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Chujo S, Matsubara H, Mase Y, Kato K, Kondo M. Recurrence Rate during 5-Year Period after Suspension of Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration. J Clin Med 2024; 13:4317. [PMID: 39124583 PMCID: PMC11312843 DOI: 10.3390/jcm13154317] [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: 06/03/2024] [Revised: 07/08/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
Purpose: To determine the recurrence rate of neovascular age-related macular degeneration (nAMD) during a 5-year period after the suspension of anti-vascular endothelial growth factor (anti-VEGF) treatments. Methods: Thirty-four eyes of 34 nAMD patients who met the inclusion criteria and were treated by anti-VEGF drugs were studied. All met the treatment suspension criteria and were followed for 5 years after the suspension of the anti-VEGF treatment. Patients with a recurrence within one year were placed in Group A, and patients with a recurrence between 1 and 5 years were placed in Group B. The rate and time of a recurrence were analyzed using the Kaplan-Meier method. We also examined whether there were differences in the baseline factors of age, sex, subtype, treatment period, and treatment interval between Groups A and B. Results: Twenty-five of 34 eyes (73.5%) had a recurrence within 5 years of stopping the anti-VEGF treatments. Thirteen (52.0%) of the 25 eyes had a recurrence within 1 year, 4 (16.0%) eyes between 1 and 2 years, 4 (16.0%) eyes between 2 and 3 years, 2 (8%) between 3 and 4 years, and 2 eyes (8%) between 4 and 5 years. The baseline factors were not significantly different between Groups A and B. Conclusions: The results showed that the recurrence rate was highest within one year after the suspension of the anti-VEGF treatments, with a number of recurrences one year after the suspension. Clinicians should remember that nAMD may recur several years after the suspension of anti-VEGF treatments.
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Affiliation(s)
- Shinichiro Chujo
- Department of Ophthalmology, Mie University Graduate School of Medicine 2-174 Edobashi, Tsu 514-8507, Japan; (H.M.); (Y.M.); (K.K.); (M.K.)
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Samacá-Samacá D, Hernández-Castillo C, Prieto-Pinto L, Rodríguez F, Sardi C, Ocampo H, Kock J, Hernández F. Efficacy and safety of faricimab for neovascular age-related macular degeneration: a systematic review and network meta-analysis. BMJ Open Ophthalmol 2024; 9:e001702. [PMID: 39043575 PMCID: PMC11268043 DOI: 10.1136/bmjophth-2024-001702] [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: 03/07/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of faricimab compared with other anti-vascular endothelial growth factor (anti-VEGF) agents in treating neovascular age-related macular degeneration (nAMD) patients. METHODS AND ANALYSIS A systematic review (SR) was conducted up to January 2023. Network meta-analyses (NMA) were performed, including sensitivity and subgroup analyses for naïve population. Outcomes included changes in visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS] letters), anatomical changes, frequency of injections and adverse events. The Cochrane Collaboration guidelines and the Confidence in Network Meta-Analysis framework were used for the SR and the certainty of evidence, respectively. RESULTS From 4128 identified records through electronic databases and complementary searches, 63 randomised controlled trials (RCTs) met the eligibility criteria, with 42 included in the NMA. Faricimab showed a significant reduction in the number of annual injections compared with most fixed and flexible anti-VEGF treatment regimens, while showing no statistically significant differences in visual acuity through ETDRS letter gain, demonstrating a comparable efficacy. Retinal thickness results showed comparable efficacy to other anti-VEGF agents, and inferior only to brolucizumab. Results also showed that more patients treated with faricimab were free from post-treatment retinal fluid compared with aflibercept every 8 weeks, and both ranibizumab and bevacizumab, in the fixed and pro re nata (PRN) assessed schedules. Faricimab showed a comparable safety profile regarding the risk of ocular adverse events and serious ocular adverse events (SOAE), except for the comparison with brolucizumab quarterly, in which faricimab showed a significant reduction for SOAE risk. CONCLUSION Faricimab showed a comparable clinical benefit in efficacy and safety outcomes, with a reduction in annual injections compared with fixed and flexible anti-VEGF drug regimens, representing a valuable treatment option for nAMD patients. PROSPERO REGISTRATION NUMBER CRD42023394226.
