Eyeworld

EW SECONDARY FEATURE 86 patients with retinal disease receive injections (U.S. ophthalmologists said 52%, while non-U.S. ophthal- mologists said 48%). Twenty-four percent personally perform injec- tions in all of their patients with retinal disease. According to Steve Charles, MD, Memphis, Tenn., the use of intravitreal injections among ASCRS members is so high because "com- prehensive ophthalmologists see the patients first and possibly more of- ten and wish to offer more services. Additionally, the monthly long drives to urban retinal specialists may be a problem for rural patients, and offering intravitreal injections provides one-stop care for patients and revenue for ophthalmologists." He said that usage is higher outside of the U.S. because other countries have fewer medical retina experts and because they have national health systems. ASCRS members were also asked the following question: Which agent do you use for the treatment of AMD (select all that apply)? Overall, more ophthalmologists use Avastin (bevacizumab, Genen- tech, South San Francisco), followed by Lucentis (ranibizumab, Genen- tech) and then Eylea (aflibercept, Regeneron, Tarrytown, N.Y.). U.S. physicians use Avastin most often, followed by Eylea and then Lucentis (Figure 1). Physicians were asked which agent they use to treat diabetic reti- nopathy (select all that apply). Again, overall, most respon- dents use Avastin, followed by Lu- centis and then Eylea. U.S. ophthal- mologists use Avastin, followed by Eylea and then Lucentis (Figure 2). The same trend was seen for the treatment of retinal vein occlusion (Figure 3). The anti-VEGF of choice may vary depending on the specific dis- ease state. "Avastin is nearly as good as Lucentis and Eylea for AMD, and Eylea is better than Lucentis, which is in turn better than Avastin for di- abetic macular edema as was shown in Protocol T," Dr. Charles said. The Comparison of AMD Treatment Trials (CATT) study was conducted to describe the effects of Lucentis and Avastin when admin- istered monthly or as needed for 2 years and to describe the impact of switching to as-needed treatment after 1 year of monthly study. 1 At enrollment, patients were as- signed to 1 of 4 treatment groups: October 2015 Figure 2 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Bevacizumab (Avastin) Ranibizumab (Lucentis) Aflibercept (Eylea) Other % All % U.S. % Non U.S. Figure 1 Bevacizumab (Avastin) Ranibizumab (Lucentis) Aflibercept (Eylea) Other % All % U.S. % Non U.S. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Figure 3 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Bevacizumab (Avastin) Ranibizumab (Lucentis) Aflibercept (Eylea) Other % All % U.S. % Non U.S. Global Trends in Ophthalmology ™ Copyright © 2015 Global Trends in Ophthalmology and the American Society of Cataract & Refractive Surgery. All rights reserved. Lucentis or Avastin either monthly or as needed. At 1 year, patients initially assigned to monthly treat- ment were reassigned randomly to monthly or as-needed treatment, but the drug assignment did not change. Among patients who were given the same treatment regimen for 2 years, the mean gain in visual acuity was similar for both drugs. The mean gain was greater for monthly than for as-needed treatment. The pro- portion of eyes without fluid ranged from 13.9% in the Avastin as-need- ed group to 45.5% in the Lucentis monthly group. Eyes that switched from monthly to as-needed treat- ment experienced a greater mean decrease in vision during year 2, and there was a lower proportion of eyes without fluid. Both drugs had similar rates of death and arterio- thrombotic events. The proportion of patients with one or more system- ic serious adverse events was higher with Avastin than Lucentis (39.9% compared with 31.7%). For diabetic macular edema, Protocol T has found that intravitre- ous Eylea, Avastin, and Lucentis im- proved vision in eyes with center-in- volved DME, but the relative effect depended on baseline visual acuity. 2 When the initial visual acuity loss was mild, there were no apparent differences. However, at worse levels of visual acuity, Eylea was more effective at improving acuity. EW References 1. CATT Research Group, Martin DF, Maguire MG, Fine SL, et al. Ranibizumab and bevaci- zumab for treatment of neovascular age-re- lated macular degeneration: two-year results. Ophthalmology. 2012;119(7):1388–1398. 2. The Diabetic Retinopathy Clinical Research Network. Aflibercept, bevacizumab, or ranibi- zumab for diabetic macular edema. N Engl J Med. 2015;372:1193–1203. Editors' note: Dr. Charles has no finan- cial interests related to this article. Contact information Charles: scharles@att.net Intravitreal continued from page 85

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