Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review

Shwu-Jiuan Sheu,1,2 Cheng-Kuo Cheng,3,4 Hsi-Kung Kuo,5 Ching-Yao Tsai,2,6 Tai-Chi Lin,2,7 Jonathan Tan,8 Hitesh Chandwani,8 Michael Adena,9 Shih-Jen Chen2,7 1Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2Department of Ophthalmology, School of Medicine, Nation...

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Autores principales:	Sheu SJ, Cheng CK, Kuo HK, Tsai CY, Lin TC, Tan J, Chandwani H, Adena M, Chen SJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Macular edema diabetes treatment patterns treatment outcome anti-vascular endothelial growth factor corticosteroid Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/93403d9fefa74cc0aab64b2143790535
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spelling	oai:doaj.org-article:93403d9fefa74cc0aab64b21437905352021-12-02T07:33:25ZTreatment patterns in diabetic macular edema in Taiwan: a retrospective chart review1177-5483https://doaj.org/article/93403d9fefa74cc0aab64b21437905352018-10-01T00:00:00Zhttps://www.dovepress.com/treatment-patterns-in-diabetic-macular-edema-in-taiwan-a-retrospective-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Shwu-Jiuan Sheu,1,2 Cheng-Kuo Cheng,3,4 Hsi-Kung Kuo,5 Ching-Yao Tsai,2,6 Tai-Chi Lin,2,7 Jonathan Tan,8 Hitesh Chandwani,8 Michael Adena,9 Shih-Jen Chen2,7 1Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 4Department of Medicine, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; 5Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 6Department of Ophthalmology, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan; 7Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; 8Global Health Economics and Outcomes Research, Allergan Singapore Pte. Ltd., Singapore, Singapore; 9Datalytics Pty Ltd, Kingston, ACT, Australia Objectives: To characterize diabetic macular edema (DME) treatment patterns in Taiwan and examine their impact on health care resource utilization and visual and anatomic outcomes. Methods: Retrospective, observational cohort study of longitudinal data from medical records of five hospital ophthalmology clinics. Patients with type 2 diabetes and DME who received ≥1 laser treatment or pharmacotherapy (intravitreal/subtenon corticosteroids and/or intravitreal anti-vascular endothelial growth factor [VEGF] agents) between January 2012 and December 2013 (index period) and attended ≥1 follow-up visit after the first treatment during that period were identified (prevalent population, N=431). In addition, a subset that received no anti-VEGFs before 2012 (anti-VEGF-naïve population, N=77) was analyzed. Outcome measures were change in DME treatment distribution between January 2009 and December 2014 and health care resource utilization over up to 3 years from the first DME treatment received in the index period (prevalent population), mean number of anti-VEGF injections and change from baseline in visual acuity and central macular thickness over 12 months (anti-VEGF-naïve population).Results: Between 2009 and 2014, laser treatment use declined, overall use of anti-VEGFs increased, and bevacizumab use decreased proportionately as ranibizumab use increased. Patients receiving corticosteroids and anti-VEGFs in the first 6 months post-index had greater health care resource utilization than those treated with laser, corticosteroids, or anti-VEGF alone (P<0.0001, cross-cohort comparison). Among anti-VEGF-naïve patients, 69% received one to four anti-VEGF injections in the first year post-index. Overall, visual acuity improvement from baseline was minimal at 1 year (0.4 letters, observed data; 0.1 letters, last observation carried forward), and modest central macular thickness reduction (28 µm [last observation carried forward]) was detected.Conclusion: In Taiwanese clinics, DME treatment patterns have shifted from use of laser to anti-VEGFs (with higher health care resource utilization); however, few patients receive anti-VEGF injections at the frequency reported in landmark trials, consistent with poorer visual outcomes. Effective alternative treatments with lower treatment burden should be considered. Keywords: macular edema, diabetes, treatment patterns, treatment outcome, anti-vascular endothelial growth factor, corticosteroidSheu SJCheng CKKuo HKTsai CYLin TCTan JChandwani HAdena MChen SJDove Medical PressarticleMacular edemadiabetestreatment patternstreatment outcomeanti-vascular endothelial growth factorcorticosteroidOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 12, Pp 2189-2198 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Macular edema diabetes treatment patterns treatment outcome anti-vascular endothelial growth factor corticosteroid Ophthalmology RE1-994