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Affiliation(s)
| | | | | | - Francisco Rodríguez
- FUNDONAL, Bogota, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C, Colombia
| | - Carolina Sardi
- Instituto Nacional de Investigación en Oftalmología, Medellín, Colombia
| | | | - Joshua Kock
- Evidence Generation, Roche Colombia, Bogotá D.C, Colombia
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Roubelat FP, Barioulet L, Varenne F, Escudier C, Meyer P, Gomane C, Butterworth J, Pagot-Mathis V, Fournié P, Gualino V, Soler V. The Reinforced Treat-and-Extend Protocol for Exudative Age-Related Macular Degeneration: Retrospective Assessment of 24-Month Real-World Outcomes in France. Ophthalmol Ther 2024; 13:1647-1667. [PMID: 38625500 PMCID: PMC11109064 DOI: 10.1007/s40123-024-00938-7] [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: 01/15/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION The aim of this work is to evaluate the real-world outcomes of the reinforced treat-and-extend (RTE) protocol for the treatment of exudative age-related macular degeneration with intravitreal injections of aflibercept or ranibizumab (anti-vascular endothelial growth factor therapies). METHODS This was a retrospective review of patients from two tertiary ophthalmology centers in France initiating the RTE protocol between February 2018 and June 2021. The primary outcome was change in best-corrected visual acuity (BCVA) after 24 months. Secondary outcomes were change in central retinal thickness (CRT), recurrence, and management-related factors (injection interval, number of injections/consultations). Outcomes were additionally evaluated after protocol changes (strict versus modified RTE protocol groups). RESULTS Sixty-eight patients (72 eyes) were included (68% females; mean age 82.2 ± 7.8 years). After 24 months, mean BCVA significantly improved (65.22 ± 14 vs. 71.96 ± 13 Early Treatment Diabetic Retinopathy Study letters; p < 0.001) and CRT significantly decreased (388.6 ± 104 vs. 278.8 ± 51 μM; p < 0.001) with 21% of eyes showing signs of exudation. Over the 24 months, a mean total of 14.9 ± 4.0 injections and 8.6 ± 1.4 consultations were performed. Mean 24-month injection interval was 7.9 ± 2.3 weeks. Initial and 24-month ophthalmic outcomes for eyes in the strict (47%) versus modified (53%) groups were not significantly different, but mean time interval to first recurrence of disease activity was significantly shorter for the modified group (7.3 ± 2.4 vs. 9.9 ± 2.5 weeks; p < 0.001). Patients in the strict RTE group received significantly less injections (13.9 ± 3.6 vs. 16.5 ± 3.9; p = 0.006) and mean 24-month injection interval was significantly longer (9.5 ± 2.7 vs. 6.5 ± 2.1 weeks; p < 0.001). Consultation number was similar (8.5 ± 1.9 vs. 8.8 ± 1.6; p = 0.93). Treatment with aflibercept versus ranibizumab did not influence ophthalmic or management outcomes. CONCLUSIONS The RTE protocol, even when modified, reduced consultations but improved ophthalmic outcomes. The RTE protocol could reduce hospital visits and overall burden while also encouraging better patient compliance. Video Abstract available for this article. VIDEO ABSTRACT Vincent Soler and François-Philippe Roubelat summarize the Reinforced Treat-and-Extend Protocol and main results (MP4 225022 KB).
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Affiliation(s)
- François-Philippe Roubelat
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Lisa Barioulet
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Fanny Varenne
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Clément Escudier
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Pauline Meyer
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Clément Gomane
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Jacqueline Butterworth
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Véronique Pagot-Mathis
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Pierre Fournié
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
- Faculty of Medicine, University of Toulouse III, Toulouse, France
| | - Vincent Gualino
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
- Ophthalmology Department, Clinique Honoré-Cave, Montauban, France
| | - Vincent Soler
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France.
- Faculty of Medicine, University of Toulouse III, Toulouse, France.
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Willis ET, Kim JE, Schneider EW. Home Optical Coherence Tomography Monitoring for Neovascular Age-Related Macular Degeneration: Transformative Technology or Cool Toy? Ophthalmol Ther 2024; 13:1407-1416. [PMID: 38704812 PMCID: PMC11109031 DOI: 10.1007/s40123-024-00953-8] [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: 01/19/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
The pending introduction of home-based optical coherence tomography (OCT) in managing neovascular age-related macular degeneration (nAMD) has sparked interesting debates. Advocates assert that home-based OCT will revolutionize care of patients with nAMD, while skeptics question its real-world viability and point out its potential drawbacks. This article delves into the dichotomy, presenting the "pro" argument highlighting the transformative potential of home OCT and the "con" perspective, which scrutinizes the limitations and challenges to adapting the technology to the real-world setting. By exploring both sides of the discourse, we aim to address the promises and complexities surrounding the role of home OCT in the management of nAMD.
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Affiliation(s)
- Ethan T Willis
- Tennessee Retina, PC, Nashville, USA
- University of Tennessee College of Medicine, Memphis, TN, USA
| | - Judy E Kim
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Woo SJ, Jung JA, Kim T, Oh I, Kim MY, Bressler NM. Association of baseline factors with 1-year outcomes in the SB11-ranibizumab equivalence trial: A post hoc analysis. Asia Pac J Ophthalmol (Phila) 2024:100069. [PMID: 38759795 DOI: 10.1016/j.apjo.2024.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE To identify baseline factors associated with 1-year outcomes when treating neovascular age-related macular degeneration (nAMD) with ranibizumab biosimilar SB11 or reference ranibizumab (rRBZ), and to compare efficacy of the two products within subgroups judged to be clinically relevant. DESIGN Post hoc analysis of a prospective, equivalence phase 3 randomized clinical trial (RCT) METHODS: 705 patients with nAMD were randomized 1:1 to receive SB11 or rRBZ for 48 weeks. Pooled and randomized groups were used to identify baseline factors associated with clinical outcomes at Week 52 using multiple linear regression models. Significant factors identified in regression analyses were confirmed in analyses of variance. Subgroup analyses comparing best-corrected visual acuity (BCVA) changes between SB11 and rRBZ were conducted. RESULTS 634 (89.9%) participants completed the 52-week visit. Regression analyses showed that younger age, lower BCVA, and smaller total lesion area at baseline were associated with greater BCVA gain at Week 52, while older age, lower BCVA, and thicker central subfield thickness (CST) at baseline were predictors of greater CST reduction in the pooled group. Subgroup analyses demonstrated that BCVA outcomes appeared comparable for the SB11 and rRBZ groups. CONCLUSION Post hoc analyses of the SB11-rRBZ equivalence study showed that baseline age, BCVA, CST, and total lesion area were prognostic factors for visual or anatomical outcomes of nAMD, while subgroup analyses demonstrated comparable results for SB11 and rRBZ. Collectively, the results appear comparable to similar RCTs of anti-vascular endothelial growth factor reference products for nAMD and strengthen confidence in the biosimilarity of SB11.
