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Hara C, Suzue M, Fujimoto S, Fukushima Y, Sayanagi K, Nishida K, Maruyama K, Sato S, Nishida K. Comparison of Loading Dose between Aflibercept and Faricimab for Neovascular Age-Related Macular Degeneration. J Clin Med 2024; 13:385. [PMID: 38256517 PMCID: PMC10816479 DOI: 10.3390/jcm13020385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Recently, faricimab was approved as the new drug for neovascular age-related macular degeneration (nAMD). We lack the knowledge to choose between the existing drug and this new drug to use for treatment-naïve nAMD cases. In this study, we compared the functional and morphologic effects in loading dose between patients with treatment-naïve nAMD treated with either intravitreal aflibercept (IVA) or intravitreal faricimab (IVF) injection in a clinical setting. METHOD This retrospective study included 30 eyes of 28 patients who started treatment with IVA between June and September 2022 and 30 eyes of 29 patients who were administered IVF between October 2022 and March 2023. All patients received three monthly IVA or IVF. The best corrected visual acuity (BCVA), central retinal thickness (CRT), and the proportion of eyes with residual exudative change at baseline and 1,2, and 3 months after initial treatment were compared between the groups. RESULTS The mean BCVA significantly improved from pre-treatment after the loading dose in the IVA group (0.46 ± 0.46-0.36 ± 0.37, p = 0.0047) but not in the IVF group (0.46 ± 0.41-0.44 ± 0.45, p = 0.60). The mean CRT significantly improved in both groups. The proportion of eyes with residual exudative change was greater in the IVF group than in the IVA group 2 months after the first treatment (p = 0.026). The analysis of cases that achieved complete resolution of exudative changes after the loading dose showed that the IVA group had a significant improvement in the BCVA, whereas the IVF group did not (p = 0.0047 and 0.20, respectively). CONCLUSIONS Although both IVA and IVF significantly improved CRT, the BCVA improved significantly in the IVA group but not in the IVF group.
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Affiliation(s)
- Chikako Hara
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Masaki Suzue
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Satoko Fujimoto
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Yoko Fukushima
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Kaori Sayanagi
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Kentaro Nishida
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Kazuichi Maruyama
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
- Department of Vision Informatics, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
| | - Shigeru Sato
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Kohji Nishida
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita 565-0871, Osaka, Japan
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Hanson RLW, Airody A, Sivaprasad S, Gale RP. Optical coherence tomography imaging biomarkers associated with neovascular age-related macular degeneration: a systematic review. Eye (Lond) 2023; 37:2438-2453. [PMID: 36526863 PMCID: PMC9871156 DOI: 10.1038/s41433-022-02360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/13/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this systematic literature review is twofold, (1) detail the impact of retinal biomarkers identifiable via optical coherence tomography (OCT) on disease progression and response to treatment in neovascular age-related macular degeneration (nAMD) and (2) establish which biomarkers are currently identifiable by artificial intelligence (AI) models and the utilisation of this technology. Following the PRISMA guidelines, PubMed was searched for peer-reviewed publications dated between January 2016 and January 2022. POPULATION Patients diagnosed with nAMD with OCT imaging. SETTINGS Comparable settings to NHS hospitals. STUDY DESIGNS Randomised controlled trials, prospective/retrospective cohort studies and review articles. From 228 articles, 130 were full-text reviewed, 50 were removed for falling outside the scope of this review with 10 added from the author's inventory, resulting in the inclusion of 90 articles. From 9 biomarkers identified; intraretinal fluid (IRF), subretinal fluid, pigment epithelial detachment, subretinal hyperreflective material (SHRM), retinal pigmental epithelial (RPE) atrophy, drusen, outer retinal tabulation (ORT), hyperreflective foci (HF) and retinal thickness, 5 are considered pertinent to nAMD disease progression; IRF, SHRM, drusen, ORT and HF. A number of these biomarkers can be classified using current AI models. Significant retinal biomarkers pertinent to disease activity and progression in nAMD are identifiable via OCT; IRF being the most important in terms of the significant impact on visual outcome. Incorporating AI into ophthalmology practice is a promising advancement towards automated and reproducible analyses of OCT data with the ability to diagnose disease and predict future disease conversion. SYSTEMATIC REVIEW REGISTRATION This review has been registered with PROSPERO (registration ID: CRD42021233200).
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Affiliation(s)
- Rachel L W Hanson
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Archana Airody
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Sobha Sivaprasad
- Moorfields National Institute of Health Research, Biomedical Research Centre, London, UK
| | - Richard P Gale
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
- Hull York Medical School, University of York, York, UK.
- York Biomedical Research Institute, University of York, York, UK.
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3
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Victor AA, Putri YM. Pro re nata versus fixed aflibercept regimen for neovascular age-related macular degeneration: a systematic review and meta-analysis. Int J Retina Vitreous 2022; 8:67. [PMID: 36138445 PMCID: PMC9503225 DOI: 10.1186/s40942-022-00416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aflibercept is a relatively new anti-VEGF used to treat neovascular age-related macular degeneration (AMD). The purpose of this review is to evaluate the effect of pro re nata (PRN) and fixed regimen (bimonthly) of aflibercept injection for neovascular AMD on visual outcomes at 12 months of follow-up. METHODS We conducted a systematic search in PubMed (MEDLINE), Embase, Scopus, and Web of Science, EBSCOHost, and ClinicalTrials.gov databases. Number of injections, number of hospital visit, mean change of best corrected visual acuity (BCVA), mean change of central macular thickness (CMT), and adverse effects of the included studies were evaluated. Meta-analysis were performed using Review Manager 5.4. RESULTS Four studies were selected for meta-analyses synthesis (3 RCT, 1 retrospective study). A total of 197 eyes in PRN group and 241 eyes in the fixed group. All four studies favored fixed regimen with standardized mean difference of 0.56 (95% CI 0.36-0.75, I2 = 0%, p < 0.00001). There was no significant difference in CMT between both group with SMD of 0.17 (95% CI - 0.14-0.48, I2 = 26%, p = 0.28). CONCLUSION The present meta-analysis shows that bimonthly injection of aflibercept for neovascular AMD is superior compared to PRN injection, shown by better improvement in BCVA at 12 months follow-up. However, high risk of bias downgrade the certainty of evidence.
