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Lucenteforte E, Finocchietti M, Addis A, Tettamanti M, Varano M, Parravano M, Virgili G. Polytherapy and Multimorbidity Pattern of Users of Anti-VEGF Drugs and Dexamethasone for the Treatment of Age-Related Macular Degeneration and other Vascular Retinopathies in Clinical Practice. Pharmaceuticals (Basel) 2023; 16:ph16050646. [PMID: 37242429 DOI: 10.3390/ph16050646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: Our aim was to describe the polytherapy and multimorbidity pattern of users of anti-VEGF and dexamethasone drugs for the treatment of these conditions, and to investigate their polytherapy and multimorbidity profiles, together with adherence and the burden of care. Methods: Descriptive, population-based, pharmacoepidemiology study on the users of anti-VEGF drugs, and secondarily intravitreal dexamethasone, for the treatment of age-related macular degeneration and other vascular retinopathies in clinical practice, using administrative databases of Lazio region, Italy. We used a cohort of 50,000 residents in Lazio in 2019 with same age as comparison. Polytherapy was assessed using databases of prescribed drugs intended for outpatient use. Multimorbidity was investigated with additional sources, such as hospital discharge records, outpatient care records, and disease-specific exemptions from co-payment. Each patient was followed for 1 to 3 years from the first intravitreal injection received. Results: 16,266 residents in Lazio who received the first IVI from 1 January 2011 to 31 December 2019, with at least 1 year of observation before index date, were included. The proportion of patients with at least one comorbidity was 54.0%. Patients used an average 8.6 (SD 5.3) concomitant drugs other than anti-VEGF used for injections. A large percentage of patients (39.0%) used 10 or more concomitant drugs, including antibacterials (62.9%), drugs for peptic ulcers (56.8%), anti-thrombotics (52.3%), NSAIDs (44.0%), and anti-dyslipidaemics (42.3%). The same proportions were found across patients of all ages, probably due to high prevalence of diabetes (34.3%), especially in younger age groups. When stratified by diabetes, a comparison of multimorbidity and polytherapy with a sample of 50,000 residents of the same age found that patients receiving IVIs used more drugs and had more comorbidities, particularly in non-diabetics. Lapses of care, whether short (absence of any type of contact for at least 60 days in the first year of follow-up and 90 in the second year) or long (90 days in the first and 180 days in the second year) were common: 66% and 51.7%, respectively. Conclusions: Patients receiving intravitreal drugs for retinal conditions have high multimorbidity and polytherapy rates. Their burden of care is aggravated by the large number of contacts with the eye care system for examinations and injections. Pursuing Minimally Disruptive Medicine to optimise patient care is a difficult goal for health systems, and more research on clinical pathways and their implementation is warranted.
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Affiliation(s)
- Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marco Finocchietti
- Department of Epidemiology, Lazio Regional Health Service, 00154 Rome, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, 00154 Rome, Italy
| | - Mauro Tettamanti
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | | | | | - Gianni Virgili
- Department of NEUROFARBA, Eye Clinic, Careggi University Hospital, University of Florence, 50134 Florence, Italy
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Spini A, Giometto S, Donnini S, Posarelli M, Dotta F, Ziche M, Tosi GM, Girardi A, Lucenteforte E, Gini R, Etminan M, Virgili G. Risk of Intraocular Pressure Increase With Intravitreal Injections of Vascular Endothelial Growth Factor Inhibitors: A Cohort Study. Am J Ophthalmol 2023; 248:45-50. [PMID: 36410468 DOI: 10.1016/j.ajo.2022.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Intraocular pressure increase (IOPi) after intravitreal injections of vascular endothelial growth factor inhibitors (VEGFis) might be different among different VEGFis (bevacizumab, aflibercept, ranibizumab). The purpose of this study was to evaluate the risk of IOPi among new users of bevacizumab, ranibizumab, and aflibercept in nondiabetic patients in Tuscany, Italy. DESIGN Retrospective cohort study. METHODS Tuscan regional administrative database was used to identify subjects with a first VEGFi intravitreal injection between 2011 and 2020, followed to first incidence of IOPi. Diabetic subjects, those with pre-existing IOPi, or previous use of dexamethasone implants were excluded. Multivariable Cox regression analyses (intention-to-treat and as treated) were conducted to evaluate risk of IOPi among aflibercept, bevacizumab, and ranibizumab, adjusting for potential confounding variables. IOPi was defined as the first record of International Classification of Diseases, Ninth Revision (ICD-9-CM) code 365 or use of 2 glaucoma drugs dispensations within 180 days of each other. RESULTS We identified 6585 new users of VEGFis: 1749 aflibercept, 1112 bevacizumab, and 3724 ranibizumab. Women made up 60% of the cohort, with a mean age of 73.6 years. In the intention-to-treat analysis, the adjusted hazard ratio (HR) for incident IOPi, compared with aflibercept, was higher for bevacizumab (HR = 2.20, 95% CI = 1.64-2.95) and ranibizumab users (HR = 1.88, 95% CI = 1.46-2.42), respectively. The HRs remained robust after exclusion of patients with proxy of retinal vascular occlusion. As treated analysis confirmed such results (bevacizumab: HR = 3.76, 95% CI = 2.30-6.17; ranibizumab: HR = 2.49, 95% CI = 1.62-3.82). CONCLUSIONS This study found an increased risk of IOPi among nondiabetic patients with ranibizumab and bevacizumab compared with aflibercept. Future studies are needed to validate these findings.
