Carroll Robert M, Yu Yinxi, VanderBeek Brian L
Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Eur J Ophthalmol. 2020 Jan;30(1):72-80. doi: 10.1177/1120672119827856. Epub 2019 Feb 14.
To determine whether anemia and other demographic or laboratory "risk factors" impact anti-vascular endothelial growth factor treatment in diabetic macular edema patients.
This is a retrospective, time-varying cohort study using a medical claims database to identify new diabetic macular edema patients who had received at least one intravitreal injection of anti-vascular endothelial growth factor. Exclusion occurred for having <2 years in the plan prior to diabetic macular edema diagnosis, any history of proliferative retinopathy or any treatment that is used for diabetic macular edema. Covariates of interest were demographic characteristics, laboratory values, and clinical factors such as previous anti-vascular endothelial growth factor used, number of involved eyes, year of treatment, and time since last injection. Those variables that changed with time were assessed and updated at each visit. The main outcome measure was the odds of receiving treatment at any visit.
In total, 189 new diabetic macular edema patients with follow-up were analyzed, covering 729 visits with 543 (74.5%) receiving treatment. Univariate analysis showed that male gender (odds ratio: 0.54, 95% confidence interval: 0.32-0.91, p = 0.03), every week since last injection (odds ratio: 0.94, 95% confidence interval: 0.91-0.97, p = 0.001), and having two eyes affected (odds ratio: 2.09, 95% confidence interval: 1.10-3.97, p = 0.02) were associated with getting an injection. After multivariate analysis, only time since previous injection with every week that passed reduced the odds on having an injection at the next visit (odds ratio: 0.95, 95% confidence interval: 0.92-0.97, p < 0.001). Anemia was not associated with receiving an injection (odds ratio: 1.05, 95% confidence interval: 0.61-1.80, p = 0.86).
This study used time-varying methodology to better identify which patients will likely need an injection at any one visit. While anemia was not found to impact injections, our results can aid future endeavors that may incorporate clinical visit information in developing a full prediction model to help make diabetic macular edema care more efficient.
确定贫血及其他人口统计学或实验室“危险因素”是否会影响糖尿病性黄斑水肿患者的抗血管内皮生长因子治疗。
这是一项回顾性、随时间变化的队列研究，使用医疗理赔数据库来识别至少接受过一次玻璃体内注射抗血管内皮生长因子的新糖尿病性黄斑水肿患者。在糖尿病性黄斑水肿诊断前计划内时间不足2年、有任何增殖性视网膜病变病史或任何用于糖尿病性黄斑水肿的治疗的患者被排除。感兴趣的协变量包括人口统计学特征、实验室值以及临床因素，如先前使用的抗血管内皮生长因子、受累眼数、治疗年份和上次注射后的时间。对随时间变化的变量在每次就诊时进行评估和更新。主要结局指标是在任何一次就诊时接受治疗的几率。
总共分析了189例有随访的新糖尿病性黄斑水肿患者，涵盖729次就诊，其中543例（74.5%）接受了治疗。单因素分析显示，男性（比值比：0.54，95%置信区间：0.32 - 0.91，p = 0.03）、自上次注射后每周（比值比：0.94，95%置信区间：0.91 - 0.97，p = 0.001）以及双眼受累（比值比：2.09，95%置信区间：1.10 - 3.97，p = 0.02）与接受注射有关。多因素分析后，仅自上次注射后每周过去的时间会降低下次就诊时接受注射的几率（比值比：0.95，95%置信区间：0.92 - 0.97，p < 0.001）。贫血与接受注射无关（比值比：1.05，95%置信区间：0.61 - 1.80，p = 0.86）。
本研究采用随时间变化的方法来更好地确定哪些患者在任何一次就诊时可能需要注射。虽然未发现贫血会影响注射，但我们的结果可为未来在开发完整预测模型时纳入临床就诊信息以提高糖尿病性黄斑水肿治疗效率的努力提供帮助。