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Affiliation(s)
- Andi Arus Victor
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Yan Martha Putri
- Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Veritti D, Sarao V, Soppelsa V, Danese C, Chhablani J, Lanzetta P. Managing Neovascular Age-Related Macular Degeneration in Clinical Practice: Systematic Review, Meta-Analysis, and Meta-Regression. J Clin Med 2022; 11:jcm11020325. [PMID: 35054021 PMCID: PMC8781865 DOI: 10.3390/jcm11020325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
The use of anti-vascular endothelial growth factor (VEGF) agents has profoundly changed the prognosis of neovascular age-related macular degeneration (nAMD). As clinical experiences have accumulated, it has become mandatory to summarize data to give information that can be useful in everyday practice. We conducted a systematic review to identify randomized controlled trials (RCTs) and observational studies that reported 12-month changes in best-corrected visual acuity (BCVA) in patients with nAMD on anti-VEGF monotherapy. Data were analyzed in a random-effects meta-analysis with BCVA change as the primary outcome. Meta-regression was conducted to evaluate the impact of multiple covariates. Four hundred and twelve heterogeneous study populations (109,666 eyes) were included. Anti-VEGFs induced an overall improvement of +5.37 ETDRS letters at 12 months. Meta-regression showed that mean BCVA change was statistically greater for RCTs (p = 0.0032) in comparison with observational studies. Populations following a proactive regimen had better outcomes than those following a reactive treatment regimen. Mean BCVA change was greater in younger populations, with lower baseline BCVA and treated with a higher number of injections (p < 0.001). Our results confirm that anti-VEGFs may produce a significant functional improvement at 12 months in patients with nAMD.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
| | - Valentina Soppelsa
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Carla Danese
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA 15261, USA;
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
- Correspondence: ; Tel.: +39-04-3255-9907
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Lu Y, Huang W, Zhang Y, Huang X, Zhang X, Ma H, Ren G, Shi F, Kuang L, Yan S, Luo S, Zhang J, He J, Yang W, Gao Z, Leng Y. Factors for Visual Acuity Improvement After Anti-VEGF Treatment of Wet Age-Related Macular Degeneration in China: 12 Months Follow up. Front Med (Lausanne) 2021; 8:735318. [PMID: 34859005 PMCID: PMC8632047 DOI: 10.3389/fmed.2021.735318] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate the treatment solutions and effectiveness of intravitreal ranibizumab (RBZ) or conbercept in patients with wet age-related macular degeneration (wAMD) in a real-life setting in China. Methods: The medical records of 368 patients with wAMD who started RBZ or conbercept treatment between 1 May 2014 and 30 April 2018 were evaluated. All patients were defined on fundus angiography at baseline to determine the subtype of AMD (PCV or CNV). We report visual acuity (VA) and central retinal thickness (CRT) measurements at baseline and 12 months. Results: The average number of anti-VEGF injections was 2.1 ± 1.2. The BCVA improvement of these two groups was similar with a difference of 1.00 letter (95% CI: −1.4~3.4, p = 0.8505). At the end of the study, a BCVA increase of at least 5 letters was determined to be a satisfactory efficacy endpoint. Several factors were related to the possible improvement in the satisfactory efficacy endpoint, including female sex (OR 2.07, 95% CI 1.22~3.51), number of injections (OR 1.40, 95% CI 1.12~1.75) and VA change at the first month (OR 13.75, 95% CI 7.41~25.51). Additionally, some factors were related to the possible reduction in the satisfactory efficacy endpoint, including diabetes (OR 0.27, 95% CI 0.10~0.73) and disease history (OR 0.75, 95% CI 0.57~0.98). Conclusion: Our study demonstrates that anti-VEGF drugs can effectively improve BCVA and reduce CRT in AMD patients. Sex, number of injections, VA change at the first month, diabetes and disease history are the most important factors affecting visual acuity.
