Demand for Anti-VEGF Injections for Retinal Diseases Expected to Surge

The demand for intravitreal vascular endothelial growth factor (VEGF) inhibitor therapy is forecasted to increase by about 50% over the next 5 years in Denmark, due largely to an aging population, a nationwide cohort study showed.

Extrapolating data from 2017 to 2022, there was a projected 50% increase in the number of VEGF injections for neovascular age-related macular degeneration (nAMD), a 56% increase in injections for retinal vein occlusion (RVO), and a 24% increase in injections for diabetic macular edema (DME) in 2027, reported Benjamin Sommer Thinggaard, MD, of the University of Southern Denmark in Odense, and co-authors in a research letter published in JAMA Network Open.

Injections for RVO and nAMD will account for most of the increased demand, given their association with increasing age, they noted. On the other hand, only “a minor increase in injections in patients with DME is expected, given improvements in antidiabetic treatment and early detection of DME during the past 10 years due to the increase in patients with diabetes.”

Brian L. VanderBeek, MD, MPH, of the University of Pennsylvania in Philadelphia, told MedPage Today that “there is likely an overall trend for increasing need for anti-VEGF agents in the developed world over the next 10 years.”

However, “I would say that in the U.S., AMD is the primary driver for anti-VEGF injections, but the second leading cause would be DME/diabetic retinopathy, not RVO,” due to the higher rate of diabetes, and thus, more DME patients, he said.

The study authors noted that the overall use rate of anti-VEGF injections was 13.8 per 1,000 patients, including 9.2 per 1,000 for nAMD, 2.0 per 1,000 for RVO, and 1.6 per 1,000 for DME, with diagnoses not identified for 8.5% of patients.

Beginning in 2019, injection rates increased annually by more than 10,000 injections, from 95,677 in 2019 to 131,010 injections in 2022. “Although the annual incidence of patients with nAMD, RVO, or DME receiving VEGF inhibitor therapy remained consistent between 2019 and 2022, the overall number of injections for nAMD increased from 12,992 in 2019 to 17,338 in 2022,” Thinggaard and team wrote.

They pointed out that the introduction of intravitreal VEGF inhibitor therapy for these three conditions has “halved” the number of people ages 50 and older newly diagnosed with blindness.

“Future development of alternative methods for delivering VEGF inhibitors, such as refillable ports, depots, and implants, could potentially reduce the frequency of individual injections,” they suggested. “Still, the forecasted increase in VEGF inhibitor injections based on these nationwide data might facilitate accurate planning of future ophthalmological services.”

This is being borne out in the U.S., where a large percentage of patients in clinical trials of the recently approved agents faricimab (Vabysmo) and aflibercept 8 mg (Eylea HD) only needed injections every 4 months, said VanderBeek. “Other delivery systems that offer longer-lasting results are also promising, but still farther off into the future (particularly with the withdrawal of the port-delivery system from the U.S. market).”

“The new anti-VEGF additions to the market are extremely promising for reducing the injection frequency burden. In the future, I am excited to see the clinical trial results of the anti-VEGF gene therapy results. I think that has a real possibility of long-term disease quiescence with a single treatment,” VanderBeek added.

For this study, Thinggaard and colleagues used data including birth date, diagnosis codes, and procedure codes for 4,059,802 individuals older than 40 from the Danish National Patient Register and the Danish Civil Registration System from January 2007 through December 2022.

Over this time period, 901,826 anti-VEGF injections were administered to 56,081 Danish patients (median age at initial injection 77.2, 58% women) with a diagnosis of nAMD, RVO, or DME per ICD-10 codes.

The authors acknowledged that the undetermined diagnoses that prompted anti-VEGF injections for 8.5% of the patients was a limitation, “yet this uncertainty does not impact our 5-year projections.”