spellingShingle	Macular edema diabetes treatment patterns treatment outcome anti-vascular endothelial growth factor corticosteroid Ophthalmology RE1-994 Sheu SJ Cheng CK Kuo HK Tsai CY Lin TC Tan J Chandwani H Adena M Chen SJ Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review
description	Shwu-Jiuan Sheu,1,2 Cheng-Kuo Cheng,3,4 Hsi-Kung Kuo,5 Ching-Yao Tsai,2,6 Tai-Chi Lin,2,7 Jonathan Tan,8 Hitesh Chandwani,8 Michael Adena,9 Shih-Jen Chen2,7 1Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 4Department of Medicine, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; 5Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 6Department of Ophthalmology, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan; 7Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; 8Global Health Economics and Outcomes Research, Allergan Singapore Pte. Ltd., Singapore, Singapore; 9Datalytics Pty Ltd, Kingston, ACT, Australia Objectives: To characterize diabetic macular edema (DME) treatment patterns in Taiwan and examine their impact on health care resource utilization and visual and anatomic outcomes. Methods: Retrospective, observational cohort study of longitudinal data from medical records of five hospital ophthalmology clinics. Patients with type 2 diabetes and DME who received ≥1 laser treatment or pharmacotherapy (intravitreal/subtenon corticosteroids and/or intravitreal anti-vascular endothelial growth factor [VEGF] agents) between January 2012 and December 2013 (index period) and attended ≥1 follow-up visit after the first treatment during that period were identified (prevalent population, N=431). In addition, a subset that received no anti-VEGFs before 2012 (anti-VEGF-naïve population, N=77) was analyzed. Outcome measures were change in DME treatment distribution between January 2009 and December 2014 and health care resource utilization over up to 3 years from the first DME treatment received in the index period (prevalent population), mean number of anti-VEGF injections and change from baseline in visual acuity and central macular thickness over 12 months (anti-VEGF-naïve population).Results: Between 2009 and 2014, laser treatment use declined, overall use of anti-VEGFs increased, and bevacizumab use decreased proportionately as ranibizumab use increased. Patients receiving corticosteroids and anti-VEGFs in the first 6 months post-index had greater health care resource utilization than those treated with laser, corticosteroids, or anti-VEGF alone (P<0.0001, cross-cohort comparison). Among anti-VEGF-naïve patients, 69% received one to four anti-VEGF injections in the first year post-index. Overall, visual acuity improvement from baseline was minimal at 1 year (0.4 letters, observed data; 0.1 letters, last observation carried forward), and modest central macular thickness reduction (28 µm [last observation carried forward]) was detected.Conclusion: In Taiwanese clinics, DME treatment patterns have shifted from use of laser to anti-VEGFs (with higher health care resource utilization); however, few patients receive anti-VEGF injections at the frequency reported in landmark trials, consistent with poorer visual outcomes. Effective alternative treatments with lower treatment burden should be considered. Keywords: macular edema, diabetes, treatment patterns, treatment outcome, anti-vascular endothelial growth factor, corticosteroid
format	article
author	Sheu SJ Cheng CK Kuo HK Tsai CY Lin TC Tan J Chandwani H Adena M Chen SJ
author_facet	Sheu SJ Cheng CK Kuo HK Tsai CY Lin TC Tan J Chandwani H Adena M Chen SJ
author_sort	Sheu SJ
title	Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review
title_short	Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review
title_full	Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review
title_fullStr	Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review
title_full_unstemmed	Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review
title_sort	treatment patterns in diabetic macular edema in taiwan: a retrospective chart review
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/93403d9fefa74cc0aab64b2143790535
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Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review

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