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Affiliation(s)
- Yan Lu
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Wenzhi Huang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yuehong Zhang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Xiongfei Huang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Xu Zhang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Haizhi Ma
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Guoliang Ren
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Feng Shi
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Lihui Kuang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Shigang Yan
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Shuke Luo
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Junyan Zhang
- Bothwin Clinical Study Consultant, Redmond, WA, United States
| | - Jingfang He
- Bothwin Clinical Study Consultant, Shanghai, China
| | - Weizhong Yang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zongyin Gao
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yunxia Leng
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
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Ryu G, Noh D, Moon G, Sagong M. Real-World Outcomes of Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration: A Large-Scale Postmarketing Surveillance in Korea. Clin Ophthalmol 2021; 15:3601-3611. [PMID: 34471345 PMCID: PMC8405230 DOI: 10.2147/opth.s324600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To investigate the efficacy and safety of intravitreal aflibercept (IVT-AFL) in Asian patients with neovascular age-related macular degeneration (nAMD) in a real-world clinical setting. PATIENTS AND METHODS In this analysis of a prospective, regulatory, postmarketing surveillance study for IVT-AFL, 3115 patients with nAMD were included and followed for 8 months. The mean changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were analyzed using last observation carried forward method. A post hoc subgroup analysis and a multivariate logistic regression analysis were also performed to assess factors related to treatment outcomes. RESULTS Mean BCVA improved from 0.62 to 0.51 logarithm of minimum angle resolution and mean CRT decreased from 383.3 to 289.7 μm, with a mean of 3.4 injections during the 8-month follow-up. In the subgroup analysis, patients who had received 3 initial monthly doses had significantly better anatomical improvements than those treated as needed. Patients with confirmed polypoidal choroidal vasculopathy (PCV) had significantly better anatomical improvements and better visual recovery than those with other types of nAMD. The multivariate regression analysis demonstrated that age, injection number, PCV, and baseline BCVA were significantly associated with higher odds of gaining 3 lines at 8 months, and sex, injection number, PCV, and baseline CRT were associated with CRT ≤250 µm at 8 months. No new safety findings were identified. CONCLUSION IVT-AFL was effective and well tolerated in a real-world setting with a large number of Asian patients with nAMD. Number of injections and PCV were important determinants for improved treatment outcomes.
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Affiliation(s)
- Gahyung Ryu
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea
- Yeungnam Eye Center, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Donghyoun Noh
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea
- Yeungnam Eye Center, Yeungnam University Hospital, Daegu, Republic of Korea
| | | | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea
- Yeungnam Eye Center, Yeungnam University Hospital, Daegu, Republic of Korea
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Skrzypczak T, Jany A, Bugajska-Abramek E, Bogusławska J, Kowal-Lange A. A Comparative Study of Ranibizumab and Aflibercept for Neovascular Age-Related Macular Degeneration: 12-Month Outcomes of Polish Therapeutic Program in Non-Tertiary Institution. Cureus 2021; 13:e15916. [PMID: 34336421 PMCID: PMC8312781 DOI: 10.7759/cureus.15916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction This single-center study aimed to compare the 12-month treatment outcomes of ranibizumab with that of aflibercept in routine clinical practice. Methods Cohort of patients diagnosed with treatment-naïve neovascular age-related macular degeneration (AMD), treated using either ranibizumab (n = 33 eyes) or aflibercept (n = 44 eyes) monotherapy over a 12-month follow-up period was analyzed. Anonymous data were extracted from the electronic database dedicated to the drug program. Results In the ranibizumab group, there were no statistically significant changes in best-corrected visual acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and central retina thickness (CRT) (µm), between baseline (67.9 ± 8.6 & 384.9 ± 97.9) and at 12 months (67.9 ± 12.1 & 398.9 ± 127.1; P = 0.372 & P = 0.884, respectively). In the aflibercept, there was an improvement in BCVA and reduction in CRT between baseline (64.2 ± 8.1 & 414.3 ± 97.8) and at 12 months (70.7 ± 7.4 & 342.3 ± 71.6; P < 0.001 & P < 0.001, respectively). There was no difference in BCVA between the two groups at either diagnosis (P = 0.101) or 12 months (P = 0.917). Mean number of injections in the ranibizumab group was significantly lower (4.9 ± 1.5) than in the aflibercept group (6.7 ± 1; P < 0.001). Conclusions One initial injection of ranibizumab and then pro re nata (PRN) regimen resulted in stabilization of disease progression. Drug selection and treatment scheme could influence twelve-months outcomes. In the aflibercept group, three initial monthly injections and then every two months provided both significant BCVA improvement and CRT reduction at 12 months of treatment.
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Affiliation(s)
| | - Aleksandra Jany
- Faculty of Medicine, Wroclaw Medical University, Wroclaw, POL
| | - Ewa Bugajska-Abramek
- Department of Ophthalmology, Regional Specialist Hospital in Wroclaw, Research and Development Center, Wroclaw, POL
| | - Joanna Bogusławska
- Department of Ophthalmology, Regional Specialist Hospital in Wroclaw, Research and Development Center, Wroclaw, POL
| | - Agnieszka Kowal-Lange
- Department of Ophthalmology, Regional Specialist Hospital in Wroclaw, Research and Development Center, Wroclaw, POL
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Sagong M, Woo SJ, Lee Y. Real-World Effectiveness, Treatment Pattern, and Safety of Ranibizumab in Korean Patients with Neovascular Age-Related Macular Degeneration: Subgroup Analyses from the LUMINOUS Study. Clin Ophthalmol 2021; 15:1995-2011. [PMID: 34007153 PMCID: PMC8123958 DOI: 10.2147/opth.s303884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To evaluate the real-world effectiveness, treatment patterns, and safety of ranibizumab in Korean patients with neovascular age-related macular degeneration (nAMD). METHODS LUMINOUS™ is a 5-year, global, prospective, observational, open-label study. Adults aged ≥18 years who were either treatment-naïve or prior-treated were enrolled and treated with ranibizumab 0.5 mg as per the local label. Outcome measures included mean (± standard deviation [SD]) changes from baseline in visual acuity (VA) and central retinal thickness (CRT), and rate of ocular and non-ocular adverse events (AEs). RESULTS Overall, 367 Korean patients with nAMD (152 treatment-naïve and 215 prior-treated) were enrolled. The mean (SD) VA changes from baseline at 1-year were +10.1 (±21.77; P=0.0005) and +1.4 (±15.17; P=0.2142) Early Treatment Diabetic Retinopathy Study letters, with mean numbers of injections of 5.2 and 3.4 in the treatment-naïve and prior-treated groups, respectively. VA gains were greater in patients with lower baseline VA, who received a loading dose, and with polypoidal choroidal vasculopathy (PCV). Multivariate logistic regression analyses demonstrated younger age, worse baseline VA, and those who received loading dose being associated with higher odds of any gain in VA at 1 year (P<0.05). Mean (SD) CRT changes from baseline were -126.7 (±174.90) µm (P<0.0001) and +10.8 (±89.62) µm (P=0.5833) in the treatment-naïve and prior-treated groups, respectively, with greater reductions observed in patients with PCV. Ocular and non-ocular AEs were reported in 8.4% (n=31) and 10.1% (n=37) of patients, respectively. CONCLUSION The LUMINOUS study confirms real-world effectiveness and safety of ranibizumab in Korean patients with nAMD; factors including age, baseline VA, and loading-dose were associated with VA gain at one-year post-treatment.
