Treating Wet Age-Related Macular Degeneration and Diabetic Macular Edema - Episode 7

Selecting the Optimal Anti-VEGF Agent for Wet AMD and DME Treatment

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Nicholas G. Anderson, MD, shares factors to consider when selecting an anti-VEGF agent for treatment of wet AMD and DME.

Jim Kenney, RPh, MBA: What factors do you consider when you’re selecting an anti-VEGF agent? I know Dr. Anderson, you talked about that a little, that you use all of these products in different situations. Can you speak to that a little more specifically in terms of why you might choose one product over another?

Nicholas G. Anderson, MD: Certainly, and again as you said, I do use all these medications, I would say overall with a fairly similar frequency. I think the challenge for us as physicians really in any specialty is how do we take this broad and extensive clinical trial data, mountains and mountains of evidence, and how do we then apply that very broad data to the individual patient sitting in front of us? We can look at real-world data, we can look at FDA-approval trials, we can look at post-marketing trials. In the end, I’m treating the patient who’s in front of me. And again, there is no average patient with macular degeneration. There is no average patient with diabetic macular edema. So I’m always looking to see how can I best care for this patient sitting in the chair in front of me? My treatments are primarily patient centered. As we often say, what medication would I use to treat my own mother? In fact, my own mother does have macular degeneration, so this does hit home for me. For me, efficacy and safety are always my primary decision factors.

Cost is certainly a factor as well. I can have an absolute magical therapy that can cure every disease known to mankind, but if the patient can’t afford it, it doesn’t do that patient any good. And then of course, we also have to consider cost to the health care system at large, rather than just to the patient, because the more we spend on macular degeneration, then perhaps the less money we have as a society to pay for oncology. I’m really still looking at what is the most effective treatment for the patient sitting in front of me, and it can vary quite a bit. I’ll also say that I very frequently will switch therapies. I do use treat and extend primarily, and I often treat patients in what I call cycles. So I may do 3 or 4 injections and then sit back and reevaluate the totality of those 3 to 6 months of therapy. I never try to make a treatment decision or a change in therapy based on 1 treatment. The OCT [optical coherence tomography] may go up a bit, the OCT thickness may go down a bit, vision may go up a few letters, it may go down a few letters, but I really try to look at the big picture, and I try to see how that patient has been doing over the past several months. If the treatment has been effective, I’ll often stick with that same medication. I may try to further extend the interval. If over those several months, the patient is not doing as well as I think they could be doing, I may tighten the interval, or I may switch to a different medication.

Jim Kenney, RPh, MBA: Thank you.

Transcript Edited for Clarity