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Ford JL, Karatza E, Mody H, Nagaraja Shastri P, Khajeh Pour S, Yang TY, Swanson M, Chao D, Devineni D. Clinical Pharmacology Perspective on Development of Adeno-Associated Virus Vector-Based Retina Gene Therapy. Clin Pharmacol Ther 2024; 115:1212-1232. [PMID: 38450707 DOI: 10.1002/cpt.3230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Abstract
Adeno-associated virus (AAV) vector-based gene therapy is an innovative modality being increasingly investigated to treat diseases by modifying or replacing defective genes or expressing therapeutic entities. With its unique anatomic and physiological characteristics, the eye constitutes a very attractive target for gene therapy. Specifically, the ocular space is easily accessible and is generally considered "immune-privileged" with a low risk of systemic side effects following local drug administration. As retina cells have limited cellular turnover, a one-time gene delivery has the potential to provide long-term transgene expression. Despite the initial success with voretigene neparvovec (Luxturna), the first approved retina gene therapy, there are still challenges to be overcome for successful clinical development of these products and scientific questions to be answered. The current review paper aims to integrate published experience learned thus far for AAV-based retina gene therapy related to preclinical to clinical translation; first-in-human dose selection; relevant bioanalytical assays and strategies; clinical development considerations including trial design, biodistribution and vector shedding, immunogenicity, transgene expression, and pediatric populations; opportunities for model-informed drug development; and regulatory perspectives. The information presented herein is intended to serve as a guide to inform the clinical development strategy for retina gene therapy with a focus on clinical pharmacology.
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Affiliation(s)
| | - Eleni Karatza
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Hardik Mody
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | | | - Sana Khajeh Pour
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Tong-Yuan Yang
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Michael Swanson
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Daniel Chao
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
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Enríquez-Fuentes JE, Oribio-Quinto C, Pascual-Santiago MA, Alarcón-García AD, Fernández-Vigo JI. Long-term results of treatment of neovascular age-related macular degeneration using antiangiogenic drugs: A review of the literature. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:195-204. [PMID: 38216049 DOI: 10.1016/j.oftale.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/16/2023] [Indexed: 01/14/2024]
Abstract
Age-related macular degeneration (AMD) is one of the main causes of visual acuity (VA) loss in people over 50 years of age worldwide, with neovascular AMD (nAMD) accounting for 80% of cases of severe vision loss due to this disease. Anti-vascular endothelial growth factor (anti-VEGF) drugs have been used for the treatment of this disease for more than a decade, changing drastically the visual prognosis of these patients. However, initial studies reporting data on outcomes were short term. Currently, there are different series published on the long-term results of AMD after treatment with anti-VEGF, and the aim of this review is to synthesize these results. The mean follow-up of the included studies was 8.2 years (range 5-12 years). The mean initial VA was 55.3 letters in the Early Treatment Diabetic Retinopathy Study (ETDRS) (range 45.6-65) and the mean final VA was 50.1 letters (range 33.0-64.3), with a mean loss of 5.2 letters. At the end of follow-up, 29.4% of the patients maintained a VA > 70 letters. The 67.9% of patients remained stable at the end of follow-up (< 15 letter loss), with a severe loss (≥ 15 letters) of 30.1%. Fibrosis and atrophy were the main causes of long-term VA loss, occurring at the end of follow-up in 52.5% and 60.5%, respectively.
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Affiliation(s)
- J E Enríquez-Fuentes
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.
| | - C Oribio-Quinto
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - M A Pascual-Santiago
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - A D Alarcón-García
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain
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Begaj T, Jeong D, Park JG, Runner MM, Capone A, Dass AB, Drenser KA, Faia LJ, Farley ND, Garretson BR, Hassan TS, Mahmoud TH, Margherio A, Raphaelian PV, Randhawa S, Ruby AJ, Sneed S, Rao P, Wolfe JD, Williams GA. LONG-TERM USE OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2024; 44:222-229. [PMID: 37903288 DOI: 10.1097/iae.0000000000003961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
PURPOSE Although pivotal trials have demonstrated efficacy of anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration, there is a paucity of clinical data about the long-term (>5 years) treatment. METHODS Retrospective analysis of all patients with neovascular age-related macular degeneration who were actively treated, had received >40 anti-vascular endothelial growth factor injections, and were followed for ≥5 years. Snellen-corrected visual acuity, initial drug choice, and times elapsed between treatments were collected. Rates of endophthalmitis and outcomes of submacular hemorrhage were also evaluated. RESULTS A total of 88 patients (162 eyes) met the inclusion criteria: the average patient age was 86.3 years with an average follow-up period of 7.6 years. The average total number of injections per eye was 69 (18.0 SD); a total of 11,208 injections were given throughout the study period, and 6 cases (0.05%) of endophthalmitis were observed. Overall, there was a clinical and statistical difference in average Snellen-corrected visual acuity at Injections #2,#3, #4, #5, #6, #10, and #20, as compared with baseline ( P = 0.03, P < 0.01, P = 0.02, P < 0.01, P = 0.01, P = 0.01, P < 0.01, respectively). Patients in the Snellen-corrected visual acuity subgroup 20/20 to 20/40 maintained vision until injection #30. Seven eyes experienced a visually significant submacular hemorrhage. CONCLUSION This neovascular age-related macular degeneration cohort received on average eight anti-vascular endothelial growth factor injections per year for approximately 8 years; eyes with good (≥20/40) initial baseline vision maintained their visual acuity, whereas those with worse Snellen-corrected visual acuity (≤20/50) had a robust initial improvement that diminished with time. Most patients were maintained on the same initial drug of choice and the rate of endophthalmitis was low.
