A Retrospective Study of Ranibizumab Treatment Regimens for Neovascular Age-Related Macular Degeneration (nAMD) in Australia and the United Kingdom

• Published in: Advances in therapy 2017-03, Vol.34 (3), p.703-712
• Main Authors: Johnston, Robert L., Carius, Hans-Joachim, Skelly, Adrian, Ferreira, Alberto, Milnes, Fran, Mitchell, Paul
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiogenesis Inhibitors - administration & dosage; Angiogenesis Inhibitors - adverse effects; Australia - epidemiology; Cardiology; Choroidal Neovascularization - diagnosis; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - physiopathology; Databases, Factual; Drug Administration Schedule; Drug Monitoring - methods; Electronic Health Records - statistics & numerical data; Endocrinology; Female; Health technology assessment; Humans; Internal Medicine; Intravitreal Injections; Male; Medicine; Medicine & Public Health; Oncology; Original Research; Pharmacology/Toxicology; Ranibizumab - administration & dosage; Ranibizumab - adverse effects; Rheumatology; Treatment Outcome; United Kingdom - epidemiology; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - drug effects; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - epidemiology; Wet Macular Degeneration - metabolism; Wet Macular Degeneration - physiopathology
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-017-0483-1

Introduction Neovascular age-related macular degeneration (nAMD) is the leading cause of vision loss among persons aged 65 years and older. Anti-vascular endothelial growth factor (anti-VEGF) treatment is the recommended standard of care. The current study compares the effectiveness of ranibizumab in routine clinical practice in two countries that generally apply two different treatment regimens, treat-and-extend (T&E) in Australia or pro re nata (PRN) in the UK. Methods This retrospective, comparative, non-randomised cohort study is based on patients’ data from electronic medical record (EMR) databases in Australia and the UK. Treatment regimens were defined based on location, with Australia as a proxy for analysing T&E and UK as a proxy for analysing PRN. The study included patients with a diagnosis of nAMD who started treatment with ranibizumab between January 2009 and July 2014. A total of 647 eyes of 570 patients in Australia and 3187 eyes of 2755 patients in the UK with complete 12-months follow-up were analysed. Results Baseline patient characteristics were comparable between the two cohorts. After 1 year of treatment, T&E-treated eyes achieved higher mean (±SE) visual acuity (VA) gains (5.00 ± 0.54 letters [95% confidence interval (CI) 3.93–6.06]) than PRN-treated eyes [3.04 ± 0.24 letters (95% CI 2.57–3.51); difference in means 2.07 ± 0.69 (95% CI 0.73–3.41), p