ASRS Posters Review Long-term Visual Outcomes, Treatment Burden of Anti-VEGF Therapies

Best visual acuity (BVA) prior to starting anti–vascular endothelial growth factor (VEGF) therapy may be impacting treatment plan and ultimately, long-term visual outcomes for patients with diabetic macular edema (DME), according to a poster¹ presented at the American Society of Retina Specialists 40th Annual Scientific Meeting, held July 13-16, 2022, in New York, New York.

The researchers evaluated the frequency of treatment, as well as long-term visual outcomes using the IRIS Registry. Intravitreal therapy (IVT) with anti-VEGF is the first-line treatment for DME.

“The efficacy of anti-VEGF injections has been demonstrated in short-term large clinical trials, but recent studies have shown that patients with DME in routine clinical practice do not achieve similar vision improvements as those observed in clinical trials,” the authors explained.

They conducted a retrospective analysis among patients with DME who were treatment naïve and initiated anti-VEGF IVT from January 1, 2015, to December 31, 2019. Patients were followed for up to 6 years, during which the change in BVA from baseline, as well as the average number of injections and intervals, were reported.

A total of 147,687 patients and 190,345 eyes were included in the study. The mean age (SD) was 64.2 (11.4) years and 49% were female. The majority of patients were White (64.5%). Overall, the researchers found eyes with worse vision had greater improvements in BVA compared with eyes with better vision.

When patients were stratified by baseline BVA, the overall change in BVA was negative for eyes that started between 20/25 and 20/25-20/40, the researchers found.

When stratifying by the frequency of treatment, the change in BVA from baseline was +2.8 in patients who received 1 to 2 injections each year. In comparison, the change was +4.8 in patients receiving at least 11 injections in the first year, a trend that remained consistent over the years. In years 3 to 6, patients who were only receiving 1 to 2 or 3 to 4 injections actually experienced BVA loss from baseline. Patients receiving at least 5 injections each year did not experience a loss in BVA from baseline.

Adjusted analyses found being Black or Hispanic, or on Medicaid, was associated with a decline in BVS from baseline to 1 year of follow-up.

In addition, year over year, up to 6 years and regardless of baseline BVA, the number of injections decreased and the interval of injections increased.

Findings suggest that long-term visual outcomes in DME may be affected by BVA at the initiation of anti-VEGF treatment, as well as by the number of injections administered,” the researchers concluded. “These results will better equip ophthalmologists in their clinical decision-making and management of patients with DME.”

Another poster found high adherence to and satisfaction with anti-VEGF therapy to treat DME and neovascular age-related macular degeneration (nAMD), but barriers related to care and burdens of the condition that could be reduced further.²

The researchers recruited 165 patients (67 with DME and 98 with nAMD) and 28 caregivers (9 of patients with DME and 19 of patients with nAMD) across 9 clin­ical sites to complete a cross-sectional quantitative survey.

While a small proportion of patients (12% with DME and 3% with nAMD) reported missing at least 1 injection visit in the previous 12 months, 61% of patients with DME and 47% of patients with nAMD reported at least 1 barrier to attending these injection visits. Common barriers were treatment related (46% with DME and 40% with nAMD), such as pain and discomfort or the lack of treatment benefit, and clinic and appointment factors (43% with DME and 40% with nAMD), such as lack of reminders or transportation.

A majority (78.5%) of caregivers reported at least 1 barrier preventing patients from receiving treatment or attending visits, which was mostly attributed to COVID-19 restrictions (68% for nAMD and 56% for AMD).­­­

Twenty-seven precent of patients had to travel at least 1 hour for their appointment, and after the appointment, 21% reported needing more than 1 day to recover. Nearly one-third (33%) of patients reported personal factors negatively impacted by treatment, with the most common being activities of daily living and employment for patients with DME and activities of daily living and traveling or other leisure activities for patients with nAMD.

Caregivers of patients with DME reported providing care a mean (SD) of 4 (4) hours a day, 5 (3) days a week to their recipients. Caregivers of patients with nAMD reported providing care a mean of 5 (7) hours a day, 5 (3) days a week. Only 22% of caregivers of patients with DME reported treatment appointments affected their employment, time with friends and family, and traveling or other leisure activities compared with 68% of caregivers of patients with nAMD.

“More durable therapies, with longer treatment intervals and fewer clinic visits, could potentially alleviate the treatment burden and address current barriers experienced by patients and caregivers,” the researchers concluded.

They reported that the small caregiver sample size may be too limited to draw robust conclusions and that all responses may be subject to recall and information bias. In addition, they acknowledged the limited diversity in patient ethnicity/race, with 90% of patients with nAMD and 63% of patients with DME being White.

References

1. Kuo BL, Tabano D, Garmo V, et al. Association of real-world visual acuity outcomes and frequency of anti-VEGF injections in patients with diabetic macular edema: 6-year follow-up using the IRIS Registry. Presented at: ASRS 40th Annual Scientific Meeting; July 13-16, 2022; New York, New York.

2. Holekamp NM, Sheth VS, Adam MK, et al. Patient and caregiver experience with anti-VEGF intravitreal injections to treat neovascular age-related macular degeneration and diabetic macular edema in the US. Presented at: ASRS 40th Annual Scientific Meeting; July 13-16, 2022; New York, New York.