Key Takeaways
- Aflibercept 2 mg was the most commonly used anti-VEGF agent from 2017 to 2023, accounting for more than half of all injections.
- Overall use of aflibercept and bevacizumab increased over the study period, while ranibizumab use declined.
- Faricimab use rose rapidly after its introduction, showing the largest relative increase between 2022 and 2023.
From 2017 to 2023, aflibercept 2 mg was the most commonly used intravitreal anti-VEGF agent in U.S. ophthalmology, according to a study.
In this retrospective cross-sectional study, researchers examined de-identified data from the Epic Cosmos database, which includes electronic health record information from 238 million patients across all 50 states. Ophthalmology encounters involving intravitreal injections were categorized by medication, diagnosis, and primary insurance payor. Outcomes included the total number of injections per year, rates per 100,000 ophthalmology encounters, and utilization by retinal condition and insurance type.
Between 2017 and 2023, a total of 571,545 anti-VEGF injections were administered. Aflibercept 2 mg accounted for 53.6% of injections, followed by bevacizumab 1.25 mg at 34.8%, ranibizumab at 7.83%, and faricimab 6 mg at 3.43%. Other agents, including brolucizumab, ranibizumab biosimilars, and aflibercept 8 mg, each represented less than 1% of use.
Over the study period, the rate of aflibercept 2 mg use increased from 361.3 to 913.1 injections per 100,000 ophthalmology encounters, while bevacizumab use rose from 274.1 to 538.1. Ranibizumab use declined from 92.4 to 64.0 injections per 100,000 encounters. Faricimab use increased from 37.9 to 189.9 injections per 100,000 encounters between 2022 and 2023.
Insurance-based differences were observed. Medicare patients received aflibercept 2 mg at higher rates than bevacizumab and faricimab, a pattern not observed among commercially insured patients. Among Medicaid patients, use of bevacizumab and aflibercept 2 mg showed a marginally significant difference.
Reference
Malhotra K, Colcombe J, Patil S, et al. U.S. trends of anti-vascular endothelial growth factor use from 2017-2023: An analysis of medicare, medicaid, and commercial insurance. PLoS One. 2026;21(1):e0335390. doi: 10.1371/journal.pone.0335390. PMID: 41529044; PMCID: PMC12798985.
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