Diabetic macular edema (DME) associated with diabetic retinopathy (DR) is a rapidly evolving market as a result of multiple intravitreal pharmacotherapy product approvals across different drug classes in Europe since 2011. Although laser photocoagulation has long been the standard of care for patients with the most advanced stages of DR, recent clinical trial results suggest that intravitreal pharmacotherapy injections may be effective treatment for this broader patient population as well. The Diabetic Retinopathy/Diabetic Macular Edema | Current Treatment Overview provides a synopsis of current treatment goals, key therapies, and medical practice in the United States and EU5 markets for DR and DME. The Diabetic Retinopathy/Diabetic Macular Edema | Current Treatment | EU detailed, expanded analysis offers a snapshot of how ophthalmologists in the EU5 are currently treating DR and DME patients, with a particular focus on use of intravitreal vascular endothelial growth factor (VEGF) inhibitors and intravitreal corticosteroid implants, as well as insight into the factors driving such prescribing habits.

Table of contents

  • Diabetic Macular Edema / Diabetic Retinopathy - Current Treatment - Detailed, Expanded Analysis (EU)
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • Bilateral Retinopathy Is Common for DR and DME Patients
        • DR Severity Among Patients with DR and DME: Total EU5 (Survey Data)
        • DR Severity Among Patients with DR by Country (Survey Data)
        • DR Severity Among Patients with DME by Country (Survey Data)
        • Coexisiting DME Among Patients with Different DR Severity Levels: Total EU5 (Survey Data)
        • Unilateral vs. Bilateral Retinopathy Among DR and DME Patients: Total EU5 (Survey Data)
        • Unilateral vs. Bilateral Edema Among DME Patients with Bilateral DR by Country (Survey Data)
        • Clinically Significant DME Among Patients with Unilateral DME by Country (Survey Data)
        • Clinically Significant DME Among Patients with Bilateral DME by Country (Survey Data)
        • Focal vs. Diffuse Edema Among DME Patients by Country (Survey Data)
      • Treatment Practices
        • Approved VEGF Inhibitors Dominate DME Treatment in the EU5
        • Diffuse DME Patients Administered IVT Pharmacotherapy Begin Treatment Soon After Diagnosis
        • Time From Diagnosis of Different DR Subtypes to IVT Pharmacotherapy Initiation: Total EU5 (Survey Data)
        • Mean Months from Diagnosis of Different DR Subtypes to IVT Pharmacotherapy Initiation by Country (Survey Data)
        • Current Treatment Approaches Used for DR and DME Vary by Disease Type
        • Current Treatment Approaches by DR Severity: Total EU5 (Survey Data)
        • Current Treatment Approaches for Severe NPDR by Country (Survey Data)
        • Current Treatment Approaches for PDR by Country (Survey Data)
        • Ophthalmic Medical Intervention Approaches for Severe NPDR and PDR: Total EU5 (Survey Data)
        • Ophthalmic Medical Intervention Approaches for Severe NPDR by Country (Survey Data)
        • Ophthalmic Medical Intervention Approaches for PDR by Country (Survey Data)
        • Current Treatment Approaches by DME Type: Total EU5 (Survey Data)
        • Current Treatment Approaches for Focal DME by Country (Survey Data)
        • Current Treatment Approaches for Diffuse DME by Country (Survey Data)
        • Ophthalmic Medical Intervention Approaches for Focal and Diffuse DME: Total EU5 (Survey Data)
        • Ophthalmic Medical Intervention Approaches for Focal DME by Country (Survey Data)
        • Ophthalmic Medical Intervention Approaches for Diffuse DME by Country (Survey Data)
        • Eylea's Patient Share for DME Has Grown Significantly Compared with Six Months Previously
        • Ophthalmologists' Experience Administering IVT Pharmacothearpies for DME: Total EU5 (Survey Data)
        • Current Prescriber Base by IVT Pharmacotherapies for DME for Total EU5: Comparison with 2015 (Survey Data)
        • Current Prescriber Base by IVT Pharmacotherapies for DME by Country (Survey Data)
        • Current IVT Pharmacotherapy Patient Share For DR and DME: Total EU5 (Survey Data)
        • Current IVT Pharmacotherapy Patient Share For DR and DME For Total EU5: Comparison with 2015 (Survey Data)
        • Current IVT Pharmacotherapy Patient Share For DR by Country (Survey Data)
        • Current IVT Pharmacotherapy Patient Share For DME by Country (Survey Data)