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Affiliation(s)
- Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
PURPOSE To determine the dose-response characteristics of the antivascular endothelial growth factor agents ranibizumab and aflibercept in neovascular age-related macular degeneration using published randomized trials and observational series. METHODS Literature review of published series from 2006 to 2018 as determined from electronic searches of PubMed and the Cochrane Library. Data extracted included treatment strategy, frequency, and first year visual acuity response. Monthly or bimonthly treatment schedules were classified as Fixed, pro re nata studies as PRN, treat and extend as TE, and when no strategy was listed, as Variable. RESULTS Of 2062 citations retrieved, 96 were deemed eligible; these 96 citations provided 120 data points of dose frequency versus visual acuity change in Year 1 of treatment. The dose-response curve was nonlinear, but a log transform of the number of injections per year yielded a linear relationship defined by the expression, Letters of Improvement = -6.66 + 15.7*log (number of injections Year 1). After accounting for the number of injections neither the drug used (ranibizumab or aflibercept) nor the strategy used (Fixed, pro re nata, treat and extend, or Variable) were significant predictors of acuity change. As a group, studies using the pro re nata approach had the lowest number of injections and the worst acuity improvements as a treatment strategy. CONCLUSION There seems to be a predictable, mathematically defined relationship between dose frequency and visual acuity change at 1 year in neovascular age-related macular degeneration. The performance of current treatment efforts, as suggested by reported series and Medicare claims data, seems to be substandard.
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10
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Hanson RLW, Gale RP, Gouws AD, Airody A, Scott MTW, Akthar F, Waterson S, Wells MT, Wright AJ, Bell K, Silson E, Baseler HA, Morland AB. Following the Status of Visual Cortex Over Time in Patients With Macular Degeneration Reveals Atrophy of Visually Deprived Brain Regions. ACTA ACUST UNITED AC 2019; 60:5045-5051. [DOI: 10.1167/iovs.18-25823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Rachel L. W. Hanson
- Department of Psychology, University of York, York, United Kingdom
- York Neuroimaging Centre, University of York, York, United Kingdom
| | - Richard P. Gale
- Department of Health Sciences, University of York, York, United Kingdom
- Academic Unit of Ophthalmology, York Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - André D. Gouws
- York Neuroimaging Centre, University of York, York, United Kingdom
| | - Archana Airody
- Academic Unit of Ophthalmology, York Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | | | - Farah Akthar
- Department of Psychology, University of York, York, United Kingdom
| | - Sophie Waterson
- Department of Psychology, University of York, York, United Kingdom
| | - Mason T. Wells
- Department of Psychology, University of York, York, United Kingdom
| | - Aaron J. Wright
- Department of Psychology, University of York, York, United Kingdom
| | - Kerry Bell
- Department of Psychology, University of York, York, United Kingdom
| | - Edward Silson
- Department of Psychology, University of York, York, United Kingdom
| | - Heidi A. Baseler
- Department of Psychology, University of York, York, United Kingdom
- York Neuroimaging Centre, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | - Antony B. Morland
- Department of Psychology, University of York, York, United Kingdom
- York Neuroimaging Centre, University of York, York, United Kingdom
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Kim S, Park SJ, Byun SJ, Park KH, Suh HS. Incremental economic burden associated with exudative age-related macular degeneration: a population-based study. BMC Health Serv Res 2019; 19:828. [PMID: 31718629 PMCID: PMC6852978 DOI: 10.1186/s12913-019-4666-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The exudative age-related macular degeneration (AMD) causes considerable healthcare costs for patients and healthcare system, which are expected to grow as the population ages. The objective of this study was to assess the incremental economic burden of exudative AMD by comparing total healthcare costs between the exudative AMD group and non-AMD group to understand economic burden related to exudative AMD. METHODS This retrospective cohort study used the National Health Insurance Service database including the entire Korean population. Exudative AMD group included individuals with at least one claim for ranibizumab and one claim using the registration code for exudative AMD (V201). Non-AMD group was defined as individuals without any claims regarding the diagnostic code of H35.3 or ranibizumab. The exudative AMD group and non-AMD group were matched using a propensity-score model. Incremental healthcare resource utilization and healthcare costs were measured during a one-year follow-up by employing econometric models: ordinary least squares (OLS) with log transformation and heteroscedastic retransformation; and generalized linear model (GLM) with a log link function and gamma distribution. RESULTS A total of 7119 exudative AMD patients were matched to 7119 non-AMD patients. The number of outpatient visits was higher in the exudative AMD group (P-value < 0.0001), while the length of hospitalization was shorter in exudative AMD group (P-value < 0.0001). Exudative AMD patients had total costs 2.13 times (95%CI, 2.08-2.17) greater than non-AMD group using OLS, and total costs 4.06 times (95%CI, 3.82-4.31) greater than non-AMD group using GLM. Annual incremental total costs were estimated as $5519 (OLS) and $3699 (GLM). CONCLUSIONS Exudative AMD was associated with significantly increased healthcare costs compared to the non-AMD group. Attention is needed to manage the socioeconomic burden of exudative AMD.
