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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
  1. Richard Gale1,2,
  2. Maria Pikoula3,
  3. Aaron Y Lee4,
  4. Spiros Denaxas3,
  5. Catherine Egan5,
  6. Adnan Tufail5,
  7. Paul Taylor3
  8. on behalf of UK EMR Users Group
    1. 1Ophthalmology, Hightown Surgery, York, UK
    2. 2York Teaching Hospital NHS Foundation Trust, York, North Yorkshire, UK
    3. 3Institute of Health Informatics, University College London, London, London, UK
    4. 4Department of Ophthalmology, University of Washington, Seattle, Washington, USA
    5. 5Moorfields Eye Hospital NHS Foundation Trust, London, UK
    1. Correspondence to Dr Paul Taylor, Institute of Health Informatics, University College London, London WC1E 6BT, UK; p.taylor{at}ucl.ac.uk

    Abstract

    Background/aims Clinical 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.

    Methods Data 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.

    Results Mean 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.

    Conclusions Visual 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.

    • Epidemiology
    • retina
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    Footnotes

    • Twitter @paul3548

    • Collaborators UK EMR Users Group: Ms T Akerele, Hinchingbrooke Health Care NHS Trust; Mr R Antcliff, Royal United Hospital Bath NHS Trust; Miss C Bailey, University Hospitals Bristol NHS Foundation Trust; Mr C Brand, Sheffield Teaching Hospitals NHS Foundation Trust; Professor U Chakravarthy, Belfast Health and Social Care Trust; Miss A Davis, Moorfields Eye Centre at Croydon University Hospital; Mr N Dhingra, Mid Yorkshire Hospitals NHS Trust; Miss L Downey, Hull and East Yorkshire Hospitals NHS Foundation Trust; Mr H Eleftheriadis, King's College Hospital NHS Foundation Trust; Miss S George, The Hillingdon Hospital NHS Foundation Trust; Mr F Ghanchi, Bradford Teaching Hospitals NHS Foundation Trust; Mr C Jones, Norfolk and Norwich University Hospitals NHS Foundation Trust; Mrs R Khan, Calderdale and Huddersfield NHS Foundation Trust; Mr V Kumar, Wirral University Teaching Hospital NHS Foundation Trust; Mrs P Lip, Sandwell and West Birmingham Hospitals NHS Trust; Mr A Lobo, Moorfields Eye Centre at Bedford Hospital; Professor A Lotery, University Hospital Southampton NHS Foundation Trust; Mr S Mahmood, Central Manchester University Hospitals NHS Foundation Trust; Professor G Menon, Frimley Park Hospital NHS Foundation Trust; Mr R Mukherjee, Leeds Teaching Hospitals NHS Trust; Mr S Natha, Wrightington, Wigan and Leigh NHS Foundation Trust; Miss H Palmer, University Hospitals Birmingham NHS Foundation Trust; Miss S Patra, Bart's Health NHS Trust; Mr A Patwardhan, Royal Cornwall Hospitals NHS Trust; Mr B Paul, Barking, Havering and Redbridge University Hospitals NHS Trust; Mr J Talks, The Newcastle Upon Tyne Hospitals NHS Foundation Trust; Dr E Wilkinson, Northern Devon Healthcare NHS Trust.

    • Contributors CE, RG, AL and AT designed the study. CE, PT and AT organised the collection of the data. The EMR Users Group provided the data. SD, AL and MP performed the analyses.

    • Funding This work was supported by a grant from Novartis Pharmaceuticals and received a proportion of its funding from the Department of Health’s NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. Aaron Lee is supported by NIH/NEI K23EY029246 and an unrestricted grant from Research to Prevent Blindness.

    • Competing interests Paul Taylor received a grant from Novartis Pharmaceuticals. Adnan Tufail is a Consultant to Allergan, Bayer, Heidelberg Engineering, Kanghong Pharmaceuticals, Novartis and Oxurion. Catherine Egan is a Consultant to Heidelberg Engineering. Aaron Lee reports being an employee of the US Food and Drug Administration, grants from Santen, personal fees from Genentech, grants from Carl Zeiss Meditec, grants from Novartis, personal fees from Topcon, personal fees from Verana Health, outside the submitted work. This article does not reflect the opinions of the US Government or of the US FDA

    • Patient consent for publication Not required.

    • Ethics approval Appropriate institutional review board approval was obtained at the last named author’s institution.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. De-identified data was obtained from 27 participating trusts (names and contact details available on request) via Medisoft Limited.

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