Diabetic macular edema (DME) is a progressive ophthalmological comorbidity of diabetes that can threaten vision. In DME, fluid and lipids leak from abnormal, weak retinal blood vessels, causing swelling in the macula, which is the portion of the retina that is responsible for central visual acuity. Left untreated, DME can severely and permanently impair vision, particularly in the center of the visual field. For decades, the gold-standard treatment for DME was laser photocoagulation, which remains an important component of DME treatment plans, but the 2012 U.S. approval of Genentech’s vascular endothelial growth factor (VEGF)-targeting drug Lucentis prompted an increase in the use of drug therapies to treat DME. In addition to Lucentis, Genentech’s Avastin, which is not approved for the treatment of DME, and Regeneron’s Eylea, are VEGF-targeting agents that inhibit abnormal vascular growth in the retina and are commonly used to treat DME. Along with agents that target VEGF, drug treatment strategies also include corticosteroid injections or corticosteroid implants, such as Allergan’s Ozurdex, to inhibit inflammatory processes in the eye.

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 DME patient populations. 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. With respect to 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 8% of DME 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 DME. 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 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? What has been the impact of recently approved drugs for DME?


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. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet. It 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 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 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 trending of patient share for all key therapies.

Author(s): Kathleen Davenport, Ph.D.

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