Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes.
Aged
Angiogenesis Inhibitors
/ therapeutic use
Bevacizumab
/ therapeutic use
Diabetic Retinopathy
/ drug therapy
Female
Humans
Intravitreal Injections
Macular Edema
/ drug therapy
Male
Middle Aged
Ranibizumab
/ therapeutic use
Receptors, Vascular Endothelial Growth Factor
/ therapeutic use
Recombinant Fusion Proteins
/ therapeutic use
Retrospective Studies
Treatment Outcome
Vascular Endothelial Growth Factor A
/ antagonists & inhibitors
Visual Acuity
/ physiology
macula
retina
treatment medical
Journal
The British journal of ophthalmology
ISSN: 1468-2079
Titre abrégé: Br J Ophthalmol
Pays: England
ID NLM: 0421041
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
23
01
2020
revised:
17
03
2020
accepted:
19
03
2020
pubmed:
9
4
2020
medline:
1
5
2021
entrez:
9
4
2020
Statut:
ppublish
Résumé
To assess visual acuity (VA) outcomes and antivascular endothelial growth factor (anti-VEGF) treatment intensity in diabetic macular oedema (DMO). Retrospective analysis was performed in treatment-naïve patients with DMO from 2013 to 2018 using a database of aggregated de-identified electronic medical records (Vestrum Health). At 1 year, 28 658 patient eyes underwent a mean of 6.4 anti-VEGF injections, gaining a mean of +4.2 letters (95% confidence interval for mean gain: +4.0 to +4.5 letters, p<0.001). When stratified by anti-VEGF medication and by years 2013-2018, no clinically meaningful differences in injection frequency or 1-year VA change resulted. At 1 year, 50% of eyes received ≤6 injections, while <20% received 10-13 injections, representing monthly treatment. Mean letters gained at 1 year generally showed a linear relationship with mean number of anti-VEGF injections, beyond two injections. Eyes with good baseline VA (≥20/40) generally were at risk of VA loss at 1 year; those with moderately severe baseline impairment (20/70 to 20/200) who received ≥10 injections improved by a mean of +10.3 letters. In clinical practice, patients with DMO undergo fewer anti-VEGF injections and exhibit worse visual gains compared with patients in randomised clinical trials. Visual outcomes correlate with treatment intensity at 1 year, with ceiling effects related to baseline VA.
Sections du résumé
BACKGROUND/AIM
To assess visual acuity (VA) outcomes and antivascular endothelial growth factor (anti-VEGF) treatment intensity in diabetic macular oedema (DMO).
METHODS
Retrospective analysis was performed in treatment-naïve patients with DMO from 2013 to 2018 using a database of aggregated de-identified electronic medical records (Vestrum Health).
RESULTS
At 1 year, 28 658 patient eyes underwent a mean of 6.4 anti-VEGF injections, gaining a mean of +4.2 letters (95% confidence interval for mean gain: +4.0 to +4.5 letters, p<0.001). When stratified by anti-VEGF medication and by years 2013-2018, no clinically meaningful differences in injection frequency or 1-year VA change resulted. At 1 year, 50% of eyes received ≤6 injections, while <20% received 10-13 injections, representing monthly treatment. Mean letters gained at 1 year generally showed a linear relationship with mean number of anti-VEGF injections, beyond two injections. Eyes with good baseline VA (≥20/40) generally were at risk of VA loss at 1 year; those with moderately severe baseline impairment (20/70 to 20/200) who received ≥10 injections improved by a mean of +10.3 letters.
CONCLUSION
In clinical practice, patients with DMO undergo fewer anti-VEGF injections and exhibit worse visual gains compared with patients in randomised clinical trials. Visual outcomes correlate with treatment intensity at 1 year, with ceiling effects related to baseline VA.
Identifiants
pubmed: 32265201
pii: bjophthalmol-2020-315933
doi: 10.1136/bjophthalmol-2020-315933
pmc: PMC7848066
doi:
Substances chimiques
Angiogenesis Inhibitors
0
Recombinant Fusion Proteins
0
VEGFA protein, human
0
Vascular Endothelial Growth Factor A
0
aflibercept
15C2VL427D
Bevacizumab
2S9ZZM9Q9V
Receptors, Vascular Endothelial Growth Factor
EC 2.7.10.1
Ranibizumab
ZL1R02VT79
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
216-221Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: JFP and DFW are co-founders of Vestrum Health.
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