Modeling Time Effects in Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema – A Mixed Model Analysis of Real-World Data

Objective The primary objective of this study is to present real-world data on the efficiency of diabetic macular edema (DMO) treatment with anti-vascular endothelial growth factor (anti-VEGF) agents. Methods The study included 86 unique eyes from 86 patients who received ≥3 anti-VEGF injections; the mean was 6.49 injections per patient (range 3-10, SD=2.05). The mean age was 66.98 years (SD=9.52) and the mean time in treatment was 12.17 months (SD = 6.5). Data were examined with mixed-effects modeling to account for different time trajectories for treatment in different patients. Results DMO treatment had a larger effect size on central retinal subfield thickness than visual acuity. A longer duration of treatment, a shorter time interval between injections, and better baseline values contributed to better treatment outcomes. Patients who start their treatment earlier in the course of the disease will fare better, as will patients who stay the course and keep a sufficient frequency of treatment injections. Patient gender, age, and type of anti-VEGF agent did not have a meaningful effect on the outcomes. Conclusions The treatment of DMO with VEGF inhibitors was efficacious and well-tolerated in this clinical practice setting. Maximizing patient involvement, addressing missed appointments due to unforeseen circumstances, and adopting a proactive approach will help ensure positive treatment outcomes for the majority of patients.