        • Availability of and Channels of Access to IVT Pharmacotherapies for Prescribing for DME: Total EU5 (Survey Data)
        • Availability of and Channels of Access to Avastin for Prescribing for DME by Country (Survey Data)
        • Availability of and Channels of Access to Eylea for Prescribing for DME by Country (Survey Data)
        • Availability of and Channels of Access to Lucentis for Prescribing for DME by Country (Survey Data)
        • Availability of and Channels of Access to Iluvien for Prescribing for DME by Country (Survey Data)
        • Availability of and Channels of Access to Ozurdex for Prescribing for DME by Country (Survey Data)
        • DME Patients Received Multiple Injections Prior to Discontinuation of Individual VEGF Inhibitors in the Past Year
        • Number of Injections/Implants Given for DME Prior to Discontinuation in the Past Year by Country (Survey Data)
        • Laser Photocoagulation Is a Common Nonpharmacological Approach for DR and DME Subtypes
        • Eylea and Lucentis Compete for Early-Line DME Patient Share
        • Most DME Patients Treated with Ophthalmic Medical Intervention Are on Early-Line Therapy
        • Current Line of Therapy Allocation Among DME Patients by Country (Survey Data)
        • Progression of DME Patients Between Lines of Therapy Typically Occurs Only After Several Months of Treatment
        • Months Between Line of Therapy Progression for Ophthalmic Medical Approaches for DME: Total EU5 (Survey Data)
        • Mean Months Between Line of Therapy Progression for Ophthalmic Medical Approaches for DME by Country (Survey Data)
        • Eylea Is a Common Early-Line Therapy for DME
        • Ophthalmic Treatment Approach by Line of Therapy for DME Patients: Total EU5 (Survey Data)
        • First-Line Ophthalmic Treatment Approach for DME Patients by Country (Survey Data)
        • DME Patients Treated with Iluvien and Ozurdex Are Often Administered Adjunctive Ophthalmic Approaches
        • Current IVT Pharmacotherapy Monotherapy vs. Adjunctive Therapy Use for DME: Total EU5 (Survey Data)
        • Current Anti-VEGF Monotherapy vs. Adjunctive Therapy Use for DME by Country (Survey Data)
        • Current IVT Corticosteroid Implant Monotherapy vs. Adjunctive Therapy Use for DME by Country (Survey Data)
      • Persistency and Compliance
        • Compliance Is Equally High in the EU5 for Each IVT Pharmacotherapy Administered for DME
        • Compliance Among DME Patients Receiving IVT Pharmacotherapy Injections and Implants by Country (Survey Data)
        • Persistence Among DME Patients Receiving IVT Pharmacotherapy in the Past Year by Country (Survey Data)
      • Sequencing of Treatment
        • Current Eylea-Treated Patients Are Often Treatment-Naive at Agent Initiation
        • Physicians' Treatment Initiation and Previous Approaches for DME Patients Started on IVT Agents in the Past Year: Total EU5 (Survey Data)
        • Treatment Initiation and Previous Approach Among Current Avastin-Treated DME Patients Started on Avastin in the Past Year by Country (Survey Data)
        • Treatment Initiation and Previous Approaches for Current Eylea-Treated DME Patients Started on Eylea in the Past Year by Country (Survey Data)
        • Treatment Initiation and Previous Approaches for Current Lucentis-Treated DME Patients Started on Lucentis in the Past Year by Country (Survey Data)
        • Treatment Initiation and Previous Approaches for Current Iluvien-Treated DME Patients Started on Iluvien in the Past Year by Country (Survey Data)
        • Treatment Initiation and Previous Approaches for Current Ozurdex-Treated DME Patients Started on Ozurdex in the Past Year by Country (Survey Data)
        • Treatment Journey Among DME Patients Switching from IVT Pharmacotherapies Within the Past Year: Total EU5 (Survey Data)
        • Treatment Journey Among DME Patients Switching from Avastin Within the Past Year by Country (Survey Data)
        • Treatment Journey Among DME Patients Switching from Eylea Within the Past Year by Country (Survey Data)
        • Treatment Journey Among DME Patients Switching from Lucentis Within the Past Year by Country (Survey Data)
        • Treatment Journey Among DME Patients Switching from Iluvien Within the Past Year by Country (Survey Data)
        • Treatment Journey Among DME Patients Switching from Ozurdex Within the Past Year by Country (Survey Data)
