Predicting the immediate impact of national lockdown on neovascular age-related macular degeneration and associated visual morbidity: an INSIGHT Health Data Research Hub for Eye Health report

OBJECTIVE: Predicting the impact of neovascular age-related macular degeneration (nAMD) service disruption on visual outcomes following national lockdown in the UK to contain SARS-CoV-2. METHODS AND ANALYSIS: This retrospective cohort study includes deidentified data from 2229 UK patients from the INSIGHT Health Data Research digital hub. We forecasted the number of treatment-naïve nAMD patients requiring anti-vascular endothelial growth factor (anti-VEGF) initiation during UK lockdown (16 March 2020 through 31 July 2020) at Moorfields Eye Hospital (MEH) and University Hospitals Birmingham (UHB). Best-measured visual acuity (VA) changes without anti-VEGF therapy were predicted using post hoc analysis of Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD trial sham-control arm data (n=238). RESULTS: At our centres, 376 patients were predicted to require anti-VEGF initiation during lockdown (MEH: 325; UHB: 51). Without treatment, mean VA was projected to decline after 12 months. The proportion of eyes in the MEH cohort predicted to maintain the key positive visual outcome of ≥70 ETDRS letters (Snellen equivalent 6/12) fell from 25.5% at baseline to 5.8% at 12 months (UHB: 9.8%-7.8%). Similarly, eyes with VA <25 ETDRS letters (6/96) were predicted to increase from 4.3% to 14.2% at MEH (UHB: 5.9%-7.8%) after 12 months without treatment. CONCLUSIONS: Here, we demonstrate how combining data from a recently founded national digital health data repository with historical industry-funded clinical trial data can enhance predictive modelling in nAMD. The demonstrated detrimental effects of prolonged treatment delay should incentivise healthcare providers to support nAMD patients accessing care in safe environments. TRIAL REGISTRATION NUMBER: NCT00056836

The impact of chronic hepatitis B infection, antiviral treatment and HIV coinfection on the occurrence of cancer outcomes among U.S. veterans: A retrospective cohort study

Hepatitis B infection is one of the most common viral infections. It is estimated that more than 2 billion people or one third of the world’s population have been infected with hepatitis B virus (HBV). There are around 240 million HBV chronic infected carriers worldwide with more than 780,000 deaths occurring every year. In the United States, there is estimated 12 million infected with HBV and around 1 million are chronically infected. Chronic hepatitis B infection (CHB) is the leading risk factor for liver cirrhosis and hepatocellular carcinoma (HCC). Besides liver-related outcomes, studies suggest that CHB infection is also associated with increased risk of pancreatic cancer, kidney cancer, bile duct cancer, and non-Hodgkin lymphoma. By utilizing automated clinical data from the U.S. Department of Veteran Affairs (VA), which comprises more than 120 medical facilities and serves 5.5 million veterans around the country, my goal is to examine the impact of CHB, antiviral treatment and HIV coinfection on the occurrence of cancer outcomes in the U.S. veteran population. The specific aims are: 1. To compare the incidence rates of HCC, pancreatic cancer, kidney cancer, bile duct cancer, and non-Hodgkin lymphoma between CHB infected patients in the VA and the U.S. general population in Surveillance, Epidemiology, and End Results Program (SEER) regions; 2. To determine the effect of nucleotide analogues on risk of HCC, pancreatic cancer, kidney cancer, bile duct cancer, and non-Hodgkin lymphoma in chronic hepatitis B infected patients eligible for treatment and 3. To determine the effect of HIV coinfection on the risk of developing HBV-related malignancies (HCC, pancreatic cancer, kidney cancer and bile duct cancer and non-Hodgkin lymphoma) in HBV/HIV coinfected patients compared with HBV monoinfected patients. Overall, we found non-Asian CHB patients in VA population had significantly more incident cancer cases (SIR 2.30) than the general population of SEER region regardless of cancer categories except for female breast cancer. Our study also demonstrated that the newer generation of NA has a significant effect on prolonging chronic HBV patient overall survival. However, we did not observe that new NA had a significant protective effect against the risk for getting cancers. As for the effect of HIV/HBV coinfection, we found HIV coinfection is related to reduced overall survival and, therefore, reduced chance of developing cancer because their mean duration to cancer is longer than their mean duration of survival. This study not only helps us to understand the natural history of CHB and additional effects of HIV coinfection on cancer outcomes in a U.S. population but also provides insights into future treatment and control of HBV chronic infection and its associated cancers

Predicting the immediate impact of national lockdown on neovascular age-related macular degeneration and associated visual morbidity: an INSIGHT Health Data Research Hub for Eye Health report.

OBJECTIVE Predicting the impact of neovascular age-related macular degeneration (nAMD) service disruption on visual outcomes following national lockdown in the UK to contain SARS-CoV-2. METHODS AND ANALYSIS This retrospective cohort study includes deidentified data from 2229 UK patients from the INSIGHT Health Data Research digital hub. We forecasted the number of treatment-naïve nAMD patients requiring anti-vascular endothelial growth factor (anti-VEGF) initiation during UK lockdown (16 March 2020 through 31 July 2020) at Moorfields Eye Hospital (MEH) and University Hospitals Birmingham (UHB). Best-measured visual acuity (VA) changes without anti-VEGF therapy were predicted using post hoc analysis of Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD trial sham-control arm data (n=238). RESULTS At our centres, 376 patients were predicted to require anti-VEGF initiation during lockdown (MEH: 325; UHB: 51). Without treatment, mean VA was projected to decline after 12 months. The proportion of eyes in the MEH cohort predicted to maintain the key positive visual outcome of ≥70 ETDRS letters (Snellen equivalent 6/12) fell from 25.5% at baseline to 5.8% at 12 months (UHB: 9.8%-7.8%). Similarly, eyes with VA <25 ETDRS letters (6/96) were predicted to increase from 4.3% to 14.2% at MEH (UHB: 5.9%-7.8%) after 12 months without treatment. CONCLUSIONS Here, we demonstrate how combining data from a recently founded national digital health data repository with historical industry-funded clinical trial data can enhance predictive modelling in nAMD. The demonstrated detrimental effects of prolonged treatment delay should incentivise healthcare providers to support nAMD patients accessing care in safe environments. TRIAL REGISTRATION NUMBER NCT00056836