Retinal vein occlusion (RVO), estimated to affect 1.3 million U.S. adults aged 40 or older, is a retinal vascular disorder associated with macular edema (ME) and neovascularization and is the second-most-common cause of vision loss from retinal vascular diseases. No drug treatments can effectively reopen occluded retinal veins; thus, treatment targets the secondary complications of RVO that affect vision, including ME and neovascularization. Although nonpharmacological laser therapy has long been used to treat RVO, advances in the past decade now offer physicians a mix of pharmacological therapies for the treatment of ME secondary to RVO. These treatments include intravitreal injections of agents targeting vascular endothelial growth factor (VEGF)—i.e., Genentech’s Avastin (bevacizumab), Regeneron’s Eylea (aflibercept), and Genentech’s Lucentis (ranibizumab)—and intravitreal corticosteroid injections (triamcinolone) or implants (Allergan’s Ozurdex [dexamethasone implant]). Although formal U.S. guidelines for RVO treatment have yet to be developed, VEGF-targeting agents are typically favored over intravitreal corticosteroids owing to their better side-effect profile (e.g., steroids are associated with an increased risk of cataracts and raising intraocular pressure [IOP], a precursor to the development of glaucoma).

Using national patient-level claims data, the Treatment Algorithms in Retinal Vein Occlusion report explores the use of key therapies and drug classes among newly diagnosed and recently treated RVO patient populations. Among newly diagnosed patients, we provide a quantitative analysis of percentage drug-treated, time to treatment, treatment patterns, and share by line of therapy, as well as progression between lines, recent patient-share trends, and use of concomitant treatment. Among recently treated patients, we quantify each drug’s overall drug share, use in combination with other therapies, and source of business compared with its competitors, detailing which drugs precede others through an analysis of add-versus-switch patterns. Two additional claims database queries explore persistency and compliance by therapy.

Questions Answered in This Report:

  • Newly diagnosed patients: One in every five newly diagnosed RVO patients initiated treatment with an RVO pharmacotherapy within one year of diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year, and how quickly do patients progress? 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: In Q3 2014, the use of VEGF-targeting agents dominated the treatment landscape. Which specific drugs garner the most patient share for recently treated RVO patients? How has Eylea’s FDA approval for ME following CRVO affected the patient shares of agents in the class? Which therapies have experienced market growth or decline over the key therapy periods studied?

  • Pathways to key therapies: Among patient-share leaders for RVO, Avastin is the most likely treatment to precede most agents, consistent with the drug’s leading position in early lines of therapy. How long does it take RVO patients to progress to each key therapy? What are the various sources of business for each agent (i.e., new, add/switches, or continuing business)?


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 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 RVO (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 362.30, 362.35, 362.36, 362.37) during the study period.

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.

- Quarterly trends in patient share for all key therapies.

Drug persistence (One year, all-brand).

Drug compliance (6-month, Medication Possession Ratio [MPR]).

Author(s): Virginia Schobel