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The following is a summary of “How intravitreal anti-vascular endothelial growth factor initial dosing impacts patient outcomes in diabetic macular oedema,” published in the December 2024 issue of Ophthalmology by Singh et al. 

Researchers conducted a retrospective study to compare the characteristics, treatment patterns, and outcomes of eyes with diabetic macular oedema (DME) that received and did not receive initial intravitreal anti-vascular endothelial growth factor (VEGF) doses.  

They used data from the American Academy of Ophthalmology Intelligent Research in Sight® Registry (01/01/15–31/12/20; index period). Eligible adults had documented DME within 2 months of the first anti-VEGF treatment (index date), with data available for 12 months prior and ≥ 1 visual acuity (VA) recording ≤ 60 days before the index date. Eyes had received intravitreal anti-VEGF injections during the index period but not in the previous 12 months. Characteristics and outcomes for eyes receiving initial doses (3 injections within 100 days of index date) were compared with those that did not. Multivariate Cox Proportional Hazards modeling identified predictors for treatment discontinuation, re-initiation, or switch, while Generalized Estimating Equations-adjusted modeling identified factors associated with initial doses. Demographics and characteristics were summarized, and injection frequency, number, and VA were assessed annually for up to 6 years. Discontinuations, reinitiations, and switches were compared.  

The results showed that 2,17,696 eyes (77,769 initial; 139,927 non-initial) were included from 166,868 patients. Baseline VA was slightly higher for eyes with initial doses (63.0 [18.1] vs 62.5 [19.8] letters), and this difference persisted throughout follow-up. Eyes with initial doses received more injections (11.6 [8.9] vs 6.1 [6.8]) at shorter intervals (7.6 [2.8] vs 12.6 [7.7] weeks). These differences were consistent across follow-up years. Discontinuation (45.7% vs 63.8%), re-initiation (17.2% vs. 25.0%), and switch (24.5% vs. 31.5%) rates were lower for eyes with initial doses. Asian, Black, and other/unknown race patients were less likely (P < 0.01) to receive initial doses compared to White patients, as were those with Medicare/Medicaid insurance compared to commercially insured patients (P < 0.01).  

Investigators concluded that various sociodemographic factors, including race, ethnicity, and insurance, were associated with initial anti-VEGF doses, and while eyes with frequent initial doses maintained higher VA, also required more injections, warranting further research on the impact of dose frequency vs total injections on DME outcomes. 

Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-024-03797-9