Profile of patients treated with intravitreal antiangiogenics in a Brazilian public service with high level of complexity

Rabelo, Isadora Andrade; Soares, Marina Crespo; Torigoe, Andrea Mara Simões

doi:10.5935/0004-2749.2022-0119

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ORIGINAL ARTICLE • Arq. Bras. Oftalmol. 87 (5) • 2024 • https://doi.org/10.5935/0004-2749.2022-0119 copy

Profile of patients treated with intravitreal antiangiogenics in a Brazilian public service with high level of complexity

Perfil de pacientes tratados com antiangiogênicos intravítreo em serviço público brasileiro de alto nível de complexidade

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

Intravitreal antiangiogenic therapy is currently the most invasive ophthalmic procedure performed worldwide. This study aimed to describe the clinical and epidemiological profile of patients undergoing intravitreal antiangiogenic therapy in a tertiary referral hospital in Brazil.

Methods:

This cross-sectional, retrospective, and observational study analyzed medical records of patients who received intravitreal injections of antiangiogenic agents for the treatment of retinal diseases at the ophthalmology outpatient clinic in the Hospital das Clínicas at Unicamp between January and December 2020.

Results:

The study included 429 patients and 514 eyes. The study population was predominantly male (51.28%), white (80.89%), between 50 and 80 years old (mean age, 60.92 years), had complete or incomplete first-grade education (56.88%), and did not belong to the Regional Health Department of which Campinas is a part (78.55%). Bevacizumab was the most commonly used intravitreal injectable medicine (79.38%), pro re nata was the most commonly used treatment regimen (90.27%), and macular edema was the most prevalent pathology indicative of treatment (60.12%), with diabetes etiology accounting for 48.25%. The average number of injections per patient was 3.83, with the macular neovascularization group and the pro re nata group having the highest and lowest with five and three injections, respectively. Treatment adherence was associated with the patient’s pathology, and the macular edema (52.24%) and macular neovascularization (49.48%) groups had the lowest adherence rates.

Conclusions:

This study evaluated the epidemiological and clinical profile of patients undergoing antiangiogenic therapy in a high-complexity public hospital, which is fundamental for a better understanding of the demand for ophthalmic reference service in Brazil, and the analysis of functional results and user adherence profile promotes optimization of indications and leverages the benefits of intravitreal therapy.

Keywords:
Retina; Intravitreal injections; Angiogenesis inhibitors; Macular edema; Retinal neovascularization

	Frequency
Patients treated with antiangiogenics	N	%	95% CI	p-value
Sex
Female	209	48.72	(43.91%, 53.55%)	0.6
Male	220	51.28	(46.45%, 56.09%)
Total	429	100
Age group				<0.001**
<50 years	46	10.72	(8.03%, 14.14%)
50-60 years	87	20.28	(16.64%, 24.46%)
60-70 years	145	33.8	(29.37%, 38.52%)
70-80 years	100	25.64	(21.63% 30.1%)
≥80 years	41	9.56	(7.02%, 12.84%)
Total	429	100
Educational attainment				<0.001**
No schooling	21	4.9	(3.13%, 7.5%)
Complete or incomplete primary education	244	56.88	(52.03%, 61.6%)
Complete or incomplete secondary education	81	18.88	(15.35%, 22.98%)
Complete or incomplete college education	23	5.36	(3.5%, 8.05%)
Not available	60	13.99	(10.92%, 17.72%)
Total	429	100
Race				<0.001**
White	347	80.89	(0.01%, 1.5%)
Brown	59	13.75	(76.77%, 84.43%)
Yellow	1	0.23	(10.71%, 17.46%)
Black	22	5.13	(3.32%, 7.78%)
Total	429	100
Belong to the RHD VII				<0.001**
No	337	78.55	(75.04%, 82.93%)
Yes	92	21.45	(17.07%, 24.96%)
Total	429	100