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Affiliation(s)
- Tedi Begaj
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Daeun Jeong
- Oakland University William Beaumont, Rochester, Michigan
| | - Jong G Park
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Margaret M Runner
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Antonio Capone
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - A Bawa Dass
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Kimberly A Drenser
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Lisa J Faia
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Nathan D Farley
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
| | - Bruce R Garretson
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Tarek S Hassan
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Tamer H Mahmoud
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Alan Margherio
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
| | | | - Sandeep Randhawa
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Alan J Ruby
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Scott Sneed
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Prethy Rao
- Retina and Vitreous of Texas, Houston, Texas
| | - Jeremy D Wolfe
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - George A Williams
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
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Jones R, Stratton IM, Scanlon PH, Theodoropoulou S. Disengagement and loss to follow-up in intravitreal injection clinics for neovascular age-related macular degeneration. Eye (Lond) 2023; 37:3186-3190. [PMID: 36914803 PMCID: PMC10564721 DOI: 10.1038/s41433-023-02474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/24/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND/OBJECTIVES Timely assessment and treatment of patients with neovascular AMD (nAMD) are crucial to preservation of vision. Loss to follow up (LTFU) in these patients is a problem but this has not been systematically investigated. SUBJECTS/METHODS A retrospective review of electronic medical records of patients with nAMD first treated with anti-VEGF therapy from 1st Jan 2014 to 31st Dec 2018, was conducted in January 2021. Any patient not seen for more than 12 months was classed as no longer attending. RESULTS Of the 1328 patients who attended between 2014 and 2018, 348 had failed to attend and were eligible for inclusion in this study. Reasons noted for discontinuation of care: discharged by clinician (33.3%), died (20.7%), moved to another unit outside of area (17.5%), stopped attending due to ill-health (13.5%), discharged due to failure to attend (5.6%) and patient choice to no longer attend (4.6%). There were 16 (4.6%) who did not receive any further appointments despite clinician request for follow-up. After 5 years, 50.5% of patients were no longer attending for treatment. Age was a factor in failure to attend, with 7 out of 12 patients aged >100 years no longer being followed up, compared to 1 out of 11 of 50-59 year-olds. CONCLUSIONS When analysing visual outcomes in an AMD service it is important to characterise the patients who are lost to follow up. The outcomes for this group may be avoidably poor and understanding the factors influencing LTFU rate is crucial to addressing shortcomings in a hospital AMD service.
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Affiliation(s)
- Rebecca Jones
- Gloucestershire Retinal Research Group, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK.
| | - Irene M Stratton
- Gloucestershire Retinal Research Group, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- University of Southampton, Southampton, UK
| | - Peter H Scanlon
- Gloucestershire Retinal Research Group, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- University of Gloucestershire, Cheltenham, UK
| | - Sofia Theodoropoulou
- Gloucestershire Retinal Research Group, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK
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Faes L, Mishra AV, Lipkova V, Balaskas K, Quek C, Hamilton R, Held U, Sim D, Sivaprasad S, Fu DJ. Visual and Anatomical Outcomes of a Single Intravitreal Dexamethasone in Diabetic Macular Edema: An 8 Year Real-World Study. J Clin Med 2023; 12:3878. [PMID: 37373573 DOI: 10.3390/jcm12123878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
IMPORTANCE Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetes mellitus. Intravitreal dexamethasone is a treatment option for patients unsuitable for or non-responsive to anti-angiogenic agents. OBJECTIVE To quantify visual and anatomical outcomes from an initial intravitreal dexamethasone injection over the expected 6-month period of dexamethasone release by the implant. Design and enrolment: This is a retrospective cohort study using electronic medical records of patients reviewed between 1 January 2012 and 1 April 2022. SETTING A tertiary eye-care center in London, United Kingdom; Moorfields Eye Hospital National Healthcare System Foundation Trust. PARTICIPANTS The cohort comprised 418 adult patients with DME who received an initial treatment of 700 µg intravitreal dexamethasone in the study period. Of these, 240 patients met the inclusion criteria of ≥2 hospital visits following initial injection (≥1 beyond 6 months) and no previous ocular corticosteroid treatment or missing assessment at baseline. EXPOSURE(S) Intravitreal dexamethasone implant (700 µg). MAIN OUTCOME(S) AND MEASURE(S) Probability of a positive visual outcome, defined as ≥5 or ≥10 Early Treatment Diabetic Retinopathy Study (ETDRS)-letter gain after treatment when compared to baseline (Kaplan-Meier models). RESULTS From the initial intravitreal dexamethasone injection alone, we observed a >75% chance of gaining ≥5 ETDRS letters and >50% chance of gaining ≥10 ETDRS letters within 6 months. There was less than a 50% chance of sustaining either positive visual outcome beyond 4 months. CONCLUSIONS AND RELEVANCE Most patients can be expected to have a positive visual outcome following an initial injection of dexamethasone implants that subsides within 4 months. Real-world re-treatment was observed to be delayed until after visual benefits were lost in half of the cohort. Further research will be needed to study the effects of delays in re-treatment.
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Affiliation(s)
- Livia Faes
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Amit V Mishra
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | | | - Konstantinos Balaskas
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Chrystie Quek
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Robin Hamilton
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8057 Zurich, Switzerland
| | - Dawn Sim
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
- Genentech Roche, 1 DNA Way, South San Francisco, CA 940980, USA
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Dun Jack Fu
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
- Kings College London, London WC2R 2LS, UK
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Subhi Y, Potapenko I, Hajari JN, la Cour M. Anti-VEGF Treatment of Diabetic Macular Edema in Denmark: Incidence, Burden of Therapy, and Forecasting Analyses. J Pers Med 2023; 13:jpm13030546. [PMID: 36983726 PMCID: PMC10054899 DOI: 10.3390/jpm13030546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The aim of this study was to analyze demographically stratified incidence rates of patients with diabetic macular edema (DME) commenced in anti-VEGF therapy, to study temporal trends, to report the proportion of patients in active therapy over time, and to develop a model to forecast the future number of patients in active treatment. METHODS This was a retrospective registry-based study of all patients with DME who received at least one intravitreal anti-VEGF treatment from 1 January 2007 to 30 June 2022. Population data were extracted from Statistics Denmark. RESULTS This study included 2220 patients with DME who were commenced in anti-VEGF therapy. Demographic analyses revealed higher incidence rates among males than females and among those aged 60-80 years. The number of patients in active treatment followed an exponential decay curve; hence, this was used to mathematically model the number of patients in active therapy. The number of patients in active treatment is expected to stay relatively stable with a minimal increase until the year 2023. CONCLUSIONS This study provides insight into the practical aspects of the anti-VEGF treatment of DME that allow the planning of adequate health services.
