Treatment patterns for neovascular age-related macular degeneration: analysis of 284 380 medicare beneficiaries.
OBJECTIVE
To examine trends in the treatment of newly diagnosed neovascular age-related macular degeneration (AMD).


METHODS
Retrospective cohort study.


METHODS
Among 284 380 Medicare beneficiaries with a new diagnosis between 2006 and 2008, we used the cumulative incidence function to estimate procedure rates and the mean frequency function to estimate the cumulative mean number of intravitreous injections. We used Cox log-binomial regression to estimate predictors of the use of vascular endothelial growth factor (VEGF) antagonists within 1 year after diagnosis. Discontinuation of anti-VEGF therapy was defined by absence of treatment for 12 months. Discontinuation rates were calculated using the Kaplan-Meier method.


RESULTS
The proportion of patients receiving anti-VEGF therapy increased from 60.3% to 72.7%, photodynamic therapy decreased from 12.8% to 5.3%, and thermal laser treatment decreased from 5.5% to 3.2%. Black patients (hazard ratio, 0.77; 95% confidence interval, 0.75-0.79) and patients of other/unknown race (0.83; 0.81-0.84) were less likely than white patients to receive anti-VEGF therapy. Patients with dementia were less likely to receive anti-VEGF therapy (0.88; 0.88-0.89). Among patients who received anti-VEGF therapy, the mean number of injections within 1 year of the first injection was 4.3 per treated eye. Anti-VEGF therapy was discontinued in 53.6% of eyes within 1 year, and in 61.7% of eyes within 18 months.


CONCLUSIONS
Treatment of new neovascular AMD changed significantly between 2006 and 2008, most notably in the increasing use of anti-VEGF therapies. However, few patients treated with anti-VEGF medications received monthly injections, and discontinuation rates were high.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA. lesley.curtis@duke.edu
Lesley H
LH
Curtis
Bradley G
BG
Hammill
Laura G
LG
Qualls
Lisa D
LD
DiMartino
Fang
F
Wang
Kevin A
KA
Schulman
Scott W
SW
Cousins
D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006296:Health Services / Q000639:trends; D006302:Health Services Research; D006801:Humans; D017075:Laser Coagulation / Q000706:statistics & numerical data*; D008297:Male; D016345:Medicare Part B / Q000706:statistics & numerical data*; D010778:Photochemotherapy / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D014481:United States; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D057135:Wet Macular Degeneration / Q000628:therapy*
D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A