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PtQ:bevacizumab vs. ranibizumab vs. aflibercept in AMD

(this is part 2 of a post started in general forum) (see forum post titled “PtQ:Research questions from the community”)

This posting is attempt to fulfill 2016 OHDSI symposium call for ability to post patient questions that would be interesting analyses within OHDSI.

Disease: age-related macular degeneration (AMD)
Drugs: bevacizumab, ranibizumab, aflibercept
Procedures: photodynamic therapy (into eye)

Ideal outcomes to study: loss of visual acuity

Realistic outcomes: (given our real life data today
(e.g., diagnostic data (often from claims) and realistic MEASUREMENT table data)

  • time from onset of treatment to low vision/blindness diagnosis(one eye/both eyes)

(or censoring out of the cohort without significant loss of vision) (but with follow up time at least 5 years since onset of wet AMD)
(see diagnostic categories here: http://www.icd10data.com/ICD10CM/Codes/H00-H59/H53-H54/H54-#H54.0)

An effective drug for AMD would be expected to prolong this time (of sufficient vision). Which drug (if any) is best at achieving that?
(however, intensity of treatment will play a role)

Details:
From UpToDate, there are three drugs recommended for AMD. These drugs have different costs.
Can these drugs be compared in terms of some outcome using OHDSI distributed research network?
Patients need to make a choice in terms of which one is best for their needs.

Also, in different countries - different drugs may be offered (perhaps a pathway study for AMD as first step)

Limited paste of text from UpToDate:

TREATMENT OF WET AMD — Effective therapies for exudative or wet age-related macular degeneration (AMD) include intravitreous injection of a vascular endothelial growth factor (VEGF) inhibitor, photodynamic therapy (PDT), and supplementation with zinc and antioxidant vitamins. The decision about specific therapies must take into account the likelihood of visual recovery, which is better with smaller, more recent lesions, as well as the risks of the various therapies.

In general, our approach is as follows:

  • For most patients with AMD and neovascularization, we recommend treatment with intravitreal bevacizumab, ranibizumab, or aflibercept. PDT is an alternative for patients who cannot be treated with an intravitreal VEGF inhibitor, and for patients with chronic exudative lesions who have preserved vision in one eye and are unlikely to achieve reading vision in the second eye.
  • We also suggest that patients with wet AMD in one or both eyes be treated with daily oral supplements consistent with the AREDS2 formulation (containing vitamin C 500 mg, vitamin E 400 international units, lutein 10 mg, zeaxanthin 1 mg, zinc 80 mg [as zinc oxide], and copper 2 mg [as cupric oxide]).
  • Alternatively, patients who are not smokers or former smokers may use the standard AREDS formulation, which contains beta-carotene rather than lutein or zeaxanthin. (See ‘Antioxidant vitamins and zinc’ above.)
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