article, including employment, honoraria, consultancies, expert testimony, patents, and royalties.

Study concept and design were primarily contributed by Jiang, along with Barner and assisted by Park and Ling. Data were collected by Jiang, Ling, Park, and Barner and interpreted by Jiang, Barner, Park, and Ling. The manuscript was primarily written and revised by Jiang, along with Barner, Park, and Ling.

Figures

FIGURE 1
FIGURE 1
Patient Selection Process
FIGURE 2
FIGURE 2
Use of Anti-VEGF and Laser Therapy Among Patients with DME from 2009 to 2011
FIGURE 3
FIGURE 3
Distribution of Number of Anti-VEGF Injections/Laser Photocoagulation Surgeries Received After the Initial Injection (1-Year Post-Index)
See this image and copyright information in PMC

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