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. 2022 Apr;39(4):e14746.
doi: 10.1111/dme.14746. Epub 2021 Dec 15.

Treatment patterns and persistence rates with anti-vascular endothelial growth factor treatment for diabetic macular oedema in the UK: A real-world study

Tunde Peto  1 , Toks Akerele  2 , Alexandros Sagkriotis  3 , Sofia Zappacosta  4 , Andreas Clemens  3   5 , Usha Chakravarthy  1
Affiliations

Treatment patterns and persistence rates with anti-vascular endothelial growth factor treatment for diabetic macular oedema in the UK: A real-world study

Tunde Peto et al. Diabet Med. 2022 Apr.

Abstract

Introduction: Anti-vascular endothelial growth factors (anti-VEGFs) are considered standard of care therapy for diabetic macular oedema (DME). This study examined treatment patterns and outcomes in patients with DME treated with anti-VEGF therapy.

Methods: Using anonymized electronic medical record data collected from three UK sites, this retrospective cohort study assessed rates of anti-VEGF intravitreal injections in adults with treatment-naïve DME who received their first treatment between 1 September 2010 and 31 July 2018. The proportion of patients with at least one interval of at least 12 weeks between injections; the distribution of injection intervals; the discontinuation rates; and the number of anti-VEGF injection-, injection-free- and total visits were assessed during the first and second years of treatment.

Results: Overall, 1606 patient eyes with DME were included, with no minimum follow-up. During the first and second year of treatment, 63.2% and 73.1% of eyes had at least one anti-VEGF injection interval of at least 12 weeks, respectively. In the first and second years of treatment, the mean (standard deviation) numbers of injections were 7.7 (1.9) and 5.6 (2.2), with 14.2 (5.7) and 13.4 (6.4) total clinic visits, and 6.6 (5.0) and 7.8 (5.8) injection-free visits, respectively. In total, 27.8% of patient eyes discontinued treatment during the first 2 years.

Conclusions: The high number of clinic visits and high discontinuation rates demonstrate a significant unmet need for a treatment to enable sustainable extended injection intervals, while maintaining visual acuity. This could improve patient adherence and health-related quality of life for patients with DME.

Keywords: DME; anti-VEGF; health care delivery.

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Conflict of interest statement

T.P. has received honoraria and speaker's fees from Bayer and Novartis. T.A. and U.C. have received honoraria and travel support from Bayer and Novartis. A.S. and A.C. are employees and shareholders of Novartis. S.Z. is an employee of IQVIA, which received funding from Novartis Pharma AG for the conduct of this study.

Figures

FIGURE 1
FIGURE 1
Time to (a) switch from index VEGF agent to a different VEGF agent or steroid treatment and (b) discontinuation. Discontinuation of treatment was defined as when anti‐VEGF injections were stopped and not re‐introduced for ≥180 days. The patient must have had a record of a clinic visit during that period. VEGF, vascular endothelial growth factor
FIGURE 2
FIGURE 2
Maximum durations of consecutive injection intervals during the first year of treatment with anti‐VEGF agents. *Categories not mutually exclusive. DME, diabetic macular oedema; VEGF, vascular endothelial growth factor
FIGURE 3
FIGURE 3
Pearson correlation coefficient between change from baseline in CRT and change from baseline in VA over 12 months of treatment with anti‐VEGF agents (site A).OCT biomarkers were available at one of the three sites (site A). CRT, central retinal thickness; M, month; OCT, optical coherence tomography; VA, visual acuity; VEGF, vascular endothelial growth factor
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