Title: Treatment Patterns of Ranibizumab and Aflibercept for the Management of Wet Age-Related Macular Degeneration in Routine Clinical Practice in the United States
Abstract: To compare the frequency of injections for ranibizumab and aflibercept for the treatment of wet age-related macular degeneration (wAMD) in a real-world setting. Claims from the IMS Integrated Data Warehouse were used to identify treatment-naïve patients with wAMD receiving ≥1 prescription for ranibizumab or aflibercept between 1 November 2011 and 31 March 2012 and with a follow-up of 365 days. Patients were considered to be treatment-naïve if they had received no anti-VEGF treatment for >180 days prior to the index date. Mean number of injections received within 365 days of treatment initiation and the proportion of patients receiving 3 loading doses within 3 months were calculated and compared for patients starting therapy with ranibizumab or aflibercept. No adjustments for bilateral treatment were performed. Patient characteristics were similar for patients receiving ranibizumab (N=2,799) or aflibercept (N=117) at the index date (median age: 82 years; % male, 36%). The mean (±SD) number of anti-VEGF injections received by patients starting on ranibizumab or starting on aflibercept was similar: 5.6±3.5 and 5.4±2.8, respectively (p=0.6593). In patients continuously treated with the same agent for 12 months, the mean number of injections was also similar across ranibizumab and aflibercept: 4.9±3.4 (n=1,898) vs 5.2±2.6 (n=87), respectively (p=0.2705). Approximately two-thirds of patients with more than 3 injections received 3 loading doses within the first 3 months (ranibizumab, 65.6%; aflibercept, 64.3%). Results for patients who were treatment-naïve for 365 days were consistent with the above results. There are limited data regarding real-world treatment patterns with aflibercept for the management of wAMD. Our results suggest that in routine clinical practice patients receive a comparable number of injections in the first year of treatment with both ranibizumab and aflibercept. Analysis of data from larger patient populations and for longer follow-up is warranted when these data become available.