Importance: Requirements regulating pharmaceutical prescriptions can affect physicians' choice of therapy in a clinical setting. Objective: To evaluate the change in bevacizumab use after the regulatory requirement for @entity1 -specific prescriptions (PSPs) for off-label medications in Ohio. Design, Setting, and @entity1 : This study retrospectively reviewed the aggregate data from the billing records of @entity1 receiving 1.25-mg injections of bevacizumab, 0.3- or 0.5-mg injections of ranibizumab, or 2.0-mg injections of aflibercept for age-related @entity1020 or @entity1103 in a 9-member retinal specialty private practice. The review assessed 4488 intravitreal injections in the 3-month period before ( @entity4456 to July 30, 2012) and 5253 injections in the 3-month period after ( @entity4456 to July 30, 2013) the Ohio Board of Pharmacy's requirement of PSPs for bevacizumab. Relative proportions of the drugs used for intravitreal injections were calculated and frequencies were compared. A Likert scale survey was conducted among the 9 physicians to identify reasons for their change in prescription of bevacizumab. The survey inquired about (1) the burden of PSPs, (2) concern about differences in efficacy, and (3) concern about differences in safety. Main Outcomes and Measures: Difference in drug use before and after the @entity10365 requirement for bevacizumab and the physicians' reasons for change in their drug use. Results: Bevacizumab use decreased from 2752 of 4488 pre- @entity10365 injections (61.3%) to 1503 of 5253 post- @entity10365 injections (28.6%), a change of -32.7% (95% CI, -34.6% to -30.8%; P   <   .001). Use of 0.5-mg ranibizumab injections increased from 1122 of 4488 pre- @entity10365 injections (25.0%) to 1838 of 5253 post- @entity10365 injections (35.0%), a change of 10.0% (95% CI, 8.2% to 11.8%; P   <   .001). Use of 0.3-mg ranibizumab injections increased from 0 of 4488 (before US Food and Drug Administration approval) to 429 of 5253 post- @entity10365 injections (8.2%), a change of 8.2% (95% CI, 7.4% to 8.9%; P   <   .001). Use of aflibercept injections increased from 614 of 4488 pre- @entity10365 injections (13.7%) to 1483 of 5253 post- @entity10365 injections (28.2%), a change of 14.6% (95% CI, 13.0%-16.1%; P   <   .001). In the survey of the 9 physicians concerning their reasons for decreased use of bevacizumab, 7 (78%) strongly agreed and 1 (11%) agreed that the burden of PSPs changed their choice of drug used for injection. Conclusions and Relevance: Use of bevacizumab was reduced by 32.7% 1 year after the regulatory requirement for PSPs for compounded (repackaged) medications. This change seemed to have more association with the requirement for PSPs than with a known change in efficacy or safety concerns. Although this study was based on a single US practice, regulation of repackaged medication for safety concerns should also consider the evaluation of treatment burden, cost, and adherence.

Effect of Regulatory Requirement for XXXX -Specific Prescriptions for Off-Label Medications on the Use of Intravitreal Bevacizumab.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'Participants'] @entity10365 :: ('4477', 'Gene') :: ['PSP'] @entity1103 :: ('MESH:D008269', 'Disease') :: ['diabetic macular edema'] @entity4456 :: ('5580', 'Gene') :: ['May 1'] @entity1020 :: ('MESH:D008268', 'Disease') :: ['macular degeneration']
@entity1 :: (9606,Species) :: ['Patient']
