Theodore Leng, MD: Anti-VEGF Utilization Patterns in Patients with DME

A new retrospective analysis of the IRIS registry reported that 77% of eyes with diabetic macular edema (DME) received only 1 anti-VEGF agent over a mean follow-up of 2.3 years.

The findings suggest that 52% of eyes discontinued anti-VEGF treatment after a mean of 24 weeks, of which a third reinstated after a mean of 91 weeks.

The data additionally show that 58% of patients initially received bevacizumab, but the use of the agent decreased over time with a subsequent increase in the use of on-label agents.

The findings were presented at the American Society of Retina Specialists 40th Annual Scientific Meeting.

In an interview with HCPLive, Theodore Leng, MD, Byers Eye Institute, Stanford University, discussed the findings on the anti-VEGF utilization patterns over the 6-year period, particularly his surprise at the lack of agent switching reported in the registry.

“This finding was a little bit surprising to me, because I think if you ask the average retinal specialists, do you switch agents in your DME patients, I would say the answer would probably be higher than 23% of the time,” Leng said.

Leng additionally noted that only 15% of eyes switched anti-VEGF agents during the study period after a mean of 53 weeks. He also shared his perspective on the length of time retinal specialists decide to switch a DME patient from one anti-VEGF agent to another and how the data show a longer than expected timeline.

“What this data has shown, and previous data has shown is that we are actually taking much longer time to figure that out, “Leng said. “And in this case, a year, which I thought was also an interesting finding.”

He additionally said that while it is not a surprising finding, the amount of bevacizumab use decreased by about 5.5% while the on-label medication increased at the same rate.

While the data did not show why there may be inertia in switching agents, Leng shared his own perspective on the potential issue. Although clinicians want to remain conscientious of their patient, the reasons could include a lack of time to do a deep dive into a specific patient’s scenario, their visual acuity data, and the number of previous injections with an agent.

“I think we need to be a little bit more specific as far as how we look at the patients in each clinical encounter,'' he added. “Make sure we review the data. How many treatments have we given them to date? Has there been interval improvement on the OCT and visual acuity?”