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Affiliation(s)
- Yousif Subhi
- Department of Clinical Research, University of Southern Denmark, DK-5230 Odense, Denmark
- Department of Ophthalmology, Rigshospitalet Copenhagen, DK-2600 Glostrup, Denmark
| | - Ivan Potapenko
- Department of Ophthalmology, Rigshospitalet Copenhagen, DK-2600 Glostrup, Denmark
| | - Javad Nouri Hajari
- Department of Ophthalmology, Rigshospitalet Copenhagen, DK-2600 Glostrup, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet Copenhagen, DK-2600 Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
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Lukacs R, Schneider M, Nagy ZZ, Sandor GL, Kaan K, Asztalos A, Enyedi L, Pek G, Barcsay G, Szabo A, Borbandy A, Kovacs I, Resch MD, Papp A. Seven-year outcomes following intensive anti-vascular endothelial growth factor therapy in patients with exudative age-related macular degeneration. BMC Ophthalmol 2023; 23:110. [PMID: 36932356 PMCID: PMC10022151 DOI: 10.1186/s12886-023-02843-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Anti-vascular endothelial growth factor (VEGF) therapy is currently the most effective therapy of exudative age-related macular degeneration (AMD). The aim of this study was to assess long-term benefits of intensive aflibercept and ranibizumab anti-VEGF therapy in patients with exudative AMD. METHODS Two clinical trial sites recruited their original subjects for a re-evaluation 7 years after the baseline visit of the phase-3 Vascular Endothelial Growth Factor (VEGF) Trap-Eye: Investigation of Efficacy and Safety in Wet Age-Related Macular Degeneration (VIEW 2) trial. Forty-seven eyes of 47 patients with AMD originally treated with ranibizumab (14 eyes) or aflibercept (33 eyes) were included. RESULTS Mean number of injections was 17.8 ± 3.0 during participation in the VIEW 2 trial. Fourteen of 47 (30%) eyes were given additional injections with a mean number of 5.7 ± 4.5 after the trial. At a mean follow-up time of 82 ± 5 months best corrected visual acuity (BCVA) remained stable or improved (≤ 10 letters lost) in 55% of patients in the entire study population, in 43% in the ranibizumab group and in 60% in the aflibercept group. In both groups combined mean BCVA was 54 ± 13 letters at baseline, 65 ± 17 letters at the end of the intensive phase and 45 ± 25 letters at the end of follow-up. There was no statistically significant difference in BCVA between the two groups at baseline (p = 0.88) and at the end of follow-up (p = 0.40). Macular atrophy was observed in 96% of eyes, average area was 7.22 ± 6.31 mm2 with no statistically significant difference between groups (p = 0.47). Correlation between BCVA at end-of-follow-up and the area of atrophy was significant (p < 0.001). At the end of follow-up, fluid was detected in 7 of 47 eyes (15%) indicating disease activity. CONCLUSION Long-term efficacy of aflibercept and ranibizumab was largely consistent. Following a two-year intensive therapy with as-needed regimen, BCVA was maintained or improved in almost half of the patients and in the ranibizumab group and more than half of the patients in the aflibercept group with very few injections. In a remarkable proportion of eyes, BCVA declined severely which underlines the need for long-term follow-ups and may indicate a more prolonged intensive therapy. TRIAL REGISTRATIONS VIEW 2 study: ClinicalTrials.gov ID: NCT00637377, date of registration: March 18, 2008. Long-term follow-up: IRB nr.: SE RKEB 168/2022, ClinicalTrials.gov ID: NCT05678517, date of registration: December 28, 2022, retrospectively registered.
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Affiliation(s)
- Regina Lukacs
- Department of Ophthalmology, Flor Ferenc Hospital of Pest County, Kistarcsa, Hungary
| | - Miklos Schneider
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
- grid.475435.4Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Zoltan Zsolt Nagy
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
| | - Gabor Laszlo Sandor
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
| | - Kinga Kaan
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
| | - Antonia Asztalos
- grid.414174.3Department of Ophthalmology, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Lajos Enyedi
- grid.414174.3Department of Ophthalmology, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Gyorgy Pek
- grid.414174.3Department of Ophthalmology, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Gyorgy Barcsay
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
| | - Antal Szabo
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
| | - Agnes Borbandy
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
| | - Illes Kovacs
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
| | - Miklos Denes Resch
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
| | - Andras Papp
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, H-1085 Hungary
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Yao X, Yang H, Han H, Kou X, Jiang Y, Luo M, Zhou Y, Wang J, Fan X, Wang X, Li MJ, Yan H. Genome-wide analysis of genetic pleiotropy and causal genes across three age-related ocular disorders. Hum Genet 2023; 142:507-522. [PMID: 36917350 DOI: 10.1007/s00439-023-02542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
Age-related macular degeneration (AMD), cataract, and glaucoma are leading causes of blindness worldwide. Previous genome-wide association studies (GWASs) have revealed a variety of susceptible loci associated with age-related ocular disorders, yet the genetic pleiotropy and causal genes across these diseases remain poorly understood. By leveraging large-scale genetic and observational data from ocular disease GWASs and UK Biobank (UKBB), we found significant pairwise genetic correlations and consistent epidemiological associations among these ocular disorders. Cross-disease meta-analysis uncovered seven pleiotropic loci, three of which were replicated in an additional cohort. Integration of variants in pleiotropic loci and multiple single-cell omics data identified that Müller cells and astrocytes were likely trait-related cell types underlying ocular comorbidity. In addition, we comprehensively integrated eye-specific gene expression quantitative loci (eQTLs), epigenomic profiling, and 3D genome data to prioritize causal pleiotropic genes. We found that pleiotropic genes were essential in nerve development and eye pigmentation, and targetable by aflibercept and pilocarpine for the treatment of AMD and glaucoma. These findings will not only facilitate the mechanistic research of ocular comorbidities but also benefit the therapeutic optimization of age-related ocular diseases.
