Four Year Analysis Reports Uptick in Aflibercept Use, Decrease in Ranibizumab

Ferhina Ali, MD

Intravitreal injections are one of the most commonly performed procedures in ophthalmology. When choosing an anti-VEGF injection, clinicians can choose between aflibercept, bevacizumab, and ranibizumab.

In a new retrospective descriptive study, a team of investigators from the Retina Service of Wills Eye Hospital, set out to examine the demographic, geographic and temporal trends in the use of the 3 previously mentioned intravitreal anti-VEGFs in patients with diabetic macular edema (DME) throughout the United States.

The investigators collected longitudinal data from 2013-2017 from a large clinical database, Vestrum Health, which consists of electronic medical records from over 250 retinal specialists throughout the United States.

The investigators examined the records of patients 18 years and older who had been diagnosed with DME using ICD encoding and had received an intravitreal injection of anti-VEGF using CPT coding. Patients with a history of myopia, uveitis, retinal vein occlusion and/or age-related macular degeneration were excluded from analysis. The statistical comparisons were performed using chi-squared testing.

In total, there were 57,925 injections administered between 2013 and 2017. Patient information indicates that the median age of patients was 62 years and 46.0% of the patient population were female.

Data for anti-VEGF use indicates that bevacizumab was administered 57.1% of the time followed by aflibercept with 23.7% and ranibizumab with 19.1%.

Geographic breakdowns reveal that 31.8% of intravitreal injections included in this study were administered in the Northeast, followed by 22.8% in the Southeast and 22.0% in the West.

In total, 60.4% of patients presenting with vision from 20/50-20/200 received bevacizumab, 20.8% received ranibizumab, and 24.7% received aflibercept.

“There was a significant variation in the type of anti-VEGF agent used when stratified by year, geographic location, and by initial visual acuity,” the authors wrote in their results.

Additionally, the authors note a change in the type of anti-VEGF agent administered over time across presenting acuity of better than 20/50, 20/50 to 20/200 and worse than 20/200, as well as a change in the type of anti-VEGF agent administered over time across all 5 regions of the US (p<0.001).

Use of aflibercept grew from being used .1% of the time in 2013 to 29.6% of the time in 2017, ranibizumab used declined from 47.3% to 12.3%, and bevacizumab remained stable, growing from 52.6% to 58.6% during the study period.

These overall trends demonstrate an increase in aflibercept use, with a reciprocal decline in ranibizumab over time across all regions, while the use of bevacizumab remained stable throughout the study period.

The study demonstrated the trends in the choice of anti-VEGF agents used over a 4-year period for the treatment of DME across the US by presenting visual acuity and geographic region.

The authors indicate that further analysis of the use of anti-VEGF agents may reveal whether results from clinical trials influence the trends seen in these findings.

This study was presented in a poster presentation titled “Trends in Intravitreal Anti-VEGF Use for the Treatment of DME Across the United States from 2013 to 2017” at the American Academy of Ophthalmology Annual Meeting 2018 in Chicago, Illinois.

Disclosures: none