Initial Impact of Loss of Copay Assistance From a National Nonprofit Fund on Outcomes of Retinal Disease

Purpose: Many patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or retinal vein occlusion who have lost copay assistance from the DBA Good Days national charity fund have been forced to switch treatment from branded intravitreal antivascular endothelial growth factor (anti-VEGF) therapy to bevacizumab. This study sought to characterize the short-term impact of these changes on clinical outcomes. Methods: This retrospective study included 89 eyes of 69 patients with nAMD, DME, or retinal vein occlusion who transitioned from receiving branded anti-VEGF therapy (aflibercept 2.0 mg or 8.0 mg; faricimab) to bevacizumab. The primary endpoint was changes from baseline in central subfield thickness (CST) after 1, 2, and 3 injections. Secondary endpoints included changes in best-corrected visual acuity (BCVA), intraocular pressure, intraretinal fluid, subretinal fluid, pigment epithelial detachment, injection intervals, predictors of poor outcome (BCVA loss of ≥15 Early Treatment Diabetic Retinopathy Study letters or CST increase of ≥50 µm), and switchback to branded therapy. Results: From baseline to after the third bevacizumab injection, the CST increased from a mean (±SD) 228.7 ± 52.3 µm to 271.3 ± 40.0 µm in the overall cohort ( P = .004), and from 224.1 ± 50.6 µm to 268.6 ± 38.5 µm among nAMD eyes ( P = .007). The injection interval decreased from a median 8.6 weeks (interquartile range [IQR], 7.0–10.9 weeks) preswitch to 7.5 weeks (IQR, 5.3–9.5 weeks) after 3 injections ( P < .001). Fourteen eyes (15.7%) met the criteria for poor outcome, and 15 (16.9%) were switched back to branded therapy. Worsening intraretinal fluid was an early indicator of suboptimal response, and shorter preswitch injection intervals were a predictor of switching back to branded therapy. Conclusions: Switching from branded anti-VEGF therapy to bevacizumab was associated with anatomic worsening and shorter injection intervals. Shorter preswitch intervals and early postswitch intraretinal fluid changes may help identify patients at risk for poor outcomes.