First Author: J.Bleier UK
Co Author(s): S. Régnier 0 0 0 0 0 0 0 0 0
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To assess how frequently patients in the USA visit their ophthalmologist, with or without receiving an injection, in the first 2 years after starting treatment with ranibizumab for visual impairment due macular edema secondary to central retinal vein occlusion (CRVO).
An analysis of a US physician-recorded medical claims database (IMS Health Integrated Data Warehouse), which includes records for patients treated by ophthalmologists and retinal specialists. The database includes professional fee claims representing over 870 000 practitioners covering all 50 US states and prescription claims representing 55% of all US pharmacies.
The analysis set included patients with a recorded diagnosis of CRVO who received at least one intravitreal (IVT) injection of ranibizumab between 1 June 2010 and 31 December 2012. Patients were excluded if they had received any anti-vascular endothelial growth factor (anti-VEGF) treatment in the 6 months before the first recorded injection of ranibizumab, or if they had received an injection of any other anti-VEGF after the first injection of ranibizumab. Three patient cohorts were assessed based on the duration of available follow-up data after the first ranibizumab injection: at least 6 months, at least 12 months and at least 24 months. The mean (± standard deviation [SD]) number of ranibizumab injections and the number of non-treatment visits were calculated over the follow-up period. Analyses were performed on a per eye basis with no adjustments for bilateral treatment.
The cohort with at least 6 months of follow-up data comprised 1498 patients. Their median age at first injection was 77.0 years and 46.1% were men. At least 12 months of follow-up data were available for 1130 patients, 46.0% of whom were men, with a median age of 77.0 years. The cohort with 24 months of follow-up data comprised 403 patients. Their median age was 76.0 years and 45.7% were men. The mean (SD) number of IVT injections of ranibizumab administered per patient was 3.0 (1.6) in the first 6 months, 4.3 (2.9) in the first year and 1.6 (2.6) in the second year. The mean (SD) number of visits was 7.8 (3.7) in the first year and 3.9 (4.0) in the second year. The mean (SD) number of visits to an ophthalmologist during which no injection was administered was 1.9 (1.7) in the first six months, 3.5 (2.8) in the first year and 2.4 (2.7) in the second year. During the first six months, 8.9% of patients received six or more injections and 21.1% of patients received five or more injections. Similar visit frequencies were found for branch retinal vein occlusion.
These results suggest that in routine clinical practice in the USA, patients with CRVO receive substantially fewer injections of ranibizumab in the first year of treatment (4.3 injections) than patients enrolled in clinical trials such as CRUISE (8.8 injections). The mean number of injections administered during the first 6 months of treatment was 3.0, and very few patients received the six monthly doses of ranibizumab administered in the first 6 months of the CRUISE study. During the first 6 months and first year of treatment, ranibizumab was administered on the majority of visits to ophthalmologists. During the second year of treatment, the majority of visits to ophthalmologists did not result in ranibizumab injection. Given the differences in injection frequency between real-world and clinical trial settings, further investigation of visual acuity outcomes is needed. Once sufficient data are available, the real-world treatment patterns of aflibercept and ranibizumab will be compared.