Abstract
OBJECTIVES: Anti-VEGF and corticosteroids have revolutionized the care of neovascular age-related macular degeneration (wAMD), retinal vein occlusions (RVO), and diabetic macular edema (DME). The study aimed at investigating drug-utilization of the licensed treatments, in the Italian clinical practice. METHODS: An observational study, based on data from pharmacy databases, was conducted in 6 hospitals in the Lombardy and Veneto Regions (Italy). Data referring to patients affected by wAMD, RVO or DME receiving intravitreal injections between 01/01/ 2015 and 12/31/2017 were collected, including number of injections received, administered drugs, and treated eye. A 24-month time frame after diagnosis was considered. RESULTS: 3,314 patients (3,689eyes) were diagnosed for a maculopathy requiring intravitreal therapy. Most patients (61.32%) were diagnosed with AMD, followed by DME (23.84%) and RVO (14.85%). Out of 3,314 patients, 811 (24.47%) received treatment up to 24 months. Among them, out of 578 AMD patients, 500(required a single-eye treatment, and received 7.01 and 7.51 injections with ranibizumab and aflibercept respectively. Patients treated bilaterally (13.49%) received 12.03 and 11,5 ranibizumab and aflibercept injections respectively. Out of 165 DME patients, 119 were administered 6.55, 7.63 and 3.59 injections of ranibizumab, aflibercept and dexamethasone respectively, in a single eye. 27.87% DME patients treated bilaterally, received an overall number of 11.69, 14.5 and 5.77 respectively for each drug. 68 patients were treated for RVO: 63 patients were treated in one eye, receiving 7.26, 7.67 and 3.90 ranibizumab, aflibercept and dexamethasone injections. Only 5 patients were treated bilaterally, receiving 15.33 ranibizumab or 6 aflibercept injections). CONCLUSIONS: The study highlights differences between clinical practice and prescribing information. This might depend on the organizational constraints at hospital level. Hence, hospital organizational capacity need to be improved, being able to reach the unmet need required by population ageing.