Trends of Anti-Vascular Endothelial Growth Factor Use in Ophthalmology Among Privately Insured and Medicare Advantage Patients

Parikh, Ravi; Ross, Joseph S.; Sangaralingham, Lindsey R.; Adelman, Ron A.; Shah, Nilay D.; Barkmeier, Andrew J.

doi:10.1016/j.ophtha.2016.10.036

Cited by 86 publications

(65 citation statements)

References 23 publications

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“…The primary definition was based on receipt of one of the following procedures with a DR or diabetes diagnosis code on the same claim: 1) photocoagulation (CPT 67228, 67210), 2) vitrectomy (CPT 67036, 67038-67042), and 3) intravitreal injection (CPT 67028) of antivascular endothelial growth factor agents (ranibizumab, aflibercept, or bevacizumab) or corticosteroid (triamcinolone, dexamethasone, or fluocinolone). Because medication-specific codes were not available immediately after U.S. Food and Drug Administration approval and bevacizumab lacks a code specific to ocular use (13), we also included claims for intravitreal injection of unclassified/ miscellaneous drug codes. To minimize miscoding or misclassification bias, we required all HCPCS drug codes to be jointly used with an intravitreal injection CPT code.…”

Section: Dr Outcomementioning

confidence: 99%

Incretin-Based Therapies and Diabetic Retinopathy: Real-World Evidence in Older U.S. Adults

et al. 2018

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Section: Dr Outcomementioning

confidence: 99%

Incretin-Based Therapies and Diabetic Retinopathy: Real-World Evidence in Older U.S. Adults

et al. 2018

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“…Anti-vascular endothelial growth factor (VEGF) injections have become the mainstay of treatment for exudative age-related macular degeneration (AMD), with annual increases in the total number of injections from 2006 to 2015 in the United States. 1 Currently available agents have been extensively studied for their benefit in AMD treatment and include ranibizumab (Lucentis; Genentech, South San Francisco, CA) [2][3][4] and aflibercept (Eylea; Regeneron, Tarrytown, NY), 5 both of which have been approved by the US Food and Drug Administration (FDA) for the treatment of neovascular AMD, and the non-FDA approved bevacizumab (Avastin; Genentech). 6,7 Adverse events from anti-VEGF treatment have been extensively reported in many 1-to 2-year clinical trials, [2][3][4][5][6][7] and the incidence of ocular and systemic adverse events has been low.…”

Section: Introductionmentioning

confidence: 99%

<p>Incidence of Glaucoma or Ocular Hypertension After Repeated Anti-Vascular Endothelial Growth Factor Injections for Macular Degeneration</p>

Wingard¹,

Delzell²,

Houlihan³

et al. 2019

OPTH

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Purpose: To estimate the risk of glaucoma or sustained ocular hypertension (OHT) related to anti-vascular endothelial growth factor (VEGF) injections for age-related macular degeneration (AMD). Design: Retrospective chart review. Subjects: Patients who received unilateral anti-VEGF injections for AMD at the Wheaton Eye Clinic (IL). Methods: Chart analysis was performed on 1095 patients, without prior glaucoma or OHT, who received unilateral anti-VEGF injections for AMD from 2005 to 2012, with data collected through 2013. Data collection included demographics, lens status, date and medication type of each injection, and the date of diagnosis of glaucoma or OHT by a treating glaucoma specialist, which was the main outcome measure. Rare events logistic regression was performed to determine the risk of disease development based on sex, lens status, and injection frequency. Results: Unilateral glaucoma or sustained OHT developed in 42 patients over the course of follow-up, with 40 events in the injected eye only, 2 in the contralateral eye only. Statistical modeling predicted elevated risk for onset of glaucomatous disease with a higher maximum frequency of injections (p < 0.0001, odds ratio [OR] 2.18 for each additional injection over the most injection-intense 6 months for a given subject) and with phakic lens status (p = 0.0009, OR 0.33 for pseudophakia). Conclusion: Our results show a significant risk for glaucoma or OHT development in patients undergoing repeated treatments with intravitreal anti-VEGF injections for AMD, establishing the first reliable connection between disease development and a period of highfrequency injections. In addition, we show a significantly increased risk of disease development in phakic patients, which we believe points to a mechanical explanation for this type of secondary glaucoma.

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“…Most patients with DME respond well to anti-VEGF treatment. Currently bevacizumab is used more frequently than ranibizumab or aflibercept for treatment of ophthalmic disease in clinical practice 22 because of its lower cost. In the DRCR.net Protocol T study comparing these anti-VEGF agents in patients with DME, after 1 year of treatment, aflibercept was more effective than ranibizumab or bevacizumab in improving BCVA in patients with baseline BCVA worse than 20/40, whereas the anti-VEGF agents showed comparable efficacy in patients with baseline BCVA of 20/32 to 20/40.…”

Section: Discussionmentioning

confidence: 99%

Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

Regillo¹,

Callanan²,

Diana³

et al. 2017

Ophthalmic Surg Lasers Imaging Retina

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BACKGROUND AND OBJECTIVE: Guidance on the use of corticosteroids in the treatment of diabetic macular edema (DME) is lacking. This study aimed to develop a clinically recommended treatment paradigm for DME with emphasis on the role of corticosteroids. PATIENTS AND METHODS: An expert panel of nine retinal specialists in the United States developed consensus recommendations for DME treatment through a modified Delphi process. RESULTS: The panelists typically use intravitreal injections of vascular endothelial growth factor (VEGF) antagonists as first-line treatment of DME and switch patients with an inadequate response to anti-VEGF therapy (failure of best-corrected visual acuity to improve to 20/40 or better because of edema after three to six monthly injections, or a less-than-50% reduction in excess macular thickness after three to four monthly injections) to intravitreal corticosteroid treatment. CONCLUSION: Intravitreal corticosteroids have a potentially useful role in the treatment of patients with DME who have an inadequate response to intravitreal anti-VEGF therapy. [ Ophthalmic Surg Lasers Imaging Retina. 2017;48:291–301.]

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Trends of Anti-Vascular Endothelial Growth Factor Use in Ophthalmology Among Privately Insured and Medicare Advantage Patients

Cited by 86 publications

References 23 publications

Incretin-Based Therapies and Diabetic Retinopathy: Real-World Evidence in Older U.S. Adults

Incretin-Based Therapies and Diabetic Retinopathy: Real-World Evidence in Older U.S. Adults

<p>Incidence of Glaucoma or Ocular Hypertension After Repeated Anti-Vascular Endothelial Growth Factor Injections for Macular Degeneration</p>

Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

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