Diabetic retinopathy (DR) is characterized by progressive damage to the blood vessels in the retina of a diabetic patient, from which fluid may leak causing the macula to swell. Swelling of the macula, referred to as diabetic macular edema (DME), can impact sharp vision in the center of the visual field and can occur at any stage of DR, although the prevalence increases with disease severity. Therapies targeting vascular endothelial growth factor (VEGF) have been shown to maintain and even improve visual acuity in DME patients. Genentech’s Lucentis became the first pharmacotherapy formally approved for the treatment of DME in 2012. Other VEGF-targeting therapies—specifically Genentech’s Avastin (compounded for ophthalmic use) and Regeneron Pharmaceuticals’ Eylea—are also frequently administered to patients diagnosed with DME. Treatment of DME may also include corticosteroid injections or corticosteroid implants, such as Allergan’s Ozurdex, to inhibit the inflammatory process in the eye.

Using longitudinal claims data, this report examines current trends in the treatment of DME for both newly diagnosed patients and patients filling a prescription for a key therapy in the second and third quarters of 2013. For newly diagnosed patients, the report provides a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. For recently treated patients, the report quantifies a drug’s source of business compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.

Questions Answered in This Report:

  • Newly diagnosed patients: Approximately 7% of patients with DME begin treatment with a key therapy within a year of their initial diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?

  • Recently treated patients: More than 60% of prescriptions for recently treated patients are for VEGF-targeting agents; intravitreal corticosteroid injections make up most of the remaining prescriptions. Which specific drugs garner the most patient share for recently treated DME patients? When do patients progress from one therapy to the next in DME, and how does this pattern differ among key drugs? Are most recently treated patients for each key brand coming from new (adds/switches) or continuing business?

  • Pathways to key therapies: : Longitudinal claims data reveal shifts in the use patterns of key therapies among recently treated DME patients. Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients?

Scope:

Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. The report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet and presents claims that are less than six months old at the time of publication.

Patient Sample:

Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least one claim with a diagnosis code for DME (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 362.07, 250.50) during the study period. Quantified lines of therapy analyses show exact share of each agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.

Newly Diagnosed Patients:

- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.

- Patient flowchart through one year of treatment for all first-line products, including progression rates and add/switch behavior.

- Polypharmacy and key concomitant therapies by line of therapy.

- Quarterly trends in patient share by line of therapy.

Recently Treated Patients:

- Quarterly snapshot of patient share by drug class and key products.

- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.

- Brand source of business, including share for continuing, new (switches/adds), and new (initial therapy) business.

- Polypharmacy and key concomitant therapies.

- Drug persistence and compliance.

- Quarterly trends in patient share for all key therapies.


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