Real-world anti-VEGF regimens found suboptimal

A survey of national practice patterns finds the frequency of anti-VEGF injections for wet AMD is low and the discontinuation rate is high when compared with optimal treatment strategies suggested by clinical trial evidence.

Using Medicare claims data for intravitreal injections of anti-VEGF medications, investigators calculated the frequency of anti-VEGF treatments and treatment visits for wet AMD per treated eye in the first and second year after the initial anti-VEGF injection. 

Between 2006 and 2010, the mean number of injections was 4.3 in the first year, with 58% of patients receiving one to four injections, 20% receiving five to six injections, and 22% receiving seven or more injections. Among patients who received seven or more injections during the first year, 31% received a comparable number during the second year, and 12% received no injections during the second year. Of patients who received one to four injections during the first year, 70% received no injections and 24% received one to four injections during the second year. Rates of anti-VEGF discontinuation were 57% within 12 months and 71% within 24 months.

The HORIZON, CATT and SEVEN-UP trials suggest that the most efficacious treatment strategy for sustained gains in visual acuity consists of at least seven to eight injections during the first year and at least five to six injections during the second year, coupled with frequent follow-up examinations with OCT.