U.S. Experience: Real-World Outcomes in Wet AMD
Ophthalmology Retina, July 2018
Ciulla et al. set out to assess the outcomes of “real-world” U.S. patients who receive intravitreal injections for neovascular age-related macular degeneration (AMD). They also sought to assess the impact that loss to follow-up has on visual outcomes. They found that—as previously noted in studies conducted outside the United States—patients treated with anti–vascular endothelial growth factor (anti-VEGF) agents in clinical practice receive fewer injections and have worse visual outcomes than do those treated according to a strict protocol in a randomized clinical trial.
For this retrospective study, the researchers evaluated electronic health records from a geographically and demographically diverse sample of patients treated by U.S. retina specialists. At the time of the analysis (January 2011 to July 2013), there were 77,985 patients with neovascular AMD in the database; after inclusion criteria were applied, records of 2,213 treatment-naive patients were evaluated.
The researchers divided the patients into 3 mutually exclusive cohorts, depending on whether they were considered lost to follow-up after 6, 12, or 24 months of treatment. Overall, anti-VEGF use by agent was 13% for aflibercept, 17% for ranibizumab, and 70% for bevacizumab; the 6-month cohort had a higher percentage of aflibercept use (20%), while 15% received ranibizumab, and 65% received bevacizumab.
Patients in the 6-month cohort received a mean of 5.4 injections, versus 7.3 and 12.1 injections, respectively, in the 12-and 24-month cohorts. No change in VA from baseline was noted in either the 6-or 12-month cohort; in contrast, patients in the 24-month cohort experienced a net gain of 3.1 letters. Individual patients with better VA at presentation tended to be particularly vulnerable to vision loss. In addition, patients lost to follow-up tended to have poorer VA at their final visit, the researchers noted.
Taken together, these real-world outcomes highlight an unmet need for better treatment of neovascular AMD, the researchers said.
The original article can be found here.