Treatment discontinuation patterns of anti VEGF in retinal vein occlusion

Amy Basilious; Julie Duncan; Bobbi Smuck; Monali S Malvankar-Mehta; Verena R Juncal; Phil Hooper; Tom G Sheidow

doi:10.1016/j.jcjo.2023.08.005

Treatment discontinuation patterns of anti VEGF in retinal vein occlusion

Can J Ophthalmol. 2023 Sep 2:S0008-4182(23)00251-X. doi: 10.1016/j.jcjo.2023.08.005. Online ahead of print.

Authors

Amy Basilious¹, Julie Duncan², Bobbi Smuck², Monali S Malvankar-Mehta², Verena R Juncal², Phil Hooper², Tom G Sheidow²

Affiliations

¹ Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care, London, ON.. Electronic address: amybasilious@gmail.com.
² Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care, London, ON.

PMID: 37669742
DOI: 10.1016/j.jcjo.2023.08.005

Abstract

Objective: The purpose of this research is to report on real-world anti-vascular endothelial growth factor (anti-VEGF) treatment patterns in retinal vein occlusions (RVO).

Design: Retrospective cohort study.

Participants: Treatment-naive RVO patients initiating anti-VEGF injections between 2015 and 2021.

Methods: Medical records available until June 2022 were reviewed. Demographics, diagnosis, number of injections, treatment length, reason for discontinuation, and baseline and final data (e.g., date, age, best-corrected visual acuity [BCVA], and central subfield thickness) were recorded. Statistical analyses performed with STATA 17.0 assessed differences between baseline and final values, branch (BRVO) and central retinal vein occlusion (CRVO), and treatment-discontinuation subgroups.

Results: A total of 219 treatment-naive eyes were included (70.3 ± 13.2 years of age, 52.5% female), with 99 BRVOs and 120 CRVOs (2482 injections). The discontinuation rate was 76.7% (168 of 219), with 72.7% of patients (77 of 99) with BRVOs and 75.8% of patients (91 of 120) with CRVOs discontinuing injections. Reasons for discontinuation included stable off active therapy (98 eyes), severe comorbidity or death (17 eyes), switched to intraocular steroid (implant or injection) (12 eyes), lack of visual benefit (10 eyes), ocular comorbidity (5 eyes), patient decision (5 eyes), and patient transfer (5 eyes). Among the remaining 67 eyes, 16 (24%) were lost to follow-up. Reasons for discontinuation differed between BRVO and CRVO patients (p = 0.002). Eyes with CRVO presented with worse BCVA (p < 0.0001) and achieved worse final BCVA (p < 0.0001), but both groups experienced improvements (p < 0.0001). Younger age, better baseline BCVA, and a diagnosis of BRVO were independent predictors of better final visual acuity.

Conclusion: Over 7.5 years, treatment was discontinued for three-quarters of RVOs. Stable disease was the most common reason for discontinuation, with nearly half (45%) of all RVOs in the cohort stable off active therapy. Better visual outcomes were achieved in BRVO than in CRVO, although both groups benefited from treatment.