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Affiliation(s)
- Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Republic of Korea
| | | | | | - Inkyung Oh
- Samsung Bioepis, Incheon, Republic of Korea
| | | | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Machida A, Oishi A, Ikeda J, Kurihara J, Yoneda A, Tsuiki E, Hirata Y, Murakami R, Kitaoka T. Factors Associated with Success of Switching to Faricimab for Neovascular Age-Related Macular Degeneration Refractory to Intravitreal Aflibercept. Life (Basel) 2024; 14:476. [PMID: 38672747 PMCID: PMC11051354 DOI: 10.3390/life14040476] [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: 12/20/2023] [Revised: 02/28/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
We investigated the factors associated with the success of switching to faricimab for type 1 macular neovascularization (MNV) refractory to intravitreal aflibercept (IVA). This retrospective cohort study included patients with type 1 MNV who were switched to faricimab because they were refractory to IVA at two centers. The primary endpoint was a more than two-week extension of the treatment interval after 6 months. In addition, factors related to the success or failure of extension and visual and anatomical outcomes were assessed. The analysis included 43 eyes from 43 patients. Extended dosing intervals of >2 weeks were identified in 14 eyes (32.6%). A short dosing interval before switching, absence of polypoidal lesions, and thin central choroidal thickness before switching were identified as factors involved in successful extension. For patients with refractory type 1 MNV, switching to faricimab is a safe and potential option to extend existing dosing intervals.
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Affiliation(s)
- Akira Machida
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki 852-8102, Japan; (A.M.); (J.I.); (E.T.); (Y.H.); (R.M.); (T.K.)
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki 852-8102, Japan; (A.M.); (J.I.); (E.T.); (Y.H.); (R.M.); (T.K.)
| | - Junichiro Ikeda
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki 852-8102, Japan; (A.M.); (J.I.); (E.T.); (Y.H.); (R.M.); (T.K.)
| | - Junko Kurihara
- Department of Ophthalmology, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki 852-8104, Japan
| | - Ai Yoneda
- Department of Ophthalmology, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki 852-8104, Japan
| | - Eiko Tsuiki
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki 852-8102, Japan; (A.M.); (J.I.); (E.T.); (Y.H.); (R.M.); (T.K.)
| | - Yuki Hirata
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki 852-8102, Japan; (A.M.); (J.I.); (E.T.); (Y.H.); (R.M.); (T.K.)
| | - Ryuya Murakami
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki 852-8102, Japan; (A.M.); (J.I.); (E.T.); (Y.H.); (R.M.); (T.K.)
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki 852-8102, Japan; (A.M.); (J.I.); (E.T.); (Y.H.); (R.M.); (T.K.)
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Kataoka K, Itagaki K, Hashiya N, Wakugawa S, Tanaka K, Nakayama M, Yamamoto A, Mukai R, Honjyo J, Maruko I, Kawai M, Miyara Y, Terao N, Wakatsuki Y, Onoe H, Mori R, Koizumi H, Sekiryu T, Iida T, Okada AA. Six-month outcomes of switching from aflibercept to faricimab in refractory cases of neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2024; 262:43-51. [PMID: 37668741 DOI: 10.1007/s00417-023-06222-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/02/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE To assess 6-month outcomes of switching from aflibercept to faricimab in eyes with refractory neovascular age-related macular degeneration (nAMD) previously requiring monthly injections. METHODS This multicenter retrospective study examined nAMD eyes receiving monthly aflibercept injections switched to faricimab administered monthly up to 4 injections followed by injections at a minimum of 2-month intervals as per drug labeling. Data regarding age, sex, number of previous injections, treatment intervals, and best-corrected visual acuity (BCVA) were collected. Central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and maximal pigment epithelial detachment (PED) height were measured by optical coherence tomography. RESULTS The study included 130 eyes of 124 patients. At 6 months, 53 eyes (40.8%) continued on faricimab treatment (Group 1), while 77 eyes (59.2%) discontinued faricimab for various reasons (Group 2) the most common being worse exudation. There were no significant differences between the two groups at baseline. In Group 1, CRT and SFCT significantly decreased at 1 month (P = 0.013 and 0.008), although statistical significance was lost at 6 months (P = 0.689 and 0.052). BCVA and maximal PED height showed no significant changes; however, mean treatment intervals were extended from 4.4 ± 0.5 weeks at baseline to 8.7 ± 1.7 weeks at 6 months (P < 0.001) in Group 1. No clear predictors of response were identified. CONCLUSION Switching from aflibercept to faricimab allowed for extension of treatment intervals from monthly to bimonthly in roughly 40% of eyes, suggesting that faricimab may be considered in refractory nAMD cases.
