scholarly journals Non-compliance among diabetic macular oedema patients on antivascular endothelial growth factor therapy in Malaysia

2021 ◽  
Vol 3 (2) ◽  
pp. 91-100
Author(s):  
Yew Meng Wong ◽  
Eve Lyn Chong ◽  
Vanessa Yung Ling Yeo
Keyword(s):  
Growth Factor ◽  
Macular Oedema ◽  
Treatment Options ◽  
Diabetic Macular Oedema ◽  
Standard Of Care ◽  
Dropout Rate ◽  
Common Reason ◽  
Poor General Health ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Introduction: Diabetic macular oedema (DMO) is a major cause of visual loss in the diabetic population. There are several treatment options for DMO, including intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, which have been shown to improve visual outcomes. Good compliance to treatment regimens is associated with greater visual benefit. Purpose: To estimate dropout rates and the associated reasons among DMO patients on three different anti-VEGF treatments. Study design: A retrospective review of patients with DMO who were on bevacizumab, ranibizumab and aflibercept therapy from January 2014 to December 2016. Materials and methods: Patients with DMO on anti-VEGF treatment in a private ophthalmology center were identified via an electronic database. Data on Malaysian residents aged 18 years or older were included. Foreign residents, the deceased, and those whose care had been transferred to another center were excluded from further analysis. Telephone interviews were then conducted with these patients based on a standard questionnaire to identify reasons for non-compliance. Results: This study included 134 patients. The overall lost to follow-up rate was 56.0% (75/134). After excluding the deceased, those who opted for treatment at an alternative center, and uncontactable patients, 47 (35.1%) were then identified as drop-outs. Financial constraint was the most common reason cited by 38.3% patients (18/47) and was highest in the bevacizumab group (88.9%, 16/18). The second most common reason was lack of perceivable change in vision (25.5%). In addition, 19.1% opted to stop treatment due to logistical difficulties and 12.8% of patients were satisfied with their stable visual acuity. Lastly, 4.3% were unable to continue with treatment due to poor general health. Conclusion: The dropout rate of 35.1% is higher than in previous publications from other countries. This study clarifies the challenges face by some Malaysian patients in seeking treatment for what is often a chronic disease. These results have implications on designing ways to assist patients’ cooperation with the standard of care.

scholarly journals Burden of diabetic macular oedema in patients receiving antivascular endothelial growth factor therapy in South Korea: a healthcare resource use and cost analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042484
Author(s):  
Ha-Lim Jeon ◽  
Hyesung Lee ◽  
Dongwon Yoon ◽  
Yeonkyung Lee ◽  
Jae Hui Kim ◽  
...  
Keyword(s):  
Growth Factor ◽  
Resource Use ◽  
Macular Oedema ◽  
Healthcare Resource ◽  
Diabetic Macular Oedema ◽  
Medical Costs ◽  
Healthcare Resource Use ◽  
Anti Vegf ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

ObjectiveTo examine healthcare resource utilisation (HRU) and direct medical costs for patients with diabetic macular oedema (DME) treated with antivascular endothelial growth factor (anti-VEGF) in Korea by comparing with those for (1) patients with diabetes mellitus (DM) without retinopathy and (2) patients with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF.DesignRetrospective cohort study.SettingThe Korean National Health Insurance (NHI) database from 1 January 2014 to 31 December 2016.ParticipantsWe identified 1398 patients older than 30 years of age who received anti-VEGF treatment for DME in 2015 after excluding patients who had a diagnosis of nAMD in 2015 and any cancer in the preceding year.Main outcome measuresOne-year healthcare resource use and direct medical costs of patients with DME treated with anti-VEGF.ResultsIn total, 1398 patients with DME receiving anti-VEGF, 12 813 patients with DM without retinopathy and 12 222 patients with nAMD receiving anti-VEGF were identified. Hospital admissions and outpatient visits were highest in patients with DME, while the number of licensed anti-VEGF injections in those with DME was about half that of those with nAMD (2.1 vs 3.9 per patient per year). Mean 1-year medical costs were also higher in patients with DME (US$6723) than in those with DM without retinopathy (US$2687) and nAMD (US$4980). In a multivariable analysis with matched cohorts, DME was associated with 66% higher medical costs for comorbid diseases (adjusted OR (aOR), 1.66; 95% CI 1.45 to 1.90) and 50% lower anti-VEGF injections (aOR, 0.50; 95% CI 0.46 to 0.54) compared with nAMD.ConclusionsThe overall HRU and economic burden for DME treated with anti-VEGF were higher than for DM without retinopathy or for nAMD treated with anti-VEGF. Meanwhile, the lower number of licensed anti-VEGF injections compared with nAMD may reflect a potential lack of ophthalmological treatment for DME supported by the NHI in Korea.

scholarly journals Evidence for Anti-vascular Endothelial Growth Factor Treatment of Diabetic Macular Oedema

2010 ◽  
Vol 8 (1) ◽  
pp. 36 ◽  
Author(s):  
Francesco Bandello ◽  
Umberto De Benedetto ◽  
Karl Anders Knutsson ◽  
Maurizio Battaglia Parodi ◽  
Maria Lucia Cascavilla ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Oedema ◽  
Vision Loss ◽  
Diabetic Macular Oedema ◽  
Standard Of Care ◽  
Vascular Endothelial ◽  
Cell Mitogen ◽  
Endothelial Growth Factor