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • Eylea's Patient Share Among DME Patients Is Expected to Continue to Grow One Year From Now
        • Change in Use of IVT Pharmacotherapies for DME Over the Past Year: Total EU5 (Survey Data)
        • Current vs. Anticipated Treatment of Severe NPDR and PDR Patients One Year from Now: Total EU5 (Survey Data)
        • Current vs. Anticipated Treatment of Focal and Diffuse DME Patients One Year from Now: Total EU5 (Survey Data)
        • Current vs. Anticipated IVT Pharmacotherapy Patient Share for DR and DME One Year from Now: Total EU5 (Survey Data)
        • Current vs. Anticipated IVT Pharmacotherapy Prescriber Base for DME One Year from Now: Total EU5 (Survey Data)
        • Anticipated Change in IVT Pharmacotherapy Patient Share for DR One Year from Now by Country (Survey Data)
        • Anticipated IVT Pharmacotherapy Patient Share for DME One Year from Now by Country (Survey Data)
        • Anticipated Change in IVT Pharmacotherapy Patient Share for DME One Year from Now by Country (Survey Data)
        • Anticipated Change in IVT Pharmacotherapy Prescriber Base for DME One Year from Now by Country (Survey Data)
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Efficacy and Product Access Drive Prescribing Decisions in DME
        • IVT Pharmacotherapy Is Often Initiated upon Functional and Anatomical Evidence of Diffuse DME
        • Primary Reasons for Initiating IVT Pharmacotherapy in Treatment-Naive Focal DME Patients by Country (Survey Data)
        • Primary Reasons for Initiating IVT Pharmacotherapy in Treatment-Naive Diffuse DME Patients by Country (Survey Data)
        • Eylea's Efficacy Drives Early-Line Use for DME
        • Most Influential Factors Driving Prescribing of IVT Agents for DME: Total EU5 (Survey Data)
        • Most Influential Factors Driving Prescribing of Avastin for DME by Country (Survey Data)
        • Most Influential Factors Driving Prescribing of Eylea for DME by Country (Survey Data)
        • Most Influential Factors Driving Prescribing of Lucentis for DME by Country (Survey Data)
        • Most Influential Factors Driving Prescribing of Iluvien for DME by Country (Survey Data)
        • Most Influential Factors Driving Prescribing of Ozurdex for DME by Country (Survey Data)
        • Most Likely Prescribing Scenario for DME by IVT Agents: Total EU5 (Survey Data)
        • Most Likely Prescribing Scenario for Avastin for DME by Country (Survey Data)
        • Most Likely Prescribing Scenario for Eylea for DME by Country (Survey Data)
        • Most Likely Prescribing Scenario for Lucentis for DME by Country (Survey Data)
        • Most Likely Prescribing Scenario for Iluvien for DME by Country (Survey Data)
        • Most Likely Prescribing Scenario for Ozurdex for DME by Country (Survey Data)
        • Dosing Frequency of Anti-VEGF Agents for DME After Initial Six Month of Treatment: Total EU5 (Survey Data)
        • Regimen Used for DME Patients Currently Administered Iluvien and Ozurdex: Total EU5 (Survey Data)
        • Regimen Used for DME Patients Currently Administered Iluvien by Country (Survey Data)
        • Regimen Used for DME Patients Currently Administered Ozurdex by Country (Survey Data)
        • Obstacles to Prescribing Vary by Drug Class and Approval Status
        • Main Obstacles to Increased Use of IVT Agents for the Treatment of DME: Total EU5 (Survey Data)
        • Main Obstacles to Increased Use of Avastin for the Treatment of DME by Country (Survey Data)
        • Main Obstacles to Increased Use of Eylea for the Treatment of DME by Country (Survey Data)
        • Main Obstacles to Increased Use of Lucentis for the Treatment of DME by Country (Survey Data)
        • Main Obstacles to Increased Use of Iluvien for the Treatment of DME by Country (Survey Data)
        • Main Obstacles to Increased Use of Ozurdex for the Treatment of DME by Country (Survey Data)
        • Drivers of Switching from or to IVT Therapies Highlight the Importance of Efficacy in DME
        • Primary Reasons for Switching DME Patients from IVT Agents in the Past Year: Total EU5 (Survey Data)
        • Primary Reasons for Switching DME Patients from Avastin in the Past Year by Country (Survey Data)
        • Primary Reasons for Switching DME Patients from Eylea in the Past Year by Country (Survey Data)
        • Primary Reasons for Switching DME Patients from Lucentis in the Past Year by Country (Survey Data)
        • Primary Reasons for Switching DME Patients from Ozurdex in the Past Year by Country (Survey Data)