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Affiliation(s)
- Siin Kim
- College of Pharmacy, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.,School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hae Sun Suh
- College of Pharmacy, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan, Republic of Korea.
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12
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Woo SJ, Cho GE, Cho JH. Short-term Efficacy and Safety of Ranibizumab for Neovascular Age-related Macular Degeneration in the Real World: A Post-marketing Surveillance Study. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:150-166. [PMID: 30977325 PMCID: PMC6462474 DOI: 10.3341/kjo.2018.0081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/19/2018] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate the short-term efficacy and safety of ranibizumab in the routine clinical setting in patients with neovascular age-related macular degeneration and to analyze the associated factors for visual outcome. Methods This was a post-hoc analysis of a ranibizumab regulatory post-marketing surveillance study in which 4,136 patients were enrolled and followed for 12 weeks. Change in best-corrected visual acuity (BCVA), size of choroidal neovascularization, and the presence of hemorrhage and exudate were analyzed and the association between BCVA change and baseline characteristics were investigated. Data on ocular and systemic adverse events were collected. Results Mean BCVA improved significantly and mean BCVA change was the logarithm of the minimal angle of resolution 0.13 ± 0.01 (p < 0.001). A lower baseline BCVA and younger age were significant predictive factors for visual improvement or maintenance (≥0 lines). For greater visual acuity gain (≥3 lines), no treatment history, lower baseline BCVA, younger age, and classic-type choroidal neovascularization were significant predictive factors. No new safety signals were found. Conclusions In this study, conducted in real-world clinical practice with a large number of neovascular age-related macular degeneration patients, visual and anatomical outcomes improved significantly after three monthly ranibizumab treatments. Treatment-naive patients had a higher chance of greater visual gain (≥3 lines) than non-naive patients.
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Affiliation(s)
- Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | | | - Joon Hee Cho
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.,Hyemin Eye Hospital, Seoul, Korea
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13
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Papadopoulos Z. Aflibercept: A review of its effect on the treatment of exudative age-related macular degeneration. Eur J Ophthalmol 2019; 29:368-378. [PMID: 30813810 DOI: 10.1177/1120672119832432] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Considerable improvement has been achieved in the way in which exudative age-related macular degeneration is conventionally treated and in the associated visual outcomes and prognosis, thanks to the agents with effects against vascular endothelial growth factor (anti-VEGF). By comparison to earlier treatment approaches that involved the use of lasers, the anti-VEGF agents have made it possible to accomplish more positive visual and anatomical outcomes in cases of exudative age-related macular degeneration. Indeed, owing to their positive effects, anti-VEGF agents have quickly come to be considered the gold standard for the treatment of wet age-related macular degeneration. Aflibercept, the most recently approved intravitreally administered anti-VEGF, seems to mark another milestone in the treatment of wet age-related macular degeneration. This anti-VEGF agent presents a series of singular pharmacodynamic and pharmacokinetic attributes that provide it a number of biological benefits in relation to the treatment of choroidal neovascularization compared to other agents. These attributes include high level of affinity for the VEGF-A factor, an intravitreal half-life of great length, as well as the ability to serve as an antagonist for other growth factors besides VEGF. The impact of Aflibercept on the manner in which exudative age-related macular degeneration is managed was demonstrated by thoroughly reviewing the related literature. The present review article highlights the pharmacology, pharmacokinetics, safety and effectiveness of this anti-VEGF agent as well as the landmark clinical studies that have been carried out to establish this drug as a gold standard in the therapy of neovascular age-related macular degeneration. In addition, studies regarding the outcomes and effectiveness of the various dosage regimens, either as monotherapy or in combination with other agents, are also reviewed.
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Affiliation(s)
- Zois Papadopoulos
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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14
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Guo MY, Cheng J, Etminan M, Zafari Z, Maberley D. One year effectiveness study of intravitreal aflibercept in neovascular age-related macular degeneration: a meta-analysis. Acta Ophthalmol 2019; 97:e1-e7. [PMID: 30030923 DOI: 10.1111/aos.13825] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 04/13/2018] [Indexed: 12/20/2022]
Abstract
The current body of evidence on the efficacy and safety of aflibercept for age-related macular degeneration (AMD) is steadily growing as large clinical trials and observational studies are continually completed. Our aim was to analyse 1-year visual acuity (VA) outcomes in response to aflibercept therapy and identify factors affecting treatment response using evidence generated from a pooled analysis of current studies. A literature review of multiple electronic databases (EMBASE, MEDLINE, MedMEME) revealed 12 studies meeting inclusion and exclusion criteria for statistical analysis. Treatment posology, baseline patient characteristics, study type, sample size and 12-month change in VA were pooled in a meta-analysis with VA change as the main outcome. Data were then stratified by study design and posology in subgroup analyses. A meta-regression was conducted to regress 12-month VA change against posology, baseline VA and age. Users of aflibercept experienced an overall increase of 7.37 letters (95% confidence interval: 6.27-8.48, p heterogeneity: <0.001) in VA at 12 months of follow-up. In subgroup analyses, mean VA change was higher for randomized control trials and cohorts following regular posology (>7 injections/year) compared to observational studies and irregular posology. The meta-regression showed larger VA gains with regular posology compared to an irregular posology, and decreased effect size as age increased. This meta-analysis strongly suggests improved VA outcomes at 12 months in patients with wet AMD for 2.0 mg aflibercept, comparable to but slightly lower than landmark trials. Increased injection frequency and younger age demonstrates a trend with improved outcomes.
