OBJECTIVES: Clinicians may choose to switch anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) due to various reasons, such as disease activity, unsatisfactory response, new therapeutic options, safety, physician decision. The primary objective of the study was to characterize the frequency of dosing for nAMD persistent patients who switch licensed anti-VEGF agents in the 12 months post-switch (experienced patients).

METHODS: This study was an observational, retrospective, longitudinal claims database study of licensed anti-VEGF treatments in Ontario for patients covered by the public payer.

Cohort 1 patients had ≥1 prescriptions for ranibizumab or aflibercept between January 1, 2016 and March 31, 2017, and were followed for up to 12 months following switch from a previous anti-VEGF (ranibizumab or aflibercept). Cohort 2 patients received their first anti-VEGF between January 1, and March 31, 2016 and were followed for up to 24 months.

The average number of claims was calculated for persistent patients (gap between two claims was less than days’ supply on the claim + 90 days).

RESULTS: Cohort 1 included 5,285 patients (aflibercept 92%; ranibizumab 8%). Mean number of claims 90 days prior to and post-switching was 1.49 (range 0-6) and 2.93 (1-8) respectively. Mean number of claims 12 months post-switch was 8.97 (4-23). This is consistent with a treat-and-extend treatment approach, reportedly used by Canadian physicians.

Cohort 2 included 2,751 patients (aflibercept 60.6%; ranibizumab 39.4%). In persistent patients, mean number of claims was 9.45 (4-23) for months 0-12 and 7.40 (3-22) for months 12-24.

CONCLUSIONS: The average number of claims in months 0-12 was comparable among naïve patients and switch patients, indicating patients who switch are re-loaded. Naïve patients who maintained treatment had 22% fewer claims from 12-24 months than 0-12 months.