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Affiliation(s)
- Keiko Kataoka
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, Japan.
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Nozumu Hashiya
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Sorako Wakugawa
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Koji Tanaka
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Makiko Nakayama
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, Japan
| | - Akiko Yamamoto
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, Japan
| | - Ryo Mukai
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Jyunichiro Honjyo
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Ichiro Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Moeko Kawai
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasunori Miyara
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Nobuhiro Terao
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yu Wakatsuki
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Hajime Onoe
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Ryusaburo Mori
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, Japan
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Finocchio L, Zeppieri M, Gabai A, Toneatto G, Spadea L, Salati C. Recent Developments in Gene Therapy for Neovascular Age-Related Macular Degeneration: A Review. Biomedicines 2023; 11:3221. [PMID: 38137442 PMCID: PMC10740940 DOI: 10.3390/biomedicines11123221] [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: 11/01/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Age-related macular degeneration (AMD) is a complex and multifactorial disease and a leading cause of irreversible blindness in the elderly population. The anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized the management and prognosis of neovascular AMD (nAMD) and is currently the standard of care for this disease. However, patients are required to receive repeated injections, imposing substantial social and economic burdens. The implementation of gene therapy methods to achieve sustained delivery of various therapeutic proteins holds the promise of a single treatment that could ameliorate the treatment challenges associated with chronic intravitreal therapy, and potentially improve visual outcomes. Several early-phase trials are currently underway, evaluating the safety and efficacy of gene therapy for nAMD; however, areas of controversy persist, including the therapeutic target, route of administration, and potential safety issues. In this review, we assess the evolution of gene therapy for nAMD and summarize several preclinical and early-stage clinical trials, exploring challenges and future directions.
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Affiliation(s)
- Lucia Finocchio
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Andrea Gabai
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Giacomo Toneatto
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Garay-Aramburu G, Rodriguez-Feijoo D, Aldazabal-Echeveste M, Del Barrio Z, Eiras-Fernández A, Piñero DP, Larrauri-Arana A. Predictors of stoppage and recurrence of choroidal neovascularization with a Treat- Extend-Stop protocol: 4-year follow-up. J Fr Ophtalmol 2023; 46:1204-1211. [PMID: 37658033 DOI: 10.1016/j.jfo.2023.02.021] [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: 11/30/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To analyze the long-term results of treatment of active age-related macular degeneration (AMD) with anti-vascular endothelial growth factor (VEGF) agents using the treat-extend-stop (TES) approach, defining predictive factors for stoppage of the treatment and recurrences in a real-world setting. METHODS Data from 191 eyes treated with intravitreal injections for choroidal neovascularization due to AMD were retrospectively reviewed. Changes in best-corrected visual acuity (BCVA) and membrane activity (optical coherence tomography) were recorded and evaluated over a 48-month follow-up. Logistic regression analysis was used to determine predictors of treatment stoppage and recurrences after stoppage. RESULTS BCVA improvement was found in 70.5% of eyes at 48 months, and remaining signs of activity in 27.9%. Disease inactivity was achieved in 69 eyes (31.9%), with a relapse of the membrane in 29 of these eyes (42.0%). Significant independent predictors of treatment stoppage were found: no foveal membrane, inactive membrane at 12, 24, 36 and 48 months, extension interval>8 weeks at 12 and 24 months,>15 injections at 24 months, and baseline BCVA>61 letters. Concerning recurrent membranes, only the presence of membrane activity at 36 months and baseline BCVA>61 letters were independent predictors. CONCLUSIONS Anti-VEGF treatment of AMD using the TES protocol allows for successful visual restoration in most patients, with more likely disease inactivity in those eyes with better baseline BCVA, maintaining signs of membrane inactivity during the first two years of follow-up and requiring fewer injections.
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Affiliation(s)
- G Garay-Aramburu
- Department of Ophthalmology, Begiker-Ophthalmology Research Group, Biocruces Bizkaia Health Research Institute. Facultad de Medicina, Campus de Vitoria-Gasteiz, University of the Basque Country, UPV/EHU, Avenida Montevideo 18, 48013 Bilbao, Bizkaia, Spain
| | | | | | - Z Del Barrio
- Department of Ophthalmology, Araba University Hospital, Araba, Spain
| | - A Eiras-Fernández
- Department of Ophthalmology, Araba University Hospital, Araba, Spain
| | - D P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain.
