Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness. More than half of advanced AMD patients suffer the wet (exudative, neovascular) form of the disease, characterized by abnormal growth of new blood vessels from under the retina that leak blood and fluid, often causing acute vision loss. Several currently available therapies targeting vascular endothelial growth factor (VEGF) have been shown to maintain and even improve visual acuity in wet AMD patients. The most frequently used anti-VEGF agents in wet AMD, administered via intravitreal (eye) injections, are Genentech’s cancer drug Avastin (bevacizumab), compounded for use in wet AMD; Genentech’s Lucentis (ranibizumab); and the most recent market entrant, Regeneron’s Eylea (aflibercept). Valeant/Pfizer’s Macugen (pegaptanib sodium) and QLT/Novartis’s Visudyne (verteporfin) in combination with photodynamic therapy are also used, though considerably less frequently, in wet AMD.

Using national, longitudinal, patient-level U.S. claims data, this report examines current trends in the management of wet AMD both for newly diagnosed patients and patients filling a prescription for a key therapy in Q3 2013. For the newly diagnosed patient sample, the report provides shares by line of therapy and a quantitative analysis of initiation and switching patterns between wet AMD agents. Analysis of the recently treated patient sample quantifies a drug’s source of business compared with its competitors and details which drugs precede others. Additional analyses explore how physicians’ decisions regarding brand dosing frequency impact traditional measures of persistence as well as compliance persistency and compliance by brand.

Questions Answered in This Report:

  • Newly diagnosed patients: In our analysis, approximately 30% of treatment-naive wet AMD patients 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 has year-over-year use of Lucentis, Eylea, and Avastin changed in each line of therapy?

  • Recently treated patients: Consistent with historical treatment patterns, Avastin continues to capture the majority of recently treated patient prescriptions. How quickly and how often do patients progress from one therapy to the next in wet AMD, and how does this pattern differ between key drugs? Are most recently treated patients with each key brand coming through new (adds/switches) or continuing business?

  • Pathways to key therapies: Longitudinal claims data reveal shifts in the use of different anti-VEGF therapies for wet AMD. Which therapies have experienced growth or decline in patient shares over the key therapy period studied? How has the availability of the newest-to-market agent Eylea affected the use of Lucentis and Avastin?

Scope:

Primary patient-level data: Quantitative findings from our analysis of data covering approximately 40 million lives providing the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. Quantified lines of therapy analysis showing 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. This report is delivered as a key findings slide deck, a data output file (an Excel deliverable), and a dashboard that can be accessed using the internet with claims that are just over 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 specifically for wet AMD (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic code 36252) during the study period.

Newly Diagnosed Patients:

- Patient share by 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 trending of patient share by line of therapy.

Recently Treated Patients:

- Quarterly snapshot of patient share by 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 trending of patient share for all key therapies.


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