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Multicenter Study
. 2021 Apr;105(4):549-554.
doi: 10.1136/bjophthalmol-2020-315836. Epub 2020 Jun 12.

Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser

Richard Gale  1   2 , Maria Pikoula  3 , Aaron Y Lee  4 , Spiros Denaxas  3 , Catherine Egan  5 , Adnan Tufail  5 , Paul Taylor  6 ; UK EMR Users Group
Collaborators, Affiliations
Multicenter Study

Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser

Richard Gale et al. Br J Ophthalmol. 2021 Apr.

Abstract

Background/aims: Clinical trials suggest anti-vascular endothelial growth factor is more effective than intravitreal dexamethasone as treatment for macular oedema secondary to branch retinal vein occlusion. This study asks if 'real world' data from a larger and more diverse population, followed for a longer period, also support this conclusion.

Methods: Data collected to support routine care at 27 NHS (National Health Service) Trusts between February 2002 and September 2017 contained 5661 treatment-naive patients with a single mode of treatment for macular oedema secondary to branch retinal vein occlusion and no history of cataract surgery either during or recently preceding the treatment. Number of treatment visits and change in visual acuity from baseline was plotted for three treatment groups (anti-vascular endothelial growth factor (anti-VEGF), intravitreal dexamethasone, macular laser) for up to 3 years.

Results: Mean baseline visual acuity was 57.1/53.1/62.3 letters in the anti-VEGF/dexamethasone/macular laser groups, respectively. This changed to 66.72 (+9.6)/57.6 (+4.5)/63.2 (+0.9) at 12 months. Adequate numbers allowed analysis at 18 months for all groups (66.6 (+9.5)/56.1 (+3.0)/60.8 (-1.5)) and for anti-VEGF at 36 months (68.0, +10.9) Mean number of treatments were 5.1/1.5/1.2 at 12 months, 5.9/1.7/1.2 at 18 months for all three groups and 10.3 at 36 months for anti-VEGF.

Conclusions: Visual acuity improvements were higher and more sustained with anti-VEGF. Higher treatment burden occurred with anti-VEGF but this reduced over 36 months. Patients with better vision at baseline than those in the clinical trials maintained high levels of vision with both anti-VEGF and dexamethasone.

Keywords: Epidemiology; retina.

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Conflict of interest statement

Competing interests: Paul Taylor received a grant from Novartis Pharmaceuticals. Adnan Tufail is a Consultant to Allergan, Bayer, Heidelberg Engineering, Kanghong Pharmaceuticals, Novartis and Oxurion. Catherine Egan is a Consultant to Heidelberg Engineering. Aaron Lee reports being an employee of the US Food and Drug Administration, grants from Santen, personal fees from Genentech, grants from Carl Zeiss Meditec, grants from Novartis, personal fees from Topcon, personal fees from Verana Health, outside the submitted work. This article does not reflect the opinions of the US Government or of the US FDA

Figures

Figure 1
Figure 1
ConsolidatedStandards of Reporting Trials flow diagram for the entire patient population. anti-VEGF, anti-vascular endothelial growth factor; BRVO, branchretinal vein occlusion; DMO, diabetic macular oedema; PDR, proliferativediabetic retinopathy; VA, visual acuity.
Figure 2
Figure 2
Mean VA (left) and change from baseline in VA (right) during the first 3 years for 215 all treatment groups. anti-VEGF, anti-vascular endothelial growth factor; VA, visualacuity.
Figure 3
Figure 3
Mean (left) and change (right) in VA stratified by baseline VA for the entire cohort. Percentage of patients at baseline with a measurement at 36 months for each quintile is: Q1: 4.6%, Q2: 7%, Q3: 4.7%, Q4: 5.2%, Q5: 5%. VA, visual acuity.
Figure 4
Figure 4
Mean in visual acuity for patients in our study who met the inclusion criteria for the VIBRANT and GENEVA trials, compared with that for patients with baseline visual acuity above the level set in each trial.
See this image and copyright information in PMC

References

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