| | - A Larrauri-Arana
- Department of Ophthalmology, Araba University Hospital, Araba, Spain; Universidad del País Vasco-Euskal Herriko Unibertsitatea, Vitoria-Gasteiz, Araba, Spain
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10
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Patel PJ, Villavicencio P, Hanumunthadu D. Systematic Review of Neovascular Age-Related Macular Degeneration Disease Activity Criteria Use to Shorten, Maintain or Extend Treatment Intervals with Anti-VEGF in Clinical Trials: Implications for Clinical Practice. Ophthalmol Ther 2023; 12:2323-2346. [PMID: 37477856 PMCID: PMC10441947 DOI: 10.1007/s40123-023-00768-z] [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: 04/27/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Clinical trials in neovascular age-related macular degeneration (nAMD) using anti-vascular endothelial growth factor (ant-VEGF) injections use disease activity (DA) criteria to shorten, maintain or increase the interval between injections. Differences in these DA criteria may contribute to differences in the proportions of patients with macular fluid at key time points or achieving extended dosing intervals in these trials. We identified, collated and evaluated DA criteria from pivotal anti-VEGF nAMD trials to understand how differences impact on these studies and real-world visual acuity and extending dosing outcomes. METHODS This was a systematic review of literature on Pubmed for randomised clinical trials in nAMD using a proactive treatment regimen. We excluded case reports, review articles and studies on fewer than 50 participants. RESULTS Twelve clinical trials (LUCAS, VIEW, TREX-AMD, FLUID, TREND, RIVAL, ALTAIR, CANTREAT, ARIES, TREX-Conbercept, HAWK & HARRIER, TENAYA & LUCERNE) investigating anti-VEGF treatment of nAMD were identified according to our search strategy. Different studies utilised a different combination of DA criteria. Specifically, six trials included visual acuity change; four included macular thickness change; one included visual acuity change if associated with macular thickness change; one with qualitative optical coherence tomography (OCT) features; four with qualitative OCT features if also associated with visual acuity change; 10 with macular haemorrhage and five with other fluorescein angiographic features. CONCLUSION Different clinical trials use different DA criteria when altering the interval between anti-VEGF injections. This makes it difficult to draw meaningful conclusions about secondary outcomes such as proportion of patients treated at extended dosing intervals or proportions of eyes with persistent subretinal or intraretinal fluid. Standardising DA criteria in clinical trials and preferentially using those easily applied in a real-world setting would lead to results more achievable in real-world settings and for a meaningful comparison of treatment durability.
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Affiliation(s)
- Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD, UK.
| | - Pablo Villavicencio
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD, UK
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Joshi S, Verma L, Ayachit G, Salvi R, Asad Y, Gupta A, Patil A, Ayachit A. Efficacy of a single injection of brolucizumab in neovascular age-related macular degeneration on visual acuity and micromorphometry. Indian J Ophthalmol 2023; 71:3375-3380. [PMID: 37787238 PMCID: PMC10683673 DOI: 10.4103/ijo.ijo_210_23] [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: 01/22/2023] [Revised: 06/18/2023] [Accepted: 07/03/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose To assess short-term efficacy of a single injection of brolucizumab in neovascular AMD. Methods This was a multicenter, retrospective chart review of 25 eyes of 25 patients who received a single injection of brolucizumab. Visual acuity (VA) and optical coherence tomography (OCT) features such as central subfield thickness (CSFT), subretinal fluid (SRF), intraretinal fluid, and pigment epithelial detachment (PED) were recorded at baseline, first month, and third month. Results Of the 25 eyes, 14 eyes were treatment-naïve and 11 eyes had received previous injections. VA improved from 0.68 ± 0.59 log MAR at baseline to 0.31 ± 0.43 log MAR at the end of 3 months. SRF height in first and third month was significantly reduced from baseline (P < 0.001). Subretinal hyperreflective material height significantly reduced from baseline (P value 0.008 at first month and 0.01 at third month, respectively). CSFT was 464.16 ± 247.97 microns at baseline and showed a significant reduction in first month (P < 0.001) and third month (P < 0.001). There was a significant reduction of PED height from baseline at both follow-ups. None of the eyes showed a recurrence of fluid at the end of 3 months. Conclusion Our study demonstrated sustained improvement in VA and OCT parameters after a single injection of brolucizumab at 3 months. A longer follow-up may demonstrate even farther effects of a single injection.