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Affiliation(s)
- Xueming Yao
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Hongxi Yang
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Han Han
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xuejing Kou
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yuhan Jiang
- Department of Bioinformatics, The Province and Ministry Co-Sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Menghan Luo
- Department of Bioinformatics, The Province and Ministry Co-Sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Yao Zhou
- Department of Bioinformatics, The Province and Ministry Co-Sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Jianhua Wang
- Department of Bioinformatics, The Province and Ministry Co-Sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Xutong Fan
- Department of Bioinformatics, The Province and Ministry Co-Sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Xiaohong Wang
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China.
| | - Mulin Jun Li
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China. .,Department of Bioinformatics, The Province and Ministry Co-Sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China.
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, 300052, China. .,Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, 300070, China. .,School of Medicine, Nankai University, Tianjin, 300071, China.
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Fu DJ, Hanumunthadu D, Keenan TDL, Wagner S, Balsakas K, Keane PA, Patel PJ. Characterising treatment outcomes of patients achieving quarterly aflibercept dosing for neovascular age-related macular degeneration: real-world clinical outcomes from a large tertiary care centre. Eye (Lond) 2023; 37:779-784. [PMID: 36085360 PMCID: PMC9998641 DOI: 10.1038/s41433-022-02220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/09/2022] [Accepted: 08/16/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To evaluate the proportion of patients achieving a 12-week (q12) aflibercept dosing interval in patients with neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS Retrospective, comparative, non-randomised electronic medical record (EMR) database study of the Moorfields database of treatment-naïve nAMD eyes. Extraction criteria included at least 7 aflibercept injections in first year of treatment, AMD in the diagnosis field of EMR, and minimum of 1 year follow-up data. RESULTS There were 2416 eyes of 2163 patients started on anti-vascular endothelial growth factor (anti-VEGF) between 01-11-2013 & 14-02-2020 who had received at least 7 aflibercept intravitreal injections (electronic database accessed March 2021). Of these, 1674 (68%) eyes of 1537 patients had at least one q12 dosing interval (>=84 and < =98 days between injections) during the first 2 years of treatment. This included 926 (61.8%) female patients and 856 (right eyes age at 1st injection), 936 (62.4%) Caucasian, and 32 (2.1%) Afro-Caribbean patients. The median time to the first q12 injection (95% confidence interval) was 1.76 years (1.70-1.86) with mean (±SD) of 11.8 (±6.0) injections. Visual acuity (ETDRS letters) of the eyes without q12 injection and eyes with a q12 injection was 57.9 ± 14.7 and 56.7 ± 14.8 respectively at baseline, 61.4 ± 18.1 and 63.0 ± 15.9 respectively at 12 months and 61.2 ± 20.1 and 61.1 ± 17.8 respectively at 24 months. CONCLUSION 68% of eyes were able to achieve a q12 injection dose within the first 2 years of treatment. Eyes achieving a q12 injection in the first 2 years achieved a similar visual acuity outcome at both 1 and 2-year follow-up to those unable to do so, with a fewer number of total injections.
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Affiliation(s)
- Dun Jack Fu
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Daren Hanumunthadu
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Tiarnan D L Keenan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MA, USA
| | - Siegfried Wagner
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Konstantinos Balsakas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
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Chaudhary V. Treat & extend in neovascular age-related macular degeneration: how we got here and where do we go next? Eye (Lond) 2023; 37:581-583. [PMID: 36064769 PMCID: PMC9998426 DOI: 10.1038/s41433-022-02221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Varun Chaudhary
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
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RISK FACTORS OF VISION LOSS AND MULTIPLE RECURRENCES IN MYOPIC MACULAR NEOVASCULARIZATION. Retina 2023; 43:275-285. [PMID: 36368028 DOI: 10.1097/iae.0000000000003673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To investigate the factors associated with maximum visual improvement (peak vision) gain and the risk factors of peak vision loss and multiple recurrences in myopic macular neovascularization undergoing antivascular endothelial growth factor therapy. METHODS Retrospective study of 310 eyes with active myopic macular neovascularization and median follow-up of 3.5 years. We defined peak vision gain as the maximum best-corrected visual acuity value reached under treatment and peak vision loss as best-corrected visual acuity never scoring as peak vision. We used multiple-event Prentice, Williams, and Peterson models to compute recurrences' incidence and Cox regression to identify risk factors for peak vision gain, peak vision loss, and multiple recurrences. RESULTS Eyes with worse baseline best-corrected visual acuity {hazard ratio (HR) = 2.59 (95% confidence interval [CI]: 1.63-4.11) for 0.1 logMAR increase, P < 0.001} had higher chance to achieve peak vision. Peak vision was lost in 162 eyes (52%). Older age (HR = 1.22 [95% CI: 1.02-1.43] for 10-year increase, P = 0.02) and recurrences (HR = 1.10 [95% CI: 1.01-1.22] for event, P = 0.04) predicted nonsustained peak vision. Older age (HR = 1.13 [95% CI: 1.04-1.27] for 10-year increase, P = 0.006), larger myopic macular neovascularization (HR = 1.06 [95% CI: 1.01-1.13] for 1-mm 2 increase, P = 0.04), and juxtafoveal location (HR = 1.88 [95% CI: 1.28-2.77] vs. extrafoveal, P = 0.001) predicted multiple recurrences. CONCLUSION Myopic macular neovascularization eyes lose vision mainly because of multiple recurrences. Patients at risk for recurrences should undergo more attentive monitoring to avoid vision loss.
