Addressing Treatment Dilemmas in Neovascular AMD and DME - Episode 1

Navigating Step Edits for Patients Newly Diagnosed with nAMD

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Ehsan Rahimy, MD addresses barriers like step edits with bevacizumab and biosimilars in nAMD, emphasizing the impact of insurance-guided choices on treatment outcomes and advocating for a personalized approach.

This is a video synopsis of a discussion involving Ehsan Rahimy, MD, a retina specialist at the Palo Alto Medical Foundation and adjunct faculty at Stanford University School of Medicine. Dr. Rahimy delves into clinical case scenarios focusing on patients with wet age-related macular degeneration (AMD) and diabetic macular edema (DME).

Case scenario number one involves a 65-year-old Caucasian female diagnosed with neovascular AMD. The patient underwent four monthly injections of bevacizumab, resulting in improved visual acuity from 20/63 to 20/30 and reduction in central subfield thickness (CST) from 533 to 350 microns. Dr. Rahimy emphasizes the importance of assessing optical coherence tomography (OCT) imaging for biomarkers such as intraretinal fluid and pigment epithelial detachment.

Dr. Rahimy discusses the evolving landscape of treatment options, including biosimilars for AMD and DME. Despite the effectiveness of various agents like ranibizumab, aflibercept, and faricimab, cost considerations prompt starting with bevacizumab in many cases. Flexibility exists to switch to preferred agents based on patient response, although payer mandates for biosimilars after bevacizumab failure are increasingly common.

In a cost-conscious environment, physicians often initiate treatment with bevacizumab but retain flexibility to switch to other agents as needed. However, payer preferences for biosimilars following bevacizumab failure pose additional considerations. Dr. Rahimy underscores the importance of recognizing the advancements made with anti-vascular endothelial growth factor (anti-VEGF) therapies while navigating the practicalities of treatment selection and payer preferences in clinical practice.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.