Wet age-related macular degeneration (AMD) is characterized by abnormal growth of blood vessels under the retina, leading to optic nerve damage, visual impairment, and potentially blindness. Vascular endothelial growth factor (VEGF)-targeting treatments, which inhibit angiogenesis, have proven an effective treatment for wet AMD, and these agents dominate the market. Genentech’s Avastin, although not approved for the treatment of wet AMD, is one of the most commonly used agents to treat disease given its low cost and comparable efficacy to the approved VEGF-targeting agent Genentech’s Lucentis, as well as the most-recent market entrant Regeneron’s Eylea. Despite being in the same drug class as Avastin and Lucentis, Eylea has seen strong uptake due to the perception that it can be dosed less frequently than the alternative anti-VEGF agents; it competes strongly with Avastin and Lucentis for patient share.

Using national patient-level claims data, this report analyzes physician adherence to the treatment guidelines by exploring the use of key therapies in the newly diagnosed and recently treated wet AMD patient populations. For the 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 36% of 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 often is combination therapy used in each line of therapy?

  • Recently treated patients: VEGF-targeting agents dominate the treatment of wet AMD. Which specific drugs garner the most patient share for recently treated wet AMD patients? When do patients progress from one therapy to the next in wet AMD, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming from new (adds/switches) or continuing business?

  • Pathways to key therapies: Longitudinal claims data reveal relatively consistent use patterns of key therapies among recently treated 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 it provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed via Internet, and it presents claims that are between 6-12 months old at 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 wet AMD (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic code 362.52) 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 flowcharts 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 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.

Author(s): Emma McFadden, PhD.

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