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Affiliation(s)
- Michael Y. Guo
- Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Jasmine Cheng
- Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver BC Canada
| | - Zafar Zafari
- University of Maryland School of Pharmacy; Baltimore MD USA
| | - David Maberley
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver BC Canada
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15
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Guo MY, Etminan M, Cheng JZ, Zafari Z, Maberley DAL. One-Year Effectiveness Study of Intravitreous Ranibizumab in Wet (Neovascular) Age-Related Macular Degeneration: A Meta-Analysis. Pharmacotherapy 2018; 38:197-204. [PMID: 29286545 DOI: 10.1002/phar.2079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The clinical efficacy of ranibizumab has been examined by a large number of prospective and retrospective studies to date. This meta-analysis was conducted to summarize the current body of evidence on visual acuity (VA) changes with use of ranibizumab in the treatment of wet (neovascular) age-related macular degeneration (wAMD). METHODS A literature review of multiple electronic databases (EMBASE, MEDLINE, MedMEME) was conducted to find randomized controlled trials (RCTs) and observational studies that reported changes in VA while patients with wAMD were on ranibizumab. Study factors analyzed were baseline patient characteristics, study type, sample size, and 12-month change in VA. Data were pooled in a meta-analysis with VA change as the main outcome. Data were then stratified by study design and a meta-regression was conducted to assess 12-month VA change against baseline VA and age. RESULTS A total of 42 studies were included for analysis. An overall increase of 5.58 letters (95% confidence interval [CI]: 4.42-6.75; p heterogeneity, < 0.001) was shown with use of ranibizumab compared to baseline. Improvements in VA were larger for RCTs, at 7.71 letters (95% CI: 6.66-8.76; p heterogeneity, 0.013), compared to observational studies, at 4.85 letters (95% CI: 3.32-6.38; p heterogeneity, < 0.001). The meta-regression showed a significant decrease in effect size between baseline VA and 12-month VA change. CONCLUSION This meta-analysis suggests visual improvements at 12 months of 0.5-mg ranibizumab use in patients with wAMD. A higher gain in VA was observed when pooling results from RCTs compared to those in observational studies.
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Affiliation(s)
- Michael Y Guo
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmine Z Cheng
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zafar Zafari
- Mailman School of Public Health, Columbia University, New York, New York
| | - David A L Maberley
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Lin JB, Apte RS. NAD + and sirtuins in retinal degenerative diseases: A look at future therapies. Prog Retin Eye Res 2018; 67:118-129. [PMID: 29906612 PMCID: PMC6235699 DOI: 10.1016/j.preteyeres.2018.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022]
Abstract
Retinal degenerative diseases are a major cause of morbidity in modern society because visual impairment significantly decreases the quality of life of patients. A significant challenge in treating retinal degenerative diseases is their genetic and phenotypic heterogeneity. However, despite this diversity, many of these diseases share a common endpoint involving death of light-sensitive photoreceptors. Identifying common pathogenic mechanisms that contribute to photoreceptor death in these diverse diseases may lead to a unifying therapy for multiple retinal diseases that would be highly innovative and address a great clinical need. Because the retina and photoreceptors, in particular, have immense metabolic and energetic requirements, many investigators have hypothesized that metabolic dysfunction may be a common link unifying various retinal degenerative diseases. Here, we discuss a new area of research examining the role of NAD+ and sirtuins in regulating retinal metabolism and in the pathogenesis of retinal degenerative diseases. Indeed, the results of numerous studies suggest that NAD+ intermediates or small molecules that modulate sirtuin function could enhance retinal metabolism, reduce photoreceptor death, and improve vision. Although further research is necessary to translate these findings to the bedside, they have strong potential to truly transform the standard of care for patients with retinal degenerative diseases.
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Affiliation(s)
- Jonathan B Lin
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA; Neuroscience Graduate Program, Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Rajendra S Apte
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA; Neuroscience Graduate Program, Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, USA.
