OBJECTIVES: To investigate drugs’ utilization and prescribing practices concerning wet age-related macular degeneration (wAMD), retinal vein occlusion (RVO), diabetic macular edema (DME) and choroidal neovascularization (CNV) licensed intravitreal therapies, providing Lombardy Region real-world evidence.

METHODS: In 2022-2023, a retrospective observational multi-center study, based on anonymous data from pharmacy databases, was conducted in 8 Italian hospitals. Treatment-naïve wAMD, RVO, DME, and CNV eyes, receiving an intravitreal injection from 06/01/2019 to 12/31/2020, were included. A 24-month time horizon was assumed. The typology of administered drugs and number of intravitreal injections were collected.

RESULTS: 3,858 eyes were diagnosed for a maculopathy. 53% received treatment up to 24 months.

Focusing on wAMD (N=2,112;55%), considering a single-year treatment (42%) eyes received on average 2.99±0.08, 3.39±0.11 and 2.94±0.12 injections with aflibercept, bevacizumab and ranibizumab. Assuming 24 months, eyes (58%) received on average 8.39±0.32, 8.26±0.22 and 8.40±0.39 injections with the above drugs.

Out of 944 DME eyes, 50% received a single-year treatment, with 3.69±0.19, 2.75±0.22, 1.67±0.06, 3.49±0.27 aflibercept, bevacizumab, dexamethasone and ranibizumab. On average, one fluocinolone acetonide and triamcinolone acetonide implant was delivered. Within a 24-month timeframe, 7.91±0.33 aflibercept, 6.18±0.59 bevacizumab, 6.94±0.48 dexamethasone and 4.46±0.18 ranibizumab injections were administered.

3.32±0.15, 3.31±0.24 and 1.43±0.06 was registered for RVO eyes treated for a 12-month time-period (N=301), considering aflibercept, ranibizumab and dexamethasone. Within 24 months (N=228), 8.91±0.70 ranibizumab, 7.45±0.33 aflibercept or 3.44±0.15 dexamethasone injections were performed.

Most CNV eyes (N=165;60%) received a single-year treatment, with 2.85±0.27 ranibizumab and 2.37±0.12 aflibercept injections. 40% of eyes treated for 24 months, were administered with 6.37±0.34 ranibizumab and 8.25±1.12 aflibercept injections.

CONCLUSIONS: Given the differences between real-life practices and suggested therapeutical schemes, results could support hospitals in the management of maculopathies, revealing the need of optimization strategies, also in preparation to the future introduction of new mechanisms of action and biosimilars of ranibizumab and aflibercept.