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Mollan SP, Fu DJ, Chuo CY, Gannon JG, Lee WH, Hopkins JJ, Hughes C, Denniston AK, Keane PA, Cantrell R. 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. Br J Ophthalmol 2023; 107:267-274. [PMID: 34518162 PMCID: PMC9887382 DOI: 10.1136/bjophthalmol-2021-319383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/30/2021] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Susan P Mollan
- Ophthalmology, University Hospitals Birmingham, Birmingham, UK
| | - Dun Jack Fu
- Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | - Wen Hwa Lee
- Action Against Age-Related Macular Degeneration, Oxford, UK
| | | | | | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Pearse A Keane
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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13
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Cicinelli MV, Torrioli E, La Franca L, Agrawal H, Barthelmes D, Chhablani J, Chowers I, Foa N, Goldstein M, Mansour A, Muhammed RP, Sivaprasad S, Vilela MAP, Zweifel S, Bandello F, Battaglia Parodi M. Incidence and Risk Factors of Visual Impairment in Patients with Angioid Streaks and Macular Neovascularization. Ophthalmol Retina 2022; 7:431-440. [PMID: 36503161 DOI: 10.1016/j.oret.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To estimate the incidence and risk factors of visual impairment and complications in eyes with macular neovascularization (MNV) because of angioid streaks (ASs). DESIGN Longitudinal multicenter retrospective cohort study. SUBJECTS Patients with AS-associated MNV treated with anti-VEGF agents and a follow-up of > 3 months. METHODS Clinical and MNV characteristics were collected at baseline. Visual acuity (VA) values and the presence of atrophy or fibrosis were collected at each visit. MAIN OUTCOME MEASURES Rate of VA change over time and associated factors; the incidence rate of moderate-to-severe visual impairment (MSVI) and blindness and hazard ratio (HR) of candidate risk factors for MSVI; the incidence rate of fibrosis and macular atrophy. RESULTS Overall, 84 eyes of 66 patients (39 men, 58%) with a mean (standard deviation) age of 55.7 (13.8) years were followed for a mean (standard deviation) of 67.7 (48.5) months. The median number of anti-VEGF doses per eye was 13. The average rate (95% confidence interval [CI]) of visual loss was +0.04 (0.02-0.06) logarithm of the minimum angle of resolution/year (P < 0.001); the visual loss was faster in nonnaive eyes (P = 0.007) and those with better baseline VA (P < 0.001); it was slower in eyes with pattern dystrophy-like features (P = 0.04). The incidence rates (95% CI) of MSVI and blindness were 10.4 (6.88-15)/100-eye-years and 2.33 (1.12-4.29)/100-eye-years. A higher number of injections (HR [95% CI] = 0.45 [0.19-0.94] for receiving ≥ 13 injections vs. < 13; P = 0.03) was protective against MSVI. The incidence rates (95% CI) of fibrosis and macular atrophy were 24.1 (17.5-32.3)/100-eye-years and 14.3 (10.1-19.6)/100-eye-years. CONCLUSIONS Eyes with MNV-related AS had a high rate of visual impairment and propensity to macular fibrosis and atrophy. A higher number of injections yielded better chances of maintaining good VA, suggesting the need for intensive treatment. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Edoardo Torrioli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Lamberto La Franca
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Hitesh Agrawal
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Itay Chowers
- Hadassah Medical Center, and the Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nastasia Foa
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Michaella Goldstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | | | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Manuel A P Vilela
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Battaglia Parodi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Guo Y, Wu J, Zheng X, Yin C, Wu Z. The First-Year Variation in Central Retinal Thickness Predicts Legal Blindness in Patients with Neovascular Age-Related Macular Degeneration. Ophthalmic Res 2022; 66:406-412. [PMID: 36436501 PMCID: PMC10015761 DOI: 10.1159/000528161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Due to its progressive nature, early evaluation and timely prediction of legal blindness are important in patients with neovascular age-related macular degeneration (nAMD). We examined the association between early-stage variation in central retinal thickness (CRT) and long-term visual outcomes in patients with nAMD. METHODS We included 103 nAMD patients who were administered anti-vascular endothelial growth factor (anti-VEGF). Participants were considered qualified if they were (1) 50 years and older, (2) treatment-naïve, (3) received standard anti-VEGF treatment and had complete baseline information. We further excluded patients with less than 1-year follow-up data and those who experienced best corrected visual acuity ≤35. Early-stage variability in CRT was measured as the first-year coefficient of variability (CV) of CRT. Patients were then classified into the high-variability and low-variability groups according to the X-tile. A product-limit plot was used to demonstrate the differences and tested with the log-rank test. The association between first-year variability and visual outcomes was quantified using Cox regression models. Time-to-event primary endpoint was the overall visual preservation (OVP) rate, defined as the time from the first injection to legal blindness, i.e., best corrected visual acuity ≤35 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. RESULTS A threshold of 20% of first-year CV in CRT was used to categorize 76 qualified patients into high variability (35, 46.1%) and low variability (41, 53.9%). The 5- and 10-year OVPs for patients with high versus low variability were 76% versus 48% and 59% versus 22%, respectively. High early-stage CRT variability showed a significantly higher risk of legal blindness. Even after adjusting for the demographic and clinical features, the variability remained significant (HR = 2.39, 95% CI: 1.20-4.78). CONCLUSION First-year variability of CRT was predictive of long-term visual outcomes in patients with nAMD, and 20% of the variability could be used as a clinically convenient threshold to qualitatively classify patients into high- and low-variability groups. The current study is important for identifying high-risk populations and for long-term disease management.
