Adoption patterns of anti-vascular endothelial growth factor therapies in retinal disease.

PURPOSE: To characterize real-world adoption patterns of anti-vascular endothelial growth factor (anti-VEGF) therapies across retinal vascular diseases.

METHODS

This retrospective cohort study identified patients diagnosed with exudative age-related macular degeneration (AMD), diabetic macular edema (DME), or retinal vein occlusion (RVO) within TriNetX. Monthly utilization of ranibizumab, bevacizumab, aflibercept, brolucizumab, and faricimab was measured across each indication. To provide absolute treatment context, we also determined the annual number of unique patients within each disease cohort with at least one documented exposure to any evaluated anti-VEGF agent.

RESULTS

The cohorts included 138,384 AMD patients, 322,865 DME patients, and 105,605 RVO patients. Aflibercept demonstrated sustained long-term utilization across all three indications, whereas faricimab showed rapid early uptake after its introduction. Ranibizumab utilization declined over time, while brolucizumab demonstrated limited and transient uptake. The annual number of patients receiving anti-VEGF treatment increased substantially over the observation period and reached 16,319 in AMD, 12,105 in DME, and 6,873 in RVO in 2023.

CONCLUSION

Real-world adoption of anti-VEGF therapies differs markedly across retinal diseases and agents. Aflibercept demonstrated sustained long-term use, while faricimab showed rapid early uptake. Changes in agent-specific utilization occurred alongside substantial growth in the absolute number of treated patients over the study period, underscoring the importance of interpreting drug-specific trajectories in the context of overall treatment activity.