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17
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Kim JH, Chang YS, Kim JW, Kim CG, Lee DW. Early Recurrent Hemorrhage in Submacular Hemorrhage Secondary to Type 3 Neovascularization or Retinal Angiomatous Proliferation: Incidence and Influence on Visual Prognosis. Semin Ophthalmol 2018; 33:820-828. [DOI: 10.1080/08820538.2018.1511814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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18
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Lin JB, Sene A, Santeford A, Fujiwara H, Sidhu R, Ligon MM, Shankar VA, Ban N, Mysorekar IU, Ory DS, Apte RS. Oxysterol Signatures Distinguish Age-Related Macular Degeneration from Physiologic Aging. EBioMedicine 2018; 32:9-20. [PMID: 29903570 PMCID: PMC6021272 DOI: 10.1016/j.ebiom.2018.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 01/16/2023] Open
Abstract
Macrophage aging is pathogenic in numerous diseases, including age-related macular degeneration (AMD), a leading cause of blindness in older adults. Although prior studies have explored the functional consequences of macrophage aging, less is known about its cellular basis or what defines the transition from physiologic aging to disease. Here, we show that despite their frequent self-renewal, macrophages from old mice exhibited numerous signs of aging, such as impaired oxidative respiration. Transcriptomic profiling of aged murine macrophages revealed dysregulation of diverse cellular pathways, especially in cholesterol homeostasis, that manifested in altered oxysterol signatures. Although the levels of numerous oxysterols in human peripheral blood mononuclear cells and plasma exhibited age-associated changes, plasma 24-hydroxycholesterol levels were specifically associated with AMD. These novel findings demonstrate that oxysterol levels can discriminate disease from physiologic aging. Furthermore, modulation of cholesterol homeostasis may be a novel strategy for treating age-associated diseases in which macrophage aging is pathogenic.
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Affiliation(s)
- Jonathan B Lin
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA; Neuroscience Graduate Program, Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Abdoulaye Sene
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrea Santeford
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Hideji Fujiwara
- Diabetic Cardiovascular Disease Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rohini Sidhu
- Diabetic Cardiovascular Disease Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Marianne M Ligon
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Vikram A Shankar
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Norimitsu Ban
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Indira U Mysorekar
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA; Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel S Ory
- Diabetic Cardiovascular Disease Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rajendra S Apte
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA; Diabetic Cardiovascular Disease Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, USA.
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Popa-Cherecheanu A, Iancu R, Vasile D, Pirvulescu R, Geamanu A, Coman C, Iancu G. Systemic side effects after intravitreal administration of antivascular endothelial growth factors for neovascular age-related macular degeneration. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhang Y, Chioreso C, Schweizer ML, Abràmoff MD. Effects of Aflibercept for Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis of Observational Comparative Studies. Invest Ophthalmol Vis Sci 2017; 58:5616-5627. [PMID: 29094167 PMCID: PMC5667400 DOI: 10.1167/iovs.17-22471] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purposes To compare the effects of aflibercept and other anti-vascular endothelial growth factor (anti-VEGF) medications on both functional and anatomical outcomes for treatment-naïve neovascular age-related macular degeneration (nAMD) in the real world. Methods A systematic review and meta-analysis of observational comparative studies. Results A total of 18 studies remained after literature selection and quality assessment of 1697 studies. The most common aflibercept treatment regimen was three monthly injections followed by pro re nata (PRN). Aflibercept and ranibizumab had similar effects in 2-year treatment. At 3, 6, 12, and 24 months, the differences in the logarithm of minimum angle of resolution (logMAR) decrease in aflibercept and ranibizumab groups were 0.00 (95% confidence interval [CI]: −0.03 to 0.02); 0.01 (95% CI: −0.02 to 0.05); −0.03 (95% CI: −0.07 to 0.01); and –0.06 (95% CI: −0.30 to 0.17), respectively; the differences in decrease of central retinal thickness (CRT) were 3.25 μm (95% CI: −15.03 to 21.53); 7.89 μm (95% CI: −31.91 to 47.69); 2.89 μm (95% CI: −18.33 to 24.11); and −2.42 μm (95% CI: −77.87 to 73.03), respectively. However, aflibercept was significantly more effective in patients with initial reduced visual acuity (logMAR >0.6 or <55 letters; P = 0.001). In the first year, treatment frequency was not significantly different for aflibercept and ranibizumab, but aflibercept required fewer injections than ranibizumab with PRN regimen (mean −0.90; 95% CI: −1.80 to 0.00). Conclusions Aflibercept has comparable effects with ranibizumab for treatment-naïve nAMD in the real world, and may be more effective for patients with initial lower visual acuity.
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Affiliation(s)
- Yan Zhang
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, United States
| | - Catherine Chioreso
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, United States
| | - Marin L Schweizer
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States
| | - Michael D Abràmoff
- Stephen A. Wynn Institute for Vision Research, The University of Iowa, Iowa City, Iowa, United States.,Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, Iowa, United States.,Iowa City VA Health Care System, Iowa City, Iowa, United States.,Department of Biomedical Engineering, The University of Iowa, Iowa City, Iowa, United States.,VA Center for Diagnosis and Treatment of Visual Loss, Iowa City, Iowa, United States
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21
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Garweg JG, Gerhardt C, Kodjikian L, Pfister IB. Real-Life Experience with Aflibercept and Ranibizumab in the Treatment of Newly Diagnosed Neovascular Age-Related Macular Degeneration over 24 Months. J Ocul Pharmacol Ther 2017; 33:567-572. [PMID: 28557667 DOI: 10.1089/jop.2017.0031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Comparative data appertaining to the long-term effects of Aflibercept or Ranibizumab in newly diagnosed cases of neovascular age-related macular degeneration (nAMD) over follow-up periods exceeding 12 months in clinical routine are scarce. METHODS In this retrospective comparative analysis, a case series of patients with treatment-naïve nAMD and requiring anti-vascular endothelial growth factor (VEGF) therapy in a routine clinical setting were treated with either Aflibercept [Afl (n = 106)] or Ranibizumab [Ran (n = 47)]. During the drug-loading phase, 3 monthly injections were administered. Thereafter, a treat-and-extend protocol was pursued for a maximum of 24 months. Ran was administered predominantly in eyes with classical lesions; Afl was administered in all others. The primary outcome parameters included anatomical and functional stability after 24 months. RESULTS Patients were comparable regarding age, gender distribution, and lens status. Fewer patients presented with intraretinal fluid in the Afl- than in the Ran group at diagnosis (46.2% vs. 67.4%; P = 0.02), but not after the drug-loading phase. After the drug-loading phase, visual acuity [-4.2 letters (Afl) vs. -4.5 letters (Ran); P = 0.78] and the central foveal thickness remained stable. Linked to the lesion type, the number of scheduled clinical visits during the course of 24 months was higher for the Ran- than for the Afl group [11.9 ± 4.7 visits (Ran) vs. 8.4 ± 3.1 visits (Afl); P = 0.0005]. However, the total number of injections was similar [10.5 ± 2.8 (Ran) vs. 11.7 ± 3.6 (Afl); P = 0.06]. CONCLUSIONS Based on tailoring according to the lesion type in cases of nAMD, the anatomical and the functional outcomes of treatment with either Afl or Ran were comparable for a maximum of 2 years.