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Affiliation(s)
- Yi Guo
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University., Shanghai, China
| | - Jinye Wu
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xueying Zheng
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University., Shanghai, China
| | - Chang Yin
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University., Shanghai, China
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University., Shanghai, China
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Cho HJ, Jeon YJ, Yoon W, Yoon J, Kim J, Kim JW. Neovascular age-related macular degeneration without exudative recurrence over 24 months after initial remission. Sci Rep 2022; 12:15662. [PMID: 36123375 PMCID: PMC9485132 DOI: 10.1038/s41598-022-19400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022] Open
Abstract
We investigated the characteristics of neovascular age-related macular degeneration (AMD), which rarely recurs after initial remission. This study retrospectively analyzed 392 neovascular AMD patients treated with anti-vascular endothelial growth factor (VEGF). All patients received three monthly loading doses of anti-VEGF injections, followed by a pro re nata (as needed) regimen for 24 months. The baseline characteristics associated with the odds of having no recurrence within 24 months were evaluated using multivariate modeling. After the initial three loading injections over 24 months, 58 (14.8%) eyes showed no exudative recurrence and did not require additional anti-VEGF injections. These patients without exudative recurrence had significantly better best-corrected visual acuity (P = 0.003) and lower central subfoveal thickness (P = 0.035) at 24 months than those with exudative recurrence. Additionally, the incidence of macular atrophy was significantly lower in the former than in the latter (8.6% vs. 21.9%; P = 0.020). Multivariate analysis revealed that younger age (odds ratio [OR], 0.901; P = 0.033), smaller lesion size (OR, 0.589; P = 0.016), and absence of fibrovascular pigment epithelial detachment (PED) (OR, 1.349; P = 0.028) were associated with higher odds of no recurrence during follow-up. Approximately 15% of the neovascular AMD patients showed no exudative recurrence after initial remission during the 24-month follow-up. The infrequent recurrence after initial remission correlated with younger age, smaller lesion size, and absence of fibrovascular PED.
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Affiliation(s)
- Han Joo Cho
- Kim's Eye Hospital, Konyang University College of Medicine, 156, 4ga, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul, South Korea.
| | - Young Joon Jeon
- Kim's Eye Hospital, Konyang University College of Medicine, 156, 4ga, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul, South Korea
| | - Wontae Yoon
- Kim's Eye Hospital, Konyang University College of Medicine, 156, 4ga, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul, South Korea
| | - Jihyun Yoon
- Kim's Eye Hospital, Konyang University College of Medicine, 156, 4ga, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul, South Korea
| | - Jaemin Kim
- Kim's Eye Hospital, Konyang University College of Medicine, 156, 4ga, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul, South Korea
| | - Jong Woo Kim
- Kim's Eye Hospital, Konyang University College of Medicine, 156, 4ga, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul, South Korea
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Ciulla TA, Hussain RM, Taraborelli D, Pollack JS, Williams DF. Longer-Term Anti-VEGF Therapy Outcomes in Neovascular Age-Related Macular Degeneration, Diabetic Macular Edema, and Vein Occlusion-Related Macular Edema: Clinical Outcomes in 130 247 Eyes. Ophthalmol Retina 2022; 6:796-806. [PMID: 35381391 DOI: 10.1016/j.oret.2022.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE The clinical practice visual acuity (VA) outcomes of anti-VEGF therapy for up to 5 years were assessed in patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), branch retinal vein occlusion-related macular edema (BRVO-ME), and central retinal vein occlusion-related macular edema (CRVO-ME). DESIGN A retrospective analysis was performed using the Vestrum Health Retina Database. PARTICIPANTS Treatment-naive patients with nAMD, DME, BRVO-ME, or CRVO-ME who received anti-VEGF injections between 2014 and 2019 and had follow-up data for ≥12 months. METHODS Data on age, sex, the number of anti-VEGF treatments, and VA were analyzed. MAIN OUTCOME MEASURES Mean VA change up to 3 years (BRVO-ME and CRVO-ME) and 5 years (nAMD and DME). RESULTS At 1, 3, and 5 years, in 67 666, 21 305, and 5208 eyes with nAMD, after a mean of 7.6, 19.5, and 32 injections, there was a mean change of +3.1, -0.2, and -2.2 letters, respectively. At 1, 3, and 5 years, in 40 832, 7728, and 1192 eyes with DME, after a mean of 6.2, 15.4, and 26.0 injections, there was a mean change of +4.7, +3.3, and +3.1 letters, respectively. At 1 and 3 years, in 12 451 and 3027 eyes with BRVO-ME, after a mean of 7.1 and 18.2 injections, there was a mean change of +9.5 and +7.7 letters, respectively. At 1 and 3 years, in 9298 and 2264 eyes with CRVO-ME, after a mean of 7.3 and 18.8 injections, there was a mean change of +8.3 and +6.0 letters, respectively (P < 0.01 for all VA changes of > 1 letter). In all 4 conditions, the mean VA increased with the mean number of anti-VEGF injections, eyes with a baseline VA of 20/40 or better tended to lose VA, and eyes with progressively worse baseline VA experienced a progressively greater VA gain at 3 years. CONCLUSIONS In practice, patients with nAMD, DME, BRVO-ME, and CRVO-ME showed limited visual outcomes, with patients with nAMD tending to lose VA at 3 and 5 years. Across all 4 disorders, the mean change in VA correlated with treatment intensity at 1, 3, and 5 years. Patients with better baseline VA are more vulnerable to vision loss.
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Affiliation(s)
- Thomas A Ciulla
- Indiana University School of Medicine, Indianapolis, Indiana.
