J Korean Med Sci.  2023 Jun;38(23):e174. 10.3346/jkms.2023.38.e174.

Real-World Treatment Intensity and Patterns in Patients With Myopic Choroidal Neovascularization: Common Data Model in Ophthalmology

• Bui MH
• Lee DY
• Park SJ
• Park KH

• KMID: 2543845
• DOI: http://doi.org/10.3346/jkms.2023.38.e174

Abstract

Background
A paucity of data addressing real-world treatment of myopic choroidal neovascularization (mCNV) in the era of anti-vascular endothelial growth factor (VEGF) drugs led us to investigate real-world treatment intensity and treatment patterns in patients with mCNV.
Methods
This is a retrospective, observational study using the Observational Medical Outcomes Partnership-Common Data Model database of treatment-naïve patients with mCNV over the 18-year study period (2003–2020). Outcomes were treatment intensity (time trends of total/average number of prescriptions, mean number of prescriptions in the first year and the second year after initiating treatment, proportion of patients with no treatment in the second year) and treatment patterns (subsequent patterns of treatment according to the initial treatment).
Results
Our final cohort included 94 patients with at-least 1-year observation period. Overall, 96.8% of patients received anti-VEGF drugs as first-line treatment, with most of injections from bevacizumab. The number of anti-VEGF injections in each calendar year showed an increasing trend over time; however, there was a drop in the mean number of injections in the second year compared to the first year from 2.09 to 0.47. About 77% of patients did not receive any treatment in their second year of treatment regardless of drugs. Most of patients (86.2%) followed non-switching monotherapy only and bevacizumab was the most popular choice either in the first-line (68.1%) or in the second-line (53.8%) of treatment. Aflibercept was increasingly used as the first-line treatment for patients with mCNV.
Conclusion
Anti-VEGF drugs have become the treatment of choice and second-line treatment for mCNV over the past decade. Anti-VEGF drugs are effective for the treatment of mCNV as the non-switching monotherapy is the main treatment regimen in most cases and the number of treatments decreases significantly in the second year of treatment.

Keyword

Myopic Choroidal Neovascularization; Anti-vascular Endothelial Growth Factor Drug; Treatment Pathways; Treatment Intensity; Common Data Model

Figure

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  Fig. 1 Diagram regarding the definition of mCNV patients and observation periods. Down arrows represent the exposures, filled/empty stars illustrate the presence/absence of diagnoses.VEGF = vascular endothelial growth factor, mCNV = myopic choroidal neovascularization, SE = spherical equivalent.

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  Fig. 2 The flow chart for eligible criteria.CDM = Common Data Model, mCNV = myopic choroidal neovascularization, VEGF = vascular endothelial growth factor.

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  Fig. 3 Sunburst plots presenting the Treatment Pathways in patients with myopic choroidal neovascularization. First ring indicated the first-line treatment. The second ring described the subsequent treatments among those following the certain first line ones. Each period was plotted according to index date of each patient, subsequent treatment episodes were counted until the end of observation period (cohort exit date).

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