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Affiliation(s)
- Justus G Garweg
- 1 Swiss Eye Institute , Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland .,2 University of Bern , Bern, Switzerland
| | - Christin Gerhardt
- 1 Swiss Eye Institute , Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland .,2 University of Bern , Bern, Switzerland
| | - Laurent Kodjikian
- 3 Department of Ophthalmology, Croix-Rousse University Hospital, University Claude Bernard of Lyon 1 , Lyon Cedex, France
| | - Isabel B Pfister
- 1 Swiss Eye Institute , Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland .,2 University of Bern , Bern, Switzerland
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Aflibercept in age-related macular degeneration: evaluating its role as a primary therapeutic option. Eye (Lond) 2017; 31:1523-1536. [PMID: 28548650 DOI: 10.1038/eye.2017.81] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/26/2017] [Indexed: 12/27/2022] Open
Abstract
The recent VIEW studies have demonstrated the non-inferiority of monthly and bi-monthly aflibercept in the management of wet age related macular degeneration (AMD) compared with ranibizumab. However, the current data are limited mainly to fixed dosing regimens with few studies looking at flexible dosing regimens of aflibercept in wet AMD. In addition, recent data from the VIEW 96 week extension has shown that patients being shifted from fixed dosing regimens to PRN have shown a drop in visual acuity and increase in central macular thickness. This is an indication that fixed dosing, a non-sustainable option, is only effective as long as it is continued. Regimens such as treat and extend (TAE) and pro-re nata (PRN) have been studied extensively in ranibizumab and bevacizumab and have shown to be effective options. With the presence of effective, established and less costly drugs such as ranibizumab and bevacizumab, the role of aflibercept as a primary treatment modality has yet to be clearly defined. The current review provides an analysis of the VIEW studies, as well as the extension phases. It also looks at post hoc analysis of predictors of response and outcomes. We have also conducted a search on studies comparing between PRN regimens using aflibercept and other anti-VEGF agents. This review also explores cheaper off label aflibercept; ziv-aflibercept in the treatment of wet AMD. The main purpose of the review is to delineate the role of aflibercept as a primary therapeutic option and if there are any significant advantages that would advocate its use over alternative anti-VEGF drugs. Finally, we propose a treatment algorithm for patients being started on aflibercept during the first year and thereafter.
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Abstract
OBJECTIVE This study evaluates real-world evidence regarding the frequency of anti-vascular-endothelial-growth-factor (VEGF) injections during the first year of therapy of treatment-naïve patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME) and retinal vein occlusion (RVO) from the Danish National Patient Registry. There was a switch in anti-VEGF treatment for naïve nAMD patients during the study period, following the introduction of aflibercept, which was expected to reduce the injection frequency relative to ranibizumab due to a perception of prolonged treatment duration of aflibercept. METHODS All treatment-naïve nAMD, DME or RVO patients who received an intravitreal injection in Denmark from 1 January 2012 to 31 July 2015 were eligible for inclusion. Patients were required to have been treated for at least one year and, for nAMD, to have received at least three injections during the first four months of treatment. Patients were allocated to half-year groupings (2012/1 to 2014/1) based on registration of their first intravitreal injection. Injection frequency during the first year of treatment was calculated for each group and t-tests investigated whether injection frequencies changed over time. RESULTS In treatment naïve nAMD patients (n = 500), the mean (SD) number of anti-VEGF injections increased significantly from 6.04 (1.71) in 2012/1 to 6.73 (1.62) in 2014/1 (p = .001; 2012/1 and 2012/2 vs. 2014/1) across all treatments. A similar trend was found for DME patients (n = 76) from 2012/1 to 2014/1 and RVO patients (n = 82) from 2012/2 to 2014/1, with mean injection frequencies increasing significantly from 5.14 (2.29) to 5.93 (1.98) (p = .007), and from 4.83 (1.21) to 6.08 (1.55) (p = .024), respectively. Post hoc sensitivity analysis also found a significant increase in injection frequency in nAMD patients who did not receive a loading phase (4.55 in 2012/1 and 5.05 in 2014/1; p = .006; n = 616). CONCLUSIONS In contrast to the decrease in injection frequency predicted with a switch to aflibercept treatment for nAMD, our study showed that injection frequencies increased significantly from 2012 to 2014 in patients initiating therapy across the three diseases.
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Affiliation(s)
- Henrik Vorum
- a Aalborg University Hospital and Aalborg University , Aalborg , Denmark
| | | | - Jette Zinck
- b DLi Market Intelligence , Copenhagen , Denmark
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