Diabetic macular oedema (DME) represents the most common cause of vision loss in patients affected by diabetes mellitus. Diabetic retinopathy has a significant impact on public health and the quality of life of many patients and thus requires serious consideration. The first line of treatment remains the management of systemic risk factors but this is often insufficient in controlling DME and currently, laser retinal photocoagulation is considered the standard of care. However, laser treatment reduces the risk of moderate visual loss by approximately 50 % without guaranteeing remarkable effects on visual improvement. For these reasons, new approaches in the treatment of DME have been considered, in particular the employment of anti-vascular endothelial growth factor (VEGF) drugs. VEGF is a pluripotent growth factor that functions as a vasopermeability factor and an endothelial cell mitogen and thereby represents an appealing candidate as a therapeutic target for the treatment of DME. The goal of this article is to present the evidence behind the use of anti-VEGF drugs in the treatment of DME.

scholarly journals Hyperreflective foci in predicting the treatment outcomes of diabetic macular oedema after anti-vascular endothelial growth factor therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chu-Hsuan Huang ◽  
Chang-Hao Yang ◽  
Yi-Ting Hsieh ◽  
Chung-May Yang ◽  
Tzyy-Chang Ho ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Treatment Response ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Vascular Endothelial ◽  
Outer Retina ◽  
Hyperreflective Foci ◽  
Endothelial Growth Factor

AbstractThis retrospective study evaluated the association of hyperreflective foci (HRF) with treatment response in diabetic macular oedema (DME) after anti-vascular endothelial growth factor (VEGF) therapy. The medical records, including of ophthalmologic examinations and optical coherence tomography (OCT) images, of 106 patients with DME treated with either intravitreal ranibizumab or aflibercept were reviewed. The correlations between best-corrected visual acuity (BCVA) changes and HRF along with other OCT biomarkers were analysed. The mean logMAR BCVA improved from 0.696 to 0.461 after an average of 6.2 injections in 1 year under real-world conditions. Greater visual-acuity gain was noted in patients with a greater number of HRF in the outer retina at baseline (p = 0.037), along with other factors such as poor baseline vision (p < 0.001), absence of epiretinal membrane (p = 0.048), and presence of subretinal fluid at baseline (p = 0.001). The number of HRF after treatment was correlated with the presence of hard exudate (p < 0.001) and baseline haemoglobin A1C (p = 0.001). Patients with proliferative diabetic retinopathy had greater HRF reduction after treatment (p = 0.018). The number of HRF in the outer retina, in addition to other baseline OCT biomarkers, could be used to predict the treatment response in DME after anti-VEGF treatment.

scholarly journals Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser

2020 ◽  
pp. bjophthalmol-2020-315836 ◽  
Author(s):  
Richard Gale ◽  
Maria Pikoula ◽  
Aaron Y Lee ◽  
Spiros Denaxas ◽  
Catherine Egan ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Macular Oedema ◽  
Branch Retinal Vein Occlusion ◽  
Vascular Endothelial ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Intravitreal Dexamethasone ◽  
Endothelial Growth Factor

Background/aimsClinical trials suggest anti-vascular endothelial growth factor is more effective than intravitreal dexamethasone as treatment for macular oedema secondary to branch retinal vein occlusion. This study asks if ‘real world’ data from a larger and more diverse population, followed for a longer period, also support this conclusion.MethodsData collected to support routine care at 27 NHS (National Health Service) Trusts between February 2002 and September 2017 contained 5661 treatment-naive patients with a single mode of treatment for macular oedema secondary to branch retinal vein occlusion and no history of cataract surgery either during or recently preceding the treatment. Number of treatment visits and change in visual acuity from baseline was plotted for three treatment groups (anti-vascular endothelial growth factor (anti-VEGF), intravitreal dexamethasone, macular laser) for up to 3 years.ResultsMean baseline visual acuity was 57.1/53.1/62.3 letters in the anti-VEGF/dexamethasone/macular laser groups, respectively. This changed to 66.72 (+9.6)/57.6 (+4.5)/63.2 (+0.9) at 12 months. Adequate numbers allowed analysis at 18 months for all groups (66.6 (+9.5)/56.1 (+3.0)/60.8 (-1.5)) and for anti-VEGF at 36 months (68.0, +10.9) Mean number of treatments were 5.1/1.5/1.2 at 12 months, 5.9/1.7/1.2 at 18 months for all three groups and 10.3 at 36 months for anti-VEGF.ConclusionsVisual acuity improvements were higher and more sustained with anti-VEGF. Higher treatment burden occurred with anti-VEGF but this reduced over 36 months. Patients with better vision at baseline than those in the clinical trials maintained high levels of vision with both anti-VEGF and dexamethasone.

scholarly journals Anti-VEGF Therapy and the Retina: An Update

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Vikas Tah ◽  
Harry O. Orlans ◽  
Jonathan Hyer ◽  
Edward Casswell ◽  
Nizar Din ◽  
...  
Keyword(s):  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Visual Outcome ◽  
Retinal Diseases ◽  
Ocular Angiogenesis ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Sight Loss ◽  
Endothelial Growth Factor ◽  
The Impact

Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients.

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