		Frequency
Pathology group	Pathology subgroup	N	%	95% CI	p-value
Macular edema	Edema secondary to venous occlusion	57	11.09	(55.73%, 64.35%)	<0.001**
	Diabetic macular edema	248	48.25
	Irvine-Gass syndrome	4	0.78
	Total	309	60.12
Macular neovascularization	Aneurysmal type 1 MNV	20	3.89	(17.98%, 25.25%)	0.43
	Neovascular AMD	64	12.45
	Pachyochoroid neovascularization	11	2.14
	MNV of undetermined origin	4	0.78
	Type 3 MNV	2	0.39
	Secondary to degenerative myopia	7	1.36
	Secondary to angioid streaks	2	0.39
	Total	110	21.4
Preoperatively	Preoperatively	29	5.64	(3.88%, 8.1%)	<0.001**
NVG	NVG	60	11.67	(9.09%, 14.84%)	<0.001**
Tumors and vasculopathies	Intraocular metastasis	1	0.19	(0.48%, 2.65%)	<0.001**
	Coats disease	2	0.39
	Choroidal hemangioma	2	0.39
	Eales disease	1	0.19
	Total	6	1.17

	Frequency
Patients treated with antiangiogenics	N%	%	95% CI	p-value
Antiangiogenic medication				<0.001**
Bevacizumab	408	79.38	(75.57%, 82.74%)	<0.001**
Ranibizumab	10	1.95	(0.99%, 3.67%)	<0.001**
Aflibercept	23	4.47	(2.92%, 6.74%)	<0.001**
Switch between antiangiogenics	42	8.17	(6.02%, 10.97%)	<0.001**
Antiangiogenics with com switch to corticosteroids	31	6.03	(4.2%, 8.55%)	<0.001**
Total	514	100
Used treatment regimen				<0.001**
PRN complete or incomplete	464	90.27	(87.3%, 92.63%)	<0.001**
Mixed	19	3.7	(2.3%, 5.82%)	<0.001**
T&E	31	6.03	(4.2% 8.55%)	<0.001**
Total	514	100
Switch between medications				<0.001**
No	441	85.8	(82.41%, 88.64%)
Yes	73	14.2	(11.36%, 17.59%)
Total	514	100

	Pathology group
	Macular Edema		NVG		MNV		Preoperatively		Tumors and vasculopathies
	N	%	N	%	N	%	N	%	N	%	p-value
Adherence to treatment											<0.001**
Yes	128	52.24	46	90.2	48	49.48	20	80	5	83.33
No	117	47.76	5	9.8	49	50.52	5	20	1	16.67
Total	245	100	51	100	97	100	25	100	6	100
Outcome of the therapy											0.117
Lost to follow-up	90	36.73	16	31.37	35	36.08	5	20	1	16.67
Continued in treatment	116	47.35	19	37.25	42	43.3	11	44	4	66.67
Stopped the injection by medical indication	39	15.92	16	31.37	20	20.62	9	36	1	16.67
Total	245	100	51	100	97	100	25	100	6	100

Pathology group	Pathology subgroup	Stability	Improvement	Worsened	Not available
Macular edema	DME	78 (31.45%)	99 (39.92%)	42 (16.94%)	29 (11.69%)
	Irving-Gass syndrome	2 (50%)	1 (25%)	1 (25%)	0
	Secondary to venous occlusion	13 (22.81%)	25 (43.86%)	8 (14.04%)	11 (19.3%)
NGV	NGV	24 (40%)	12 (20%)	17 (28.33%)	7 (11.67%)
MNV	Wet AMD	22 (34.38%)	24 (37.5%)	14 (21.88%)	4 (6.25%)
	Aneurysmal type 1 MNV	6 (30%)	5 (25%)	6 (30%)	3 (15%)
	MNV of undetermined origin	1 (25%)	2 (50%)	0	1 (25%)
	Type 3 MNV	0	0	0	2 (100%)
	Degenerative myopia	2 (28.57%)	3 (42.86%)	1 (14.29%)	1 (14.29%)
	Pachychoroid neovascularization	2 (18.18%)	5 (45.45%)	2 (18.18%)	2 (18.18%)
	Angioid streaks	0	0	2 (100%)	0
Preoperatively	Preoperatively	10 (34.48%)	11 (37.93%)	5 (17.24%)	3 (10.34%)
	Coats disease	1 (50%)	1 (50%)	0	0
Tumors or vasculopathies	Eales disease	0	0	1 (100%)	0
	Choroidal hemangioma	0	1 (50%)	1 (50%)	0
	Intraocular metastasis	0	1 (100%)	0	0
Total	Total	161 (31.32%)	190 (36.96%)	100 (19.46%)	63 (12.26%)

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[1] Corresponding author:Marina Crespo Soares E-mail: marina_c.soares@hotmail.com