        • Primary Reasons for Switching DME Patients to IVT Agents in the Past Year: Total EU5 (Survey Data)
        • Primary Reasons for Switching DME Patients to Avastin in the Past Year by Country (Survey Data)
        • Primary Reasons for Switching DME Patients to Eylea in the Past Year by Country (Survey Data)
        • Primary Reasons for Switching DME Patients to Lucentis in the Past Year by Country (Survey Data)
        • Primary Reasons for Switching DME Patients to Iluvien in the Past Year by Country (Survey Data)
        • Primary Reasons for Switching DME Patients to Ozurdex in the Past Year by Country (Survey Data)
        • Discontinuation of Ophthalmic Medical Intervention Is Largely Driven By Stabilization of Visual Acuity
        • Primary Reason for Discontinuation of All Ophthalmic Medical Intervention in the Past Year by Country (Survey Data)
        • Mild Disease and Patient Ineligibility Often Restrict Use of IVT Pharmacotherapy Injections
        • Primary Reasons for Not Administering IVT Pharmacotherapy Injections to More DME Patients by Country (Survey Data)
        • Primary Reasons for Not Administering IVT Corticosteroid Implants to More DME Patients by Country (Survey Data)
      • Face-to-Face Product Detailing Effectiveness
        • Opportunity Exists for DME Brand Differentiation During Detailing Vistis
        • Recent DME-Specific Detailing is Similar for Eylea, Lucentis, and Ozurdex
        • Reach of Sales Representatives for DME Brands: Total EU5 (Survey Data)
        • Detailing by Sales Representatives for DME Brands in the Past Month: Total EU5 (Survey Data)
        • Detailing by Sales Representatives for DME Brands in the Past Month by Country (Survey Data)
        • Frequency of Sales Representatives' Visits for DME Brands in the Past Six Months by Country (Survey Data)
        • Recently Detailed Ophthalmologists Are Satisfied With Performance of DME Sales Representatives
        • Recently Detailed Ophthalmogists' Satisfaction with Sales Representatives for DME Brands (Survey Data)
        • Messages Recalled from DME-Specific Detailing Visits Are Similar for Lucentis, Eylea, and Ozurdex
        • Aided Message Recall Among Physicians Recently Detailed on DME Brands: Total EU5 (Survey Data)
    • Methodology
      • Primary Market Research Methodology
      • Years in Practice by Country (Survey Data)
      • DR Patient Share by Disease Type by Country (Survey Data)
      • DR Exclusive of DME Patient Volume by Country (Survey Data)
      • DR with Coexisting DME Patient Volume by Country (Survey Data)
      • Personal IVT Pharmacotherapy Administration Rates for DR and DME by Country (Survey Data)
      • Retinal Specialist Status by Country (Survey Data)
      • Practice Type by Country (Survey Data)
    • Appendix
      • Primary Market Research
        • Avastin Dosing Frequency for DME After First Six Months of Treatment by Country (Survey Data)
        • Eylea Dosing Frequency for DME After First Six Months of Treatment by Country (Survey Data)
        • Lucentis Dosing Frequency for DME After First Six Months of Treatment by Country (Survey Data)
        • IVT Pharmacotherapy Treatment Among Patients with Bilateral CSDME by Country (Survey Data)

Author(s): Emma McFadden, PhD; Margaret M. Weigel

Emma McFadden, Ph.D., is a Director within the Central Nervous System/Ophthalmology disorders group. Her main focus is on ophthalmic indications, such as age-related macular degeneration, diabetic retinopathy, and diabetic macular edema, although she has authored research across a number of other indications, including multiple sclerosis and epilepsy. 

Prior to joining Decision Resources Group, Emma earned a B.A. in neuroscience and a Ph.D. in biochemistry from Trinity College Dublin.

 

Margaret Weigel, M.B.A., is a Business Insights Analyst on the CNS/Ophthalmology Disorders team at Decision Resources Group. Her specialties are diabetic retinopathy/diabetic macular edema, postoperative pain, and multiple sclerosis; she has authored numerous primary and secondary market research products on these indications. Ms. Weigel obtained her B.A. from Washington and Lee University, where she studied psychology and conducted research in the neuroscience department, and her M.B.A. in pharmaceutical and healthcare business from the University of the Sciences in Philadelphia.


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