title: Clinical utilization of anti-vascular endothelial growth-factor agents and patient monitoring in retinal vein occlusion and diabetic macular edema.
abstract: OBJECTIVE
  To examine the utilization of bevacizumab and ranibizumab and disease monitoring in patients with branch or central retinal vein occlusion (BRVO/CRVO) or diabetic macular edema (DME) in clinical practice.
  
  
  METHODS
  This retrospective claims analysis included newly diagnosed patients with one or more bevacizumab or ranibizumab injections. Bevacizumab or ranibizumab utilization was assessed by year of first injection: 2008-2010 cohorts (12-month follow-up), January to June 2011 cohort (6-month follow-up). The main outcome measures were mean annual numbers of injections, ophthalmologist visits and optical coherence tomography examinations, and proportion of patients with additional laser or intravitreal triamcinolone (IVTA) use.
  
  
  RESULTS
  A total of 885 BRVO, 611 CRVO, and 2,733 DME patients treated with bevacizumab were included, with too few ranibizumab-treated patients for meaningful analysis. Across the 2008, 2009, and 2010 cohorts, mean annual numbers of bevacizumab injections increased, but remained low (BRVO 2.5, 3.1, 3.3; CRVO 3.1, 3.1, 3.5; and DME 2.2, 2.5, 3.6, respectively); mean ophthalmologist visits ranged between 4.4 and 6.5, and mean optical coherence tomography examinations ranged between 3.1 and 3.9 across all conditions. A total of 42.0% of BRVO, 16.5% of CRVO, and 57.7% of DME patients received additional laser or IVTA therapy. The number of bevacizumab injections was positively associated with laser use in BRVO (3.3 versus 2.9, P<0.03), and with laser or IVTA use in DME (laser, 3.3 versus 2.7, P<0.03; IVTA, 3.3 versus 3.0, P<0.05).
  
  
  CONCLUSIONS
  During the study period (2008-2011), bevacizumab was the main anti-VEGF therapy used in clinical practice for BRVO, CRVO, and DME. Patients treated with bevacizumab were monitored less frequently and received fewer injections than patients in major clinical trials of ranibizumab.
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Szilárd
authors.initials: S
authors.lastname: Kiss
authors.affiliation: Allergan, Inc., Irvine, CA, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: IMS Health, Woodland Hills, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Brown
authors.affiliation: Pepose Vision Institute, Chesterfield, MO, USA ; Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Holekamp
authors.affiliation: Carolina Eye Associates, Southern Pines, NC, USA.
authors.forename: Arghavan
authors.initials: A
authors.lastname: Almony
authors.affiliation: Allergan, Inc., Irvine, CA, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Campbell
authors.affiliation: Allergan, Inc., Irvine, CA, USA.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Kowalski
keywords: anti-vascular endothelial growth factor; bevacizumab; diabetic macular edema; intravitreal; ranibizumab; retinal vein occlusion