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Affiliation(s)
- Shrinivas Joshi
- Department of Vitreoretina, M Joshi Eye Institute, Hubli, Karnataka, India
| | - Lalit Verma
- Department of Retina, Centre for Sight, Safdarjung Enclave, Delhi, India
| | - Guruprasad Ayachit
- Department of Vitreoretina, M Joshi Eye Institute, Hubli, Karnataka, India
| | - Rajashree Salvi
- Department of Vitreoretina, M Joshi Eye Institute, Hubli, Karnataka, India
| | - Yusra Asad
- Department of Retina, Centre for Sight, Safdarjung Enclave, Delhi, India
| | - Avnindra Gupta
- Department of Retina, Centre for Sight, Safdarjung Enclave, Delhi, India
| | - Anuja Patil
- Department of Retina, Centre for Sight, Safdarjung Enclave, Delhi, India
| | - Apoorva Ayachit
- Department of Vitreoretina, M Joshi Eye Institute, Hubli, Karnataka, India
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12
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Nichani PAH, Popovic MM, Dhoot AS, Pathak A, Muni RH, Kertes PJ. Treat-and-extend dosing of intravitreal anti-VEGF agents in neovascular age-related macular degeneration: a meta-analysis. Eye (Lond) 2023; 37:2855-2863. [PMID: 36859600 PMCID: PMC10517126 DOI: 10.1038/s41433-023-02439-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/04/2022] [Accepted: 02/01/2023] [Indexed: 03/03/2023] Open
Abstract
Intravitreal injections of antiangiogenic agents are pivotal in treating neovascular age-related macular degeneration (nAMD). The comparative efficacy and safety of treat-and-extend (T&E) versus bimonthly, monthly, and pro re nata (PRN) dosing remains unclear. A systematic review and meta-analysis of English-language RCTs reporting on efficacy and/or safety outcomes of dosing regimens of anti-VEGF agents in nAMD was performed. Best-corrected visual acuity (BCVA, ETDRS letters) at last follow-up represented the primary endpoint, while central subfield thickness (CSFT, μm), injection burden, and ocular adverse events were secondary endpoints. A random effects meta-analysis was performed, and 95% confidence intervals were calculated. Across six RCTs, 781 T&E-, 663 monthly-, 130 PRN-, and 123 bimonthly treated eyes were included. Mean changes in BCVA and CSFT at last follow-up were similar between T&E versus monthly (WMD, -0.62 letters; 95% CI, -2.12 to 0.87; P = 0.41; WMD, 5.30 microns; 95% CI, -10.67 to 21.26; P = 0.52, respectively), bimonthly (WMD, 1.68 letters; 95% CI, -3.55 to 6.91; P = 0.53; WMD, -18.91 microns; 95% CI, -46.41 to 8.60; P = 0.18, respectively), and PRN (BCVA WMD, 1.08 letters; 95% CI, -2.95 to 5.11; P = 0.60) regimens. T&E was associated with a reduced injection burden versus monthly (WMD, -4.52 injections; 95% CI, -6.66 to 2.39; P < 0.001) but higher injection burden versus PRN (WMD, 1.81 injections; 95% CI, 1.12 to 2.51; P < 0.001) dosing. There was no significant difference in safety outcomes amongst comparators. There was no significant difference in efficacy and safety between T&E, bimonthly, monthly, and PRN dosing. T&E resulted in fewer injections versus monthly and fewer clinic visits versus PRN.
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Affiliation(s)
- Prem A H Nichani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Arjan S Dhoot
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - Ananya Pathak
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
- John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Siktberg J, Kim SJ, Sternberg P, Patel S. Effectiveness of bevacizumab step therapy for neovascular age-related macular degeneration. Eye (Lond) 2023; 37:1844-1849. [PMID: 36127425 PMCID: PMC10275928 DOI: 10.1038/s41433-022-02253-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of bevacizumab step therapy for neovascular age-related macular degeneration (nAMD) in routine clinical practice. METHODS In this retrospective case series, eyes initiating treatment for nAMD at an academic medical centre from 2011-2019 were included. Exclusion criteria included previous intravitreal anti-VEGF injections, prior non-cataract intraocular surgery, <1 year of treatment, and not starting on monthly bevacizumab therapy. Of 895 eligible eyes, 548 were excluded, yielding 347 eyes in the study population. These eyes were treated for nAMD under the bevacizumab step therapy protocol with an option to switch to another agent in the event of predefined treatment failure. Treatment failure was defined as losing 15 or more Early Treatment Diabetic Retinopathy Study letters or switching to an alternative anti-VEGF agent. Eyes that did not meet these criteria were deemed treatment successes. Annual change in mean VA from baseline (ΔVA) was the primary outcome. Secondary outcomes included treatment success rate, medication switch rate, and post-switch ΔVA. RESULTS After 1 year, mean ΔVA was +8.4 letters (95% CI: +6.1 to +10.6 letters). 86% had treatment success, and 6% of eyes had switched to aflibercept. In years 2-7, ΔVA ranged from +7.0 to -0.7 letters, and treatment success rates ranged from 68 to 82%. 11% (n = 38) of eyes were switched to aflibercept. The post-switch ΔVA in these eyes was -7.1 letters (95% CI: -13.3 to -0.1) after a mean of 17.7 ± 12.6 injections over an average of 2.7 ± 2.0 years. CONCLUSION A bevacizumab step therapy protocol in routine clinical practice is effective for long-term treatment of nAMD.
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Affiliation(s)
| | - Stephen Jae Kim
- Vanderbilt University Medical Center Department of Ophthalmology, Nashville, TN, USA
| | - Paul Sternberg
- Vanderbilt University Medical Center Department of Ophthalmology, Nashville, TN, USA
| | - Shriji Patel
- Vanderbilt University Medical Center Department of Ophthalmology, Nashville, TN, USA.
