(P-471) Intravitreal Anti-vascular Endothelial Growth Factors Use in France: Cross-sectional and Longitudinal Nationwide Observational Studies

Background: The real-world conditions of use of intravitreal anti-vascular endothelial growth factors are poorly described on a large scale. Such a description could contribute to better patient management.

Objectives: To describe the sociodemographic, medical and management characteristics of IVT anti-VEGF users in France.

Methods: Nationwide observational studies were conducted among IVT users of ranibizumab or aflibercept aged 18 years or older using the French National Health Insurance databases. Current users in 2018 were included in a cross-sectional study to describe treatment history. New users between 2014 and 2018 were included in a longitudinal study to describe treatment management for up to 6 years of follow-up. Sociodemographic characteristics and medical history were described for both populations. Each analysis was conducted at the patient’s level without considering each treated eye.

Results: A total of 224,775 current users of IVT anti-VEGF in 2018 (mean age 78.1 ±11.3 years, 60% female) and 330,969 new users between 2014 and 2018 (mean age 75.9 ±12.0 years, 59% female) were included. In both populations cardiovascular co-morbidities or risk factors were common and the main treatment indications were aged-related macular degeneration and diabetic macular edema.
Among current users of IVT anti-VEGF in 2018 the mean number of years since the first treatment dispensation was 2.9 ±2.0 years, with a mean of 13.7 ±11.8 dispensing dates.
In the longitudinal study, a 26% increase in IVT anti-VEGF initiations was observed between 2014 and 2018. For new users, the mean number of years receiving a treatment was 1.6 ±1.6 and 67% had at least three dispensing dates in the first three months. A treatment interruption was registered for 83% of new users and occurred on average 6.2 ±8.2 months after initiation. The mean number of dispensing dates were 4.8 ±2.8 in the first year and 2.2 ±2.9 in the second year. The mean number of eye monitoring examinations was 6.5 ±4.7 in the first year and 4.6 ±4.4 in the second year.

Conclusions: These studies described the real-world conditions of IVT anti-VEGF dispensing at the entire French population scale. Less frequent dispensations and surveillance examinations were observed than in monthly schemes applied in registration trials for IVT anti-VEGF. These results may indicate a lack of systematic monitoring associated with fewer injections and/or clinicians’ preference for more flexible and personalized injection schemes than those originally recommended.