First Author: L.Price UK
Co Author(s): O. Almossawi G. Palexas
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To report the current trends in usage of ranibizumab, bevacizumab, aflibercept and Ozurdex® to treat retinal diseases at a National Health Service (NHS) hospital in London, UK and to allow comparison with international reported figures.
Ophthalmology department at North Middlesex University (District General) Hospital in Central London, UK.
Records of all patients treated with intravitreal therapy at the North Middlesex University Hospital department of ophthalmology were prospectively collected, including type of therapy, diagnostic indication and patient demographic data. The data was collected over a period of 16 months between September 2015 and December 2016 inclusive. Each data point was taken only once: at the time an intended therapy was commenced with the relevant diagnostic indication. The criteria for initiating each therapy was guided by the National Institute for Health and Care Excellence (NICE) guidelines for each condition.
A total of 379 patients were commenced on intravitreal therapy over the study period. The intravitreal therapies used were ranibizumab (67.6%), aflibercept (29.4%) and Ozurdex® (3%). Stratified by diagnosis, the use of ranibizumab, aflibercept and Ozurdex® respectively were: neovascular age-related macular degeneration (117 patients; 38%, 62%, 0%), diabetic macular oedema (196 patients; 87%, 10%, 3%), central retinal vein occlusion (33 patients; 39%, 50%, 11%) and branch retinal vein occlusion (33 patients; 82%, 0%, 18%). No usage of bevacizumab was recorded. The diabetic macular oedema (DMO) patients were referred from the Diabetic Retinopathy Screening Programme (DRSS), encompassing a pool of 77903 locally screened diabetic patients, of which 3214 were referred and in the care of our ophthalmology medical retinal department. Only 196 of these diabetic patients were started on intravitreal therapy within the study period given the NICE guidelines, which only allows for treatment of DMO with intravitreal anti-VEGF if the central foveal thickness exceeds 400 micrometers.
The preferred intravitreal therapy for all indications is ranibizumab (Lucentis) accounting for two-thirds of the total injections. Aflibercept (Eylea®) accounted for the majority of the remaining injections, with Ozurdex® used in only a small minority of patients. The minimal use of Ozurdex® can be explained because of concerns regarding its side effect profile, which includes an increased rate of cataract development in phakic patients and increased risk of glaucoma. Of note, there was no recorded use of bevacizumab. This is in contrast with international figures, such as in the USA, where bevacizumab accounted for nearly two-thirds of all anti-VEGF therapy in 2015. The reason for this disparity is largely due to restrictions on the use of unlicensed medication within the NHS. Overall there is a wide variation in choice of intravitreal therapy between different countries and health systems.