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Chujo S, Matsubara H, Matsui Y, Sugimoto M, Kondo M. Suspension of Anti-VEGF Treatment Does Not Affect Expansion of RPE Atrophy in Neovascular Age-Related Macular Degeneration. J Clin Med 2023; 12:jcm12113659. [PMID: 37297855 DOI: 10.3390/jcm12113659] [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: 04/21/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To determine whether atrophy of the retinal pigment epithelium (RPE) in eyes with neovascular age-related macular degeneration (nAMD), which meets the criteria for the suspension of anti-vascular endothelial growth factor (anti-VEGF) treatment, is associated with anti-VEGF treatments. METHODS Twelve eyes of 12 patients with nAMD who began anti-VEGF treatment and were followed for 1 year after meeting the criteria for the suspension of anti-VEGF were studied. Six eyes of six patients were placed in the continuation group, and six eyes of six patients were placed in the suspension group. The RPE atrophic area at the time of the last anti-VEGF treatment was set as the baseline size and that at 12 months after the baseline (Month 12) was taken as the final size. A comparison of the expansion rate of RPE atrophy between the two groups was made by the square-root transformed differences. RESULTS The expansion rate of atrophy was 0.55 (0.43, 0.72) mm/year in the continuation group and 0.33 (0.15, 0.41) mm/year in the suspension group. This difference was not significant. (p = 0.29). CONCLUSIONS Suspension of anti-VEGF treatments in eyes with nAMD does not alter the expansion rate of RPE atrophy.
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Affiliation(s)
- Shinichiro Chujo
- Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Hisashi Matsubara
- Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Yoshitsugu Matsui
- Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
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15
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Foster MJ, Shaia J, Maatouk CM, Urbano CA, Bui MT, Hom GL, Kuo BL, Singh RP, Talcott KE. Long-Term Visual Outcomes in Neovascular Age-Related Macular Degeneration Eyes With Baseline Macular Atrophy on Anti-Vascular Endothelial Growth Factor Treatment. Ophthalmic Surg Lasers Imaging Retina 2023; 54:223-230. [PMID: 36884230 DOI: 10.3928/23258160-20230223-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND AND OBJECTIVE This study explores the connection between macular atrophy (MA) status at baseline and best visual acuity (BVA) after 5 to 7 years of anti-vascular endothelial growth factor (anti-VEGF) injections on eyes with neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS This retrospective study included patients with neovascular age-related macular degeneration receiving anti-VEGF injections at least twice-yearly for 5+ years at Cole Eye Institute. Analyses of variance and linear regressions explored the connection between MA status, baseline MA intensity, and 5-year BVA change. RESULTS Of 223 included patients, 5-year BVA change was not statistically significant between MA status groups or from baseline. The population's average 7-year BVA change was -6.3 Early Treatment Diabetic Retinopathy Study letters. Type and frequency of anti-VEGF injections were comparable between MA status groups (P > .05). CONCLUSION Regardless of MA status, 5- and 7-year BVA change lacked clinical relevance. If receiving regular treatment for 5+ years, patients with baseline MA achieve comparable visual outcomes to those without MA, with similar treatment and visit burdens. [Ophthalmic Surg Lasers Imaging Retina 2023;54(X):X-X.].
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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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17
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Khachigian LM, Liew G, Teo KYC, Wong TY, Mitchell P. Emerging therapeutic strategies for unmet need in neovascular age-related macular degeneration. J Transl Med 2023; 21:133. [PMID: 36810060 PMCID: PMC9942398 DOI: 10.1186/s12967-023-03937-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/27/2023] [Indexed: 02/23/2023] Open
Abstract
Neovascular age-related macular degeneration (nAMD) is a major cause of visual impairment and blindness. Anti-vascular endothelial growth factor (VEGF) agents, such as ranibizumab, bevacizumab, aflibercept, brolucizumab and faricimab have revolutionized the clinical management of nAMD. However, there remains an unmet clinical need for new and improved therapies for nAMD, since many patients do not respond optimally, may lose response over time or exhibit sub-optimal durability, impacting on real world effectiveness. Evidence is emerging that targeting VEGF-A alone, as most agents have done until recently, may be insufficient and agents that target multiple pathways (e.g., aflibercept, faricimab and others in development) may be more efficacious. This article reviews issues and limitations that have arisen from the use of existing anti-VEGF agents, and argues that the future may lie in multi-targeted therapies including alternative agents and modalities that target both the VEGF ligand/receptor system as well as other pathways.
