First Author: P.Dugel USA
Co Author(s): S. Kiss C. Makin S.S. Johnston A. Turpcu 0 0 0 0 0 0 0 0 0
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Aflibercept and ranibizumab are two intravitreal (ITV) anti-vascular endothelial growth factor (anti-VEGF) therapies approved in the US for the treatment of neovascular age-related macular degeneration (nAMD), which differ with respect to package insert-recommended dosage and administration. These differences may impact annual utilization of these therapies in a real-world setting. Thus, we assessed real-world treatment patterns, including injection frequency and number of visits to ophthalmologist, in patients receiving ranibizumab or aflibercept for nAMD in 2 independent retrospective cohort studies of 2 large US databases.
A physician-entered claims database (IMS Integrated Data Warehouse) and an insurance claims database (Truven Health MarketScan) representing US commercial, Medicare supplemental, and Medicaid covered patients.
The IMS analysis included patients with nAMD who were naïve to anti-VEGF treatment for ≥180 days prior to the index date, received ≥1 prescription for aflibercept or ranibizumab between 1 November 2011 and 30 March 2012, and had a follow-up of ≥365 days. Mean number of injections received and number of visits to an ophthalmologist within 365 days of initiation were compared for aflibercept or ranibizumab using two sample t-tests. The MarketScan analysis included patients who had initiated anti-VEGF treatment with aflibercept or ranibizumab (index date) from November 18, 2011 to July 31,2013, were aged ≥18 y on the index date, had ≥12 months continuous insurance prior to index date (baseline period), were diagnosed with nAMD during the baseline period or on the index date (ICD-9-CM 362.52), and had at least 12 months of follow-up enrollment post index date without switching to a different anti-VEGF agent. Mean number of injections and number of visits to an ophthalmologist were assessed. Multivariate regression comparisons for aflibercept vs ranibizumab were adjusted for baseline patient demographics, comorbidities, and general health status indices.
The IMS analysis of physician-reported claims identified 90 aflibercept patients and 2015 ranibizumab patients that were anti-VEGF treatment-naïve for ≥180 days and who were treated with aflibercept or ranibizumab without switching anti-VEGF therapy for 12 months. The mean number of injections [SD] was similar for aflibercept and ranibizumab (5.2 [2.7] vs 4.9 [3.4], respectively; P=0.2909) and the total visits to an ophthalmologist were similar (7.0 [2.7] vs 7.5 [3.8], respectively; P=0.0694). The MarketScan analysis of insurance claims data identified 134 aflibercept and 571 ranibizumab patients that were treatment naïve for 12 months and who were treated with aflibercept or ranibizumab without switching for 12 months. The mean [SD] number of injections over 12 months was similar for aflibercept and ranibizumab (5.4 [2.9] vs 5.7 [3.7], respectively). Multivariable regression determined that the number of injections did not differ significantly between aflibercept and ranibizumab patients at 12 months (treating ranibizumab as reference: Incidence Rate Ratio [IRR] = 0.93, 95%CI=0.82-1.05, P=0.224). The mean number of annual ophthalmologist visits for aflibercept and ranibizumab patients was 5.7 [4.3] vs 6.4 [5.6], respectively.
Independent analyses of a physician-entered claims database and an insurance claims database suggest that in routine clinical practice, patients receive a comparable number of injections in the first year of treatment with either ranibizumab or aflibercept. Further analysis is warranted with larger patient populations and longer follow-up as data become available; however, these initial analyses suggests aflibercept and ranibizumab treatment patterns in nAMD are similar in a routine clinical practice setting.