A pharmacoepidemiologic study of ranibizumab and aflibercept use 2013-2016. The Fight Retinal Blindness! Project

INTRODUCTION To report 12-month pharmacoepidemiologic data on aflibercept and ranibizumab use in treatment-naïve eyes with neovascular age-related macular degeneration (nAMD). METHODS Participants were treatment-naïve eyes with nAMD tracked by the Fight Retinal Blindness! registry starting therapy with aflibercept or ranibizumab treatment between January 1st, 2013 and 31st December, 2016. Demographic and clinical characteristics were compared between treatment groups. RESULTS During the study period, 689 eyes initiated treatment with ranibizumab compared to 568 with aflibercept. We found a similar rate of use of both drugs. Ranibizumab-treated patients were older than aflibercept-treated patients (overall mean [SD] 82.0 [8.4] vs. 78.6 [8.1], P < 0.001). Median (Q1, Q3) lesion size was significantly larger in aflibercept-treated patients (2450 μm [1242, 3000]) compared with ranibizumab patients (2000 μm [1148, 2890], P = 0.008). Eyes treated with ranibizumab and aflibercept received a similar mean number of injections in the first 3 months (3.1 [0.7] vs. 3.0 [0.6]; P = 0.233) and at 12 months (7.3 [2.4] vs. 7.2 [2.2]; P = 0.139). The 12-month switching rates from 2013 onwards for eyes completing 12 months of follow-up were much higher for switching from ranibizumab to aflibercept (19.2%) compared with switching from aflibercept to ranibizumab (5.4%). The proportion of eyes that did not complete 12 months of treatment was 23.2% for ranibizumab and 22.2% for aflibercept-treated groups. CONCLUSION A similar rate of use for ranibizumab and aflibercept among Australian practitioners was observed between 2013 and 2016. Ranibizumab was used more often in older patients while aflibercept tended to be used more often in eyes with larger lesions