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Affiliation(s)
- Andrea Spini
- From the Department of Medicine, Surgery and Neuroscience (A.S., F.D., M.Z., G.M.T.), University of Siena, Siena, Italy; Azienda Ospedaliera Universitaria Senese (A.S., M.P., F.D., G.M.T.), Siena, Italy
| | - Sabrina Giometto
- Department of Clinical and Experimental Medicine (S.G., E.L.), University of Pisa, Pisa, Italy
| | - Sandra Donnini
- Department of Life Sciences (S.D.), University of Siena, Siena, Italy
| | - Matteo Posarelli
- Azienda Ospedaliera Universitaria Senese (A.S., M.P., F.D., G.M.T.), Siena, Italy
| | - Francesco Dotta
- From the Department of Medicine, Surgery and Neuroscience (A.S., F.D., M.Z., G.M.T.), University of Siena, Siena, Italy; Azienda Ospedaliera Universitaria Senese (A.S., M.P., F.D., G.M.T.), Siena, Italy
| | - Marina Ziche
- From the Department of Medicine, Surgery and Neuroscience (A.S., F.D., M.Z., G.M.T.), University of Siena, Siena, Italy; Azienda Ospedaliera Universitaria Senese (A.S., M.P., F.D., G.M.T.), Siena, Italy
| | - Gian Marco Tosi
- From the Department of Medicine, Surgery and Neuroscience (A.S., F.D., M.Z., G.M.T.), University of Siena, Siena, Italy
| | - Anna Girardi
- Agenzia Regionale di Sanità della Toscana (A.G., R.G.), Firenze, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine (S.G., E.L.), University of Pisa, Pisa, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana (A.G., R.G.), Firenze, Italy
| | - Mahyar Etminan
- Departments of Ophthalmology and Visual Sciences and Medicine (M.E.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Gianni Virgili
- Centre for Public Health (G.V.), Queen's University, Belfast, UK; Department NEUROFARBA (G.V.), University of Florence, Florence Italy.
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Scondotto G, Sultana J, Vadalà M, Avitabile T, Cillino S, Foti SS, Labbate L, Longo A, Mirabelli E, Puzo MR, Rapisarda C, Ibanez Toro P, Trombetta CJ, Trifirò G, Virgili G. Assessment of intravitreal anti-VEGF drugs and dexamethasone for retinal diseases in real world setting: A multi-centre prospective study from Southern Italy. Eur J Ophthalmol 2022; 32:3064-3073. [PMID: 35075918 DOI: 10.1177/11206721211073402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Describe drug utilisation and clinical outcomes of intravitreal anti-VEGF drug and dexamethasone use in the real-world setting in Southern Italy using data from multi-centre study of retinal disease. Clinical data of retinal disease patients treated with anti-VEGF drugs and dexamethasone implant in 6 out-patient ophthalmology centres from Southern Italy were collected by means of an electronic case report form. Patients receiving at least one intravitreal injection/implant of the study drugs were followed for up to two years and described in terms of demographics and clinical characteristics. Drug utilisation patterns were described. A sign-rank test was used to compare clinical data on visual acuity and other ophthalmic parameters from baseline at different follow-up times for each indication. Data from 1327 patients was collected. Most patients were diagnosed with age-related macular degeneration (AMD) (660, 49.7%), followed by diabetic macular oedema (423, 31.9%), retinal vein occlusion (164, 12.3%), and myopic choroidal neovascularization (80, 6.0%). Patients were followed for a median of 10.3 months (interquartile range: 3.6 - 24.7 months). Mean patient age was 69.7 (±10.9) years and 54.2% were males. Ranibizumab (55.4%) and aflibercept (27.5%) were the most commonly used drugs. Baseline visual acuity significantly improved by about 0.05 to 0.1 logMAR at all follow-up times for AMD and RVO but less consistently for the other diseases. Intravitreal ranibizumab use accounted for half of all treatment for retinal diseases in a Southern Italian out-patient setting. Patients treated with anti-VEGF drugs for AMD and RVO in Southern Italy experienced significant improvement in VA.
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Affiliation(s)
- Giulia Scondotto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, 18980University of Messina, Messina, Italy
| | - Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Malta.,College of Medicine and Health, University of Exeter, Exeter, Malta
| | - Maria Vadalà
- Institute of European and Mediterranean Science and Technology (IEMEST), Palermo, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, A. O. U. Policlinic-Vittorio Emanuele, Catania, Italy
| | - Salvatore Cillino
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Saveria Serena Foti
- Academic spin-off "INSPIRE - Innovative Solutions For Medical Prediction And Big Data Integration In Real World Setting" - Azienda Ospedaliera Universitaria "G. Martino" Messina, Italy
| | - Luca Labbate
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, 18980University of Messina, Messina, Italy
| | - Antonio Longo
- Department of Ophthalmology, A. O. U. Policlinic-Vittorio Emanuele, Catania, Italy
| | - Eliana Mirabelli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, 18980University of Messina, Messina, Italy
| | - Maria Rosalia Puzo
- Assistance and Pharmaceutical Services Office, Personal Policies Department, Basilicata Region, Potenza, Italy
| | - Carlo Rapisarda
- Department of Ophthalmology, A. O. U. Policlinic-Vittorio Emanuele, Catania, Italy
| | - Patricia Ibanez Toro
- Assistance and Pharmaceutical Services Office, Personal Policies Department, Basilicata Region, Potenza, Italy
| | - Costantino J Trombetta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, 18980University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Clinical Health, University of Florence, Florence, Italy.,Centre for Public Health, Queen's University of Belfast (UK), Belfast, UK
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