Cross-Sectional Survey of Real-World Physician Prescribing Practices for Anti-VEGF Agents in the Treatment of Neovascular Age-Related Macular Degeneration and Associated Patient Burden in the United States

Shilpa Gulati,1,2 Emily Coak,3 Daniel Mascia,3 Katherine Li,3 Stella Ko,4 Nicole Gidaya Bonine4 1New England Retina Consultants, Springfield, MA, USA; 2Massachusetts Chan Medical School, University of Massachusetts, Worcester, MA, USA; 3Adelphi Real World, Bollington, UK; 4Genentech, Inc., South San Francisco, CA, USACorrespondence: Emily Coak, Adelphi Real World, Bollington, UK, Email [email protected]: This study aimed to address the lack of data on the real-world use of the anti-vascular endothelial growth factor (VEGF)/anti-angiopoietin 2 agent faricimab and purely anti-VEGF agents in neovascular age-related macular degeneration (nAMD) in the United States.Patients and Methods: Data were derived from the Adelphi Real World nAMD Disease Specific Programme (DSP)™, a cross-sectional survey of patients with nAMD and their treating physicians, conducted in the US November 2023–May 2024. Ophthalmologists provided demographic and clinical data as well as reasons for agent and dosing strategy selection, for patients with nAMD, aged ≥ 55, prescribed anti-VEGF treatment at the time of survey.Results: Sixty-four physicians (90.6% retinal specialists), reported on 497 patients (faricimab, n = 89 patients; anti-VEGF, n = 408 patients). Mean (± standard deviation) age was 76.0 ± 8.5, 52.1% were female and 88.5% White. Most common symptoms at survey were blurred vision (faricimab: 56.2%, anti-VEGF: 67.9%), distortion of central vision (faricimab: 44.9%, anti-VEGF: 50.7%) and loss of visual acuity (faricimab: 39.3%, anti-VEGF: 41.9%). Main reasons for agent selection were clinical factors/efficacy (faricimab 89.9%, anti-VEGF: 93.4%), and treatment administration/compliance (faricimab 71.9%, anti-VEGF: 41.4%), which included improved patient compliance and extended dosing intervals. Faricimab was commonly dosed as treat-and-extend (67.4%) and anti-VEGFs as fixed interval (38.5%). Reasons for dosing strategy selection included improvement in visual acuity, patient functionality, clinical evidence and fewer consultations for the patient. Most physicians agreed/strongly agreed that some insurers restrict (84.4%) or deny (85.9%), access to the most appropriate products for patients.Conclusion: Despite receiving treatment, nAMD patients have substantial remaining symptom and treatment burden. Physicians may choose faricimab over purely anti-VEGF agents for its clinical efficacy and reduced treatment burden. Physicians take both clinical factors and patient burden into account when selecting agents and dosing regimens, while reimbursement concerns hinder prescribing in some patients.Keywords: nAMD, anti-VEGF agents, prescribing practices, patient burden, United States