| | | | | | - John S Pollack
- Illinois Retina Associates, Chicago, IL; Vestrum Health, Naperville, Illinois
| | - David F Williams
- Vestrum Health, Naperville, Illinois; VitreoRetinal Surgery, PA, Minneapolis, Minnesota
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Kim JH, Kim JW, Kim CG. Development of subretinal hemorrhage after treatment discontinuation for neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3231-3239. [PMID: 35612614 DOI: 10.1007/s00417-022-05702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/02/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate the incidence, risk factors, and their influence on visual outcomes of subretinal hemorrhage (SRH) in patients with neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy(PCV) who discontinue treatment. METHODS This retrospective study included 148 patients with nAMD and PCV who discontinued treatment. The development of a 3-disc area or greater extent of SRH after treatment discontinuation was identified. Visual acuity at the final visit was compared between patients with and those without SRH. Factors associated with SRH were then analyzed. RESULTS During the mean 56.8 ± 18.2 months of follow-up, treatment was discontinued at a mean 24.1 ± 16.3 months after diagnosis. SRH developed in 24 (16.2%) patients at a mean 21.5 ± 17.6 months after treatment discontinuation. The visual acuity at the final follow-up was significantly worse in patients with SRH than in those without SRH (P < 0.001). There was a significant difference in the incidence of SRH among the different types of macular neovascularization (MNV) (P = 0.024). In particular, the incidence of type 3 MNV was relatively high (36.0%). CONCLUSIONS The development of SRH may lead to very poor visual prognosis in patients who discontinue treatment. The high risk of SRH in type 3 MNV suggests the need for caution when choosing treatment discontinuation in cases of type 3 MNV.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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Neovascular age-related macular degeneration in which exudation predominantly occurs as a subretinal fluid during anti-vascular endothelial growth factor treatment. Sci Rep 2022; 12:3167. [PMID: 35210516 PMCID: PMC8873256 DOI: 10.1038/s41598-022-07108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/03/2022] [Indexed: 11/11/2022] Open
Abstract
We investigated the characteristics of neovascular age-related macular degeneration (AMD) in which exudation predominantly occurs as a subretinal fluid (SRF) during anti-vascular endothelial growth factor (VEGF) treatment. A total of 509 treatment-naïve neovascular AMD patients treated with anti-VEGF for 24 months were retrospectively analyzed. The baseline characteristics to determine the odds of occurrence of SRF alone were evaluated using multivariate modeling. SRF was the sole manifestation of lesion activity in 209 (40.9%) eyes during follow-up. The visual outcome of eyes with only SRF occurrence during follow-up was comparable to that of eyes without exudative recurrence. In addition, the incidence of macular atrophy was significantly lower in eyes with only SRF occurrence (9.6%, 20 of 208 eyes) than in eyes without exudative recurrence (16.7%, 9 of 54 eyes, P = 0.018). Multivariate analysis revealed that better best-corrected visual acuity (BCVA) at baseline (odds ratio [OR], 0.306; P = 0.001), presence of SRF alone at baseline (OR, 5.256; P < 0.001), lower pigment epithelial detachment (PED) height (less than 100 µm; OR, 4.113; P = 0.025), and aneurysmal type 1 macular neovascularization (MNV) (OR, 2.594; P = 0.002) were associated with an increased likelihood of SRF occurrence during follow-up. In conclusion, the eyes with only SRF occurrence during anti-VEGF treatment showed more favorable visual outcomes and a lower incidence of macular atrophy. The baseline characteristics, including better baseline BCVA, presence of SRF alone at baseline, lower PED height, and MNV subtype, might influence the predominant development of SRF during anti-VEGF treatment.
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Cho HJ, Yoon W, Yoon J, Na SK, Lee J, Kim J, Kim CG, Kim JW. Development of Intraretinal Fluid in Neovascular Age-Related Macular Degeneration During Anti-Vascular Endothelial Growth Factor Treatment. Am J Ophthalmol 2022; 234:6-14. [PMID: 34339661 DOI: 10.1016/j.ajo.2021.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To identify the risk factors of intraretinal fluid (IRF) development during anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD). DESIGN Retrospective cohort study. METHODS A total of 425 treatment-naïve patients with neovascular AMD who completed 24 months of follow-up were enrolled. All patients were treated with an initial series of 3 monthly loading doses of anti-VEGF injections, followed by further injections as required. Baseline characteristics were evaluated using multivariate modeling to determine the potential risk factors for IRF development. RESULTS IRF occurred in 40.2% (171/425 eyes) of all participants during the maintenance phase after the loading injections. The development of IRF during follow-up negatively affected visual outcomes regardless of the presence of IRF at baseline. Multivariate analysis showed that larger areas of choroidal neovascularization (odds ratio [OR] 1.360; P < .001), the presence of IRF at baseline (OR 5.469; P < .001), and the presence of fibrovascular pigment epithelial detachment (OR 2.043; P = .022) were associated with an increased risk of IRF during follow-up. Type 1 (OR 2.005; P = .037) and type 2 macular neovascularization (MNV) (OR 2.643; P = .009) were also associated with a higher risk of IRF than aneurysmal type 1 MNV/polypoidal choroidal vasculopathy. CONCLUSIONS The development of IRF during anti-VEGF treatment for neovascular AMD has additional negative effects on visual outcomes regardless of the presence of IRF at baseline. Baseline risk factors, including choroidal neovascularization size, presence of IRF at baseline, presence of fibrovascular pigment epithelial detachment, and MNV subtype may influence the development of IRF during anti-VEGF treatment.
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Affiliation(s)
- Han Joo Cho
- From Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea.
| | - Wontae Yoon
- From Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jihyun Yoon
- From Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Seung Kwan Na
- From Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jihyun Lee
- From Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jaemin Kim
- From Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- From Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jong Woo Kim
- From Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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20
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Aflibercept in clinical practice; visual acuity, injection numbers and adherence to treatment, for diabetic macular oedema in 21 UK hospitals over 3 years. Eye (Lond) 2022; 36:72-77. [PMID: 34244672 PMCID: PMC8727672 DOI: 10.1038/s41433-021-01625-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/23/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Randomised controlled trials provide evidence that a treatment works. Real world evidence is required to assess if proven treatments are effective in practice. METHOD Retrospective data collection on patients given aflibercept for diabetic macular oedema over 3 years from 21 UK hospitals: visual acuity (VA); Index of multiple deprivation score (IMD); injection numbers; protocols used, compared as a cohort and between sites. RESULTS Complete data: 1742 patients (from 2196 eligible) at 1 year, 860 (from 1270) at 2, 305 (from 506) at 3 years. The median VA improved from 65 to 71, 70, 70 (ETDRS letters) at 1, 2 and 3 years with 6, 9 and 12 injections, respectively. Loss to follow-up: 10% 1 year, 28.8% at 3. Centres varied: baseline: mean age 61-71 years (p < 0.0001); mean IMD score 15-37 (p < 0.0001); mean VA 49-68 (p < 0.0001). Only four centres provided a loading course of five injections at monthly intervals and one 6. This did not alter VA outcome at 1 year. Higher IMD was associated with younger age (p = 0.0023) and worse VA at baseline (p < 0.0001) not total number of injections or change in VA. Lower starting VA, higher IMD and older age were associated with lower adherence (p = 0.0010). CONCLUSIONS The data showed significant variation between treatment centres for starting age, VA and IMD which influenced adherence and chances of good VA. Once treatment was started IMD did not alter likelihood of improvement. Loading dose intensity did not alter outcome at one year.
