DME Patients Lack Initial, First-year Treatment

An analysis of a large-scale database has found that diabetic macular edema (DME) may be an undertreated disease.

The study, presented at the 121^st Annual Meeting of the American Academy of Ophthalmology (AAO 2017) in New Orleans, LA, accessed real-world DME patient data via the Intelligent Research In Sight (IRIS) Registry. The first US comprehensive eye disease clinical database, it’s comprised of 41 million patients and 166 million patient visits.

The California-based research team — led by Jeffrey R. Willis, MD, PhD, of the Department of Ophthalmology at the UC Davis Medical Center in Sacramento — performed a retrospective cohort study on the Registry.

The parameters of the study were set to newly diagnosed, treatment-naive adults at least 18 years old with DME, in an index period from July 1, 2013 to March 31, 2016. The follow-up period ran through March 31, 2017. Patients with either unilateral DME in 1 eye, or bilateral DME with a worse-seeing eye qualified.

Following particular qualifications, the researchers found 13,410 newly diagnosed and treatment-naïve cases of DME.

In gauging the initial treatment patients received for each DME diagnosis, researchers reported that 9,990 (74.5%) were first treated with observation, and no actual therapy, within the first 28 days. Another 2,091 (15.6%) were treated with an anti-vascular endothelial growth factor (VEGF) therapies in the first 28 days.

Willis distinguished that the cases treated with anti-VEGF were done so with 1 of 3 options: bevacizumab (Avastin), ranibizumab (Lucentis), and aflibercept (Eylea). A majority (71.3%) of the anti-VEGF patients were administered Avastin.

Another 1,133 cases (8.5%) were initially treated with laser therapy. Just 130 (1%) were treated with corticosteroid, and 66 (0.5%) were initially treated with a combination therapy.

The data revealed that DME patients to have received anti-VEGF initial therapy within 28 days generally did not receive many more injections in the following year. About 60% of such patients received between 1 and 4 injections in that year, while just 40% had 5 or more.

Willis concluded that it was likely that 75% of patients received no treatment within 28 days of diagnosis, and 60% of those patients likely received no treatment after a year of follow-up. Though Anti-VEGF was the most commonly-administered initial therapy, too few of patients took a regimented amount of treatment doses over the first year.

In discussing the results and methods to improve patient commitment to treatments with an AAO 2017 panel, Willis said researchers are looking at some of the barriers patients face.

“I think a lot of them will be socioeconomic issues — with finances and not being able to get into a clinic or being able to travel to a clinic,” Willis said.

With an ability to geographically track DME specialist sites in comparison to patient demographics — including age, gender, race, insurance status, and their provider’s specialty — the researchers have an advantage in the IRIS Registry for follow-up on methods to improve DME patient treatment rates.

Willis called the registry a “promising data source for ophthalmic research” in general.