To identify differences between Ranibizumab and Aflibercept in treatment-naïve patients with neovascular age-related macular degeneration (nvAMD) in a real-life clinical setting. We compared two groups of patients with a fairly similar prognosis either receiving Aflibercept or Ranibizumab within a pro re nata regimen for 1 year. Changes in visual acuity (letters) and central foveal thickness (CFT) and frequency of injections after completing the loading phase were evaluated using two separate multivariate mixed linear models. When correcting for baseline differences between the Aflibercept (11 eyes) and Ranibizumab (16 eyes) group, there was neither divergence in visual acuity (−0.97 letters (95 % CI. −6.06-4.12); p = 0.709), nor a significant difference in the reduction of CFT (−25.16 μm, 95 % CI; (−78.01-27.68); p = 0.351) between the two groups 1 year after treatment initiation. Also, the number of injection did not differ (0.04 (95 % CI; −0.16-0.09); p = 0.565). In contrast to health claims, treatment-naïve nvAMD, Ranibizumab and Aflibercept were equivalent in terms of functional and morphologic outcomes and number of injections when studied in real-life clinical practice.
Since the introduction of anti-VEGF therapy for the treatment of choroidal neovascularisation, the intravitreal injection via pars plana has become an established way of accessing the eye for therapeutic reasons. When performed under operating room conditions, the incidence of post injection complications is very low [1]. However, in some cases, endophthalmitis, lens injury, toxic reactions (depending on medication), vitreous haemorrhage or retinal and choroidal detachment have been described [1], [2], [3]. In our report, we describe a case of cyclodialysis cleft and hypotony caused by an intravitreal injection with focus on the diagnostic and therapeutic challenges that were encountered.
Background: Little is known about the patterns of actual health care delivery of anti-vascular endothelial growth factor (VEGF) treatment in patients with age-related macular degeneration, diabetic retinopathy, and retinal vein occlusion in Switzerland. The purpose of this study was to describe these treatment patterns, specifically comparing the numbers of anti-VEGF injections and associated expenditures between patients treated with ranibizumab and those treated with aflibercept in Switzerland using claims data. Methods: We identified our study patients retrospectively using the Helsana claims database, which includes data on approximately 1.2 million subjects with basic health insurance. Patients qualified for inclusion if ranibizumab or aflibercept had been initiated between December 1, 2012 (when aflibercept was approved by the Federal Office of Public Health) and November 30, 2013. Within this set, patients with at least 12 months of continuous insurance enrolment in the previous year were considered. In univariate analyses, we examined the distribution of demographic data and patient characteristics between those receiving ranibizumab and those receiving aflibercept. Numbers of injections and associated health care expenditures observed during the 6-month follow-up period after incident treatment were the two outcomes considered. In multivariate regression analyses, controlling for possible confounding factors, we compared differences in these two outcomes between patients treated with ranibizumab and those treated with aflibercept. Results: Of 3,260 patients who were on anti-VEGF treatment for an ophthalmological indication between December 1, 2012 and November 30, 2013, 1,150 qualified for inclusion. Age, geographic region, and number of physician visits in the previous year were significant factors in the number of injections given during the 6-month follow-up period. Frequency of injections and associated health care expenditures were similar between the groups when correcting for differences in patient characteristics. Conclusion: Contrary to the recommendations regarding frequency of injections and the results of clinical studies, aflibercept and ranibizumab are used in a similar fashion in Switzerland, resulting in similar total health care expenditures for both these anti-VEGF agents. Keywords: ranibizumab, aflibercept, health care costs, Switzerland
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