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Affiliation(s)
- Levon M. Khachigian
- grid.1005.40000 0004 4902 0432Vascular Biology and Translational Research, Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052 Australia
| | - Gerald Liew
- grid.476921.fCentre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - Kelvin Y. C. Teo
- grid.419272.b0000 0000 9960 1711Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Y. Wong
- grid.419272.b0000 0000 9960 1711Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore ,grid.12527.330000 0001 0662 3178Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Paul Mitchell
- grid.476921.fCentre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
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18
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Rosenberg D, Deonarain DM, Gould J, Sothivannan A, Phillips MR, Sarohia GS, Sivaprasad S, Wykoff CC, Cheung CMG, Sarraf D, Bakri SJ, Chaudhary V. Efficacy, safety, and treatment burden of treat-and-extend versus alternative anti-VEGF regimens for nAMD: a systematic review and meta-analysis. Eye (Lond) 2023; 37:6-16. [PMID: 35396574 PMCID: PMC9829919 DOI: 10.1038/s41433-022-02020-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 01/17/2023] Open
Abstract
This study aimed to compare efficacy and treatment burden of treat-and-extend (T&E) anti-VEGF against fixed and pro re nata (PRN) regimens for neovascular age-related macular degeneration (nAMD). MEDLINE, CENTRAL, and EMBASE were searched. Randomized-controlled trials and observational studies comparing T&E to PRN or fixed dosing for treatment-naïve AMD patients were included. Mean difference (MD) for visual acuity (VA) and number of injections are presented. Risk of bias was assessed according to Cochrane guidelines. Methodology was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). VA improvement was similar with T&E and fixed dosing at one (MD -0.08 letters, p = 0.95) and two years (MD 0.58 letters, p = 0.62). In contrast, VA improvements were significantly greater for T&E when compared against a PRN regimen at one (MD 3.95 letters, p < 0.0001) and two years (MD 4.08 letters, p < 0.001). Significantly fewer ranibizumab injections were administered in the T&E arm at one (MD -2.42 injections, p < 0.0001) and two years (MD -6.06 injections, p < 0.00001) relative to fixed dosing. Fewer aflibercept injections were likewise administered to patients on a T&E regimen versus fixed dosing at one year (MD -0.78 injections, p < 0.0001). Low-certainty evidence from the present synthesis implies that T&E preserves VA similar to fixed schedules with significantly fewer injections at one and two years. Also, patients with T&E dosing achieved better VA outcomes than those on PRN regimen but T&E dosing was associated with more injections.
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Grants
- Dr. Sivaprasad reports receiving research grants from Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim and Optos Plc, Travel grants from Novartis, Bayer, speaker fees from Novartis, Bayer and Optos Plc, and attending advisory board meetings for Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim, Optos Plz, Oxurion, Ophthea, Apellis, Oculis and Heidelberg Engineering.
- Dr. Wykoff reported consulting for Acuela, Adverum Biotechnologies, Inc, Aerpio, Alimera Sciences, Allegro Ophthalmics, LLC, Allergan, Apellis Pharmaceuticals, Bayer AG, Chengdu Kanghong Pharmaceuticals Group Co, Ltd, Clearside Biomedical, DORC (Dutch Ophthalmic Research Center), EyePoint Pharmaceuticals, Gentech/Roche, GyroscopeTx, IVERIC bio, Kodiak Sciences Inc, Novartis AG, ONL Therapeutics, Oxurion NV, PolyPhotonix, Recens Medical, Regeron Pharmaceuticals, Inc, REGENXBIO Inc, Santen Pharmaceutical Co, Ltd, and Takeda Pharmaceutical Company Limited and receiving research funding from Adverum Biotechnologies, Inc, Aerie Pharmaceuticals, Inc, Aerpio, Alimera Sciences, Allergan, Apellis Pharmaceuticals, Chengdu Kanghong Pharmaceutical Group Co, Ltd, Clearside Biomedical, Gemini Therapeutics, Genentech/Roche, Graybug Vision, Inc, GyroscopeTx, Ionis Pharmaceuticals, IVERIC bio, Kodiak Sciences Inc, Neurotech LLC, Novartis AG, Opthea, Outlook Therapeutics, Inc, Recens Medical, Regeneron Pharmaceuticals, Inc, REGENXBIO Inc, Samsung Pharm Co, Ltd, Santen Pharmaceutical Co, Ltd, and Xbrane Biopharma AB.
- Dr. Cheung reports grants and speaker fees from Roche, Novartis, Bayer, Allergan, and Topcon outside the submitted work.
- Dr. Sarraf has acted as consultant for Amgen, Bayer, Genentech, Novartis, and Optovue, and reports grants from Amgen, Genentech, Heidelberg, Optovue, Regeneron and Topcon, outside the submitted work.
- Dr. Bakri has acted as a consultant for Adverum, Alimera, Apellis, Allergan, Eyepoint, Kala, Genentech, Novartis, Oxurion, Roche, and Zeiss, outside the submitted work.
- Dr. Chaudhary reports acting as an advisory board member, grants and other from Novartis, acting as an advisory board member, grants and other from Bayer, grants from Allergan, and acting as an advisory board member for Roche, outside the submitted work.
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Affiliation(s)
- Daniel Rosenberg
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | - Deven M Deonarain
- St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, L8G 5E4, Canada
| | - Jonah Gould
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | - Amirthan Sothivannan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | - Mark R Phillips
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | - Gurkaran S Sarohia
- Department of Ophthalmology and Visual Sciences, University of Alberta, 400, 10924, 107 Avenue, Edmonton, AB, T5H 0X5, Canada
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, EC1V 2PD, UK
| | | | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke NUS Medical School, Singapore, Singapore
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Administration Healthcare Center, Los Angeles, CA, 90095, USA
- Greater Los Angeles VA Center, Los Angeles, CA, USA
| | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Varun Chaudhary
- St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, L8G 5E4, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8P 1H6, Canada.
- Department of Surgery, McMaster University, Hamilton, ON, L8P 1H6, Canada.
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Vofo BN, Cnaany Y, Chowers I. Clinical outcome using a modified treat-and-extend protocol for neovascular age-related macular degeneration. BMJ Open Ophthalmol 2022; 7:e001180. [PMID: 37585239 PMCID: PMC9791424 DOI: 10.1136/bmjophth-2022-001180] [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: 10/01/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022] