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Real-world treatment of DME yields fewer gains than in trials
SAN DIEGO — Patients with diabetic macular edema receive fewer intravitreal anti-VEGF injections in clinical practice than in published clinical trials, with consequently less visual acuity improvement, according to a speaker here.
Nancy M. Holekamp, MD, and colleagues looked at large national claims databases to determine real-world treatment of diabetic macular edema and found that patients receive two to three anti-VEGF injections in a 12-month period.
“This is far below the monthly dosing we saw in RIDE and RISE. It’s even less than the average nine injections people received in the BOLT study,” Holekamp said at the American Society of Retina Specialists annual meeting.
In a subsequent analysis of electronic medical record data from a large health system in Pennsylvania, Holekamp and colleagues found that 75% of patients received three or fewer injections for DME over 12 months. In the 94 eyes studied, mean change in visual acuity from baseline was a gain of four letters at 6 months and 1.9 to 3.7 letters at 12 months. In comparison, patients gained 11.4 letters and 10.5 letters in the RIDE and RISE studies, respectively.
“What we knew before is that patients who received two to three injections in a 12-month period of time were likely being undertreated. What this study shows for the first time is that patients are also experiencing less visual acuity improvement,” Holekamp said.
The injection paradigm will be difficult to change due to the large total office visit burden in this population, she said, adding that treatments with longer duration of action are needed to achieve better visual acuity outcomes with fewer injections.
Disclosure: Holekamp has received consulting fees or honoraria from Allergan.