Correlation between the rate of intravitreal injections, use of aflibercept as a second‐line treatment and visual impairment for wet AMD in Finland

Abstract

To correlate the rate of intravitreal anti-VEGF injections and the use of aflibercept as a second-line treatment with visual impairment throughout Finland. Methods: Information related to anti-VEGF treatment, proportions of bevacizumab and aflibercept and new visual impairments due to wet age-related macular degeneration (AMD) was gathered from 5 university hospitals and 14 central hospital districts between 2015 and 2017 covering 232 568 injections and 1172 visual impairments. Results: Between 2015 and 2017, the number of annual total anti-VEGF injections increased from 60 412 to 93 589 (+24.5% annual change) and of aflibercept injections from 8299 to 20 833 (+58.7% annual change). The 3-year average for total anti-VEGF injections ranged from 9.6 to 21.1 (median 13.3) per 1000 citizens between hospital districts and for aflibercept injections from 0.8 to 4.0 (median 1.9). According to the primary protocol for wet AMD, during 2015-2017, the number of total anti-VEGF injections increased from 10.9 to 15.2 per 1000 citizens with the pro re nata (PRN) protocol and from 11.3 to 18.9 with the treat-and-extend regimen (TER). The 3-year average of aflibercept injections as a second-line treatment, but not the total number of anti-VEGF or bevacizumab injections, inversely correlated with new onset visual impairments (R = À0.505, P = 0.027) in the hospital districts. The number of visual impairments did not differ between the hospital districts according to the PRN and TER protocols (1.23 AE 0.41 and 1.14 AE 0.67, respectively, per 1000 citizens aged ≥64 years, P = 0.713). Conclusion:These results emphasize that the use of aflibercept injections as a second-line treatment may decrease new onset visual impairments.

Visual impairment due to age‐related macular degeneration during 40 years in Finland and the impact of novel therapies

“…The decision to switched drug could be because visual acuity did not improve, the optical coherent tomography failed to show an effect on retinal fluid, or the interval between injections could not be extended beyond four weeks. Most switches are made to aflibercept in line with previous studies (Barthelmes et al, 2016(Barthelmes et al, , 2018Karesvuo et al, 2020;Verbraak et al, 2020). The use of ranibizumab in Finland has been very marginal all the time.…”

Autophagy Genes for Wet Age-Related Macular Degeneration in a Finnish Case-Control Study

“…The clinical hallmark of wet AMD is the pathogenic choroidal neovascularization (CNV) that may leak fluids into the retina. Exudative AMD is a rapidly progressive sight-threatening condition and should be treated aggressively with intravitreal anti-vascular epithelial growth factor (anti-VEGF) injections [9,10]. Despite this often-effective treatment, 10% of wet AMD patients present a low visual outcome within two-year follow-up [11,12].…”

“…Despite this often-effective treatment, 10% of wet AMD patients present a low visual outcome within two-year follow-up [11,12]. The varying anti-VEGF treatment responses have been explained by genetic factors, the timing of the initiation of treatment, and the choice of drug used [9,[13][14][15].…”