Personalized Anti-VEGF Regimens Improve Adherence Among Patients With Macular Degeneration

Managed care professionals can assist ophthalmologists and retina specialists in personalizing anti-vascular endothelial growth factor (anti-VEGF) treatment to encourage patient adherence, according to a recent review of literature published in the Journal of Managed Care & Specialty Pharmacy.

Neovascular age-related macular degeneration (nAMD) remains a leading cause of blindness in the United States despite the introduction of 3 FDA-approved anti-VEGF drugs. Aflibercept and ranibizumab are 2 therapies that treat nAMD, while bevacizumab, a therapy for oncology indications, is increasingly used off-label in treating nAMD.

Despite the proven efficacy in clinical trials of all 3 treatments, there are significant challenges in administering the therapies in a real-world setting that many studies fail to note: these include delays in diagnosis and treatment approval, patient response to different anti-VEGF therapies, lapses in physician regimentation of anti-VEGF injection and monitoring, and inadequate patient adherence to treatment and monitoring.

In 1 study, over the period of 1 year, visual acuity (VA) scores, which measure the ability of the eye to distinguish details and shapes at a distance, on specialized charts, and the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, increased significantly among patients who were administered ranibizumab.

The CATT trial compared outcomes of ranibizumab and bevacizumab when administered monthly or as needed. In a year, mean VA scores increased by a range of 5.9 letters in the bevacizumab cohort and 8.5 letters in the ranibizumab cohort.

The VIEW 1 and VIEW 2 trials were designed to compare ranibizumab to aflibercept. Patients with nAMD were randomly assigned doses of ranibizumab or aflibercept every 4 weeks or every 8 weeks. The results showed that there were no significant differences in outcomes between the 2 different dosing intervals of the drug.

The cost of managing nAMD can range from $65,000 to over $250,000 over 20 years. Previous studies have found bevacizumab to be more cost-effective than the other therapies. However, age, general health, and anatomic characteristics (including presence of retinal fluid leakage, hemorrhage, and fibrotic scarring) are all factors that underscore the importance of managing nAMD treatment on an individual level.

Patients are not likely to adhere to nAMD treatment due to fears of having injections in the eye, anticipating pain, or discomfort. Other determinants of health may be age-related (for example, difficulty arranging and traveling to appointments for treatment).

Retina specialists have responded to the burdens and high costs of anti-VEGF treatment by developing alternative regimens based on extended fixed intervals, as needed based on disease activity, and/or by a treat-and-extend strategy.

Managed care organizations can increase public awareness surrounding the condition through educational programs and resources. This can incentivize patients to modify lifestyle behaviors and reduce risks.

“The efficacy of anti-VEGF therapy for nAMD has been consistently demonstrated in clinical trials; however, real-world gaps and challenges can pose significant barriers to achieving treatment goals,” the authors concluded. “In collaboration with ophthalmologists and retina specialists, managed care professionals can play key roles in overcoming barriers associated with underdiagnosis of nAMD, delays between [choroidal neovascularization, CNV] growth and anti-VEGF treatment initiation, lack of awareness about AMD among the public, and the logistic, emotional, and financial burdens of frequent intravitreal injections.”