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21
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Sarkar A, Junnuthula V, Dyawanapelly S. Ocular Therapeutics and Molecular Delivery Strategies for Neovascular Age-Related Macular Degeneration (nAMD). Int J Mol Sci 2021; 22:10594. [PMID: 34638935 PMCID: PMC8508687 DOI: 10.3390/ijms221910594] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of vision loss in geriatric population. Intravitreal (IVT) injections are popular clinical option. Biologics and small molecules offer efficacy but relatively shorter half-life after intravitreal injections. To address these challenges, numerous technologies and therapies are under development. Most of these strategies aim to reduce the frequency of injections, thereby increasing patient compliance and reducing patient-associated burden. Unlike IVT frequent injections, molecular therapies such as cell therapy and gene therapy offer restoration ability hence gained a lot of traction. The recent approval of ocular gene therapy for inherited disease offers new hope in this direction. However, until such breakthrough therapies are available to the majority of patients, antibody therapeutics will be on the shelf, continuing to provide therapeutic benefits. The present review aims to highlight the status of pre-clinical and clinical studies of neovascular AMD treatment modalities including Anti-VEGF therapy, upcoming bispecific antibodies, small molecules, port delivery systems, photodynamic therapy, radiation therapy, gene therapy, cell therapy, and combination therapies.
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Affiliation(s)
- Aira Sarkar
- Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA;
| | | | - Sathish Dyawanapelly
- Department of Pharmaceutical Sciences & Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Mumbai 400019, India
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22
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Phan LT, Broadhead GK, Hong TH, Chang AA. Predictors of Visual Acuity After Treatment of Neovascular Age-Related Macular Degeneration - Current Perspectives. Clin Ophthalmol 2021; 15:3351-3367. [PMID: 34408393 PMCID: PMC8364912 DOI: 10.2147/opth.s205147] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/28/2021] [Indexed: 12/30/2022] Open
Abstract
Visual acuity is a key outcome measure in the treatment of neovascular age-related macular degeneration (nAMD) using anti-vascular endothelial growth factor agents. Large variations in visual responses between individuals within clinical trials and real-world studies may relate to underlying differences in patient and treatment factors. Most notably, a better baseline visual acuity, younger age and smaller choroidal neovascularization lesion size have been strongly associated with achieving better visual outcomes. In addition, there is emerging evidence for other roles including genetic factors and anatomical variables such as fluid status. Apart from patient-related factors, treatments that favor a higher number of injections tend to provide better visual outcomes. Overall, the identification of predictive factors does not currently play an essential role in the clinical management of patients with nAMD. However, they have allowed for the understanding that early detection, timely management and close monitoring of the disease are required to achieve optimal visual outcomes. Further investigation into predictive factors alongside the development of novel therapeutic agents may one day provide a means to accurately predict patient outcomes. Treatment regimens that offer flexible dosing patterns such as the treat-and-extend strategy currently provide a degree of personalization during treatment.
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Affiliation(s)
- Long T Phan
- Sydney Retina, Sydney, New South Wales, Australia.,Discipline of Orthoptics, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Geoffrey K Broadhead
- Sydney Retina, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Andrew A Chang
- Sydney Retina, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
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23
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Yoon WT, Kim JW, Kim CG, Kim JH. Proportion and Reasons for Ineligibility to Re-register for Extended Health Insurance in Neovascular Age-related Macular Degeneration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.7.948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To evaluate the proportion and reasons for ineligibility to re-register for extended health insurance at 5 years in patients diagnosed with neovascular age-related macular degeneration (AMD) and registered for extended health insurance. Methods: This retrospective study was performed in patients diagnosed with neovascular AMD and registered for extended health insurance with follow-up for at least 5 years. The criteria for re-registration for extended health insurance were determined along with the ineligibility for re-registration. Results: In total, 263 patients were included in the analysis. Of these, 148 (56.3%) did not satisfy the criteria for re-registration. No active treatment was performed in 98 patients during the last 6 months of the study period (no recurrence, 51 patients; additional treatment was not considered beneficial due to retinal damage even without disciform scar formation, 44 patients). Macular disciform scar formation was noted in 50 patients (33.8%). Older age (p = 0.013), poor visual acuity (p = 0.004), and retinal angiomatous proliferation (p < 0.001) were associated with ineligibility for re-registration due to severe retinal damage. Conclusions: Among the patients who were initially registered for extended health insurance, 56.3% failed to satisfy the re-registration criteria. The primary reason was advanced retinal damage. The results of this study provide useful information for patient education and to establish long-term treatment strategies.
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Bunce C, Fu DJ, Stratton I. Survival Analysis vs Longitudinal Modeling With Multiple Imputation-a False Dichotomy-Reply. JAMA Ophthalmol 2021; 139:588-589. [PMID: 33830195 DOI: 10.1001/jamaophthalmol.2021.0518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Catey Bunce
- The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Dun Jack Fu
- National Institute for Health and Research Biomedical Centre, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Irene Stratton
- Gloucestershire Retinal Research Group, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom
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25
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VanderBeek BL, Ying GS, Hubbard RA. Survival Analysis vs Longitudinal Modeling With Multiple Imputation-A False Dichotomy. JAMA Ophthalmol 2021; 139:588. [PMID: 33830177 DOI: 10.1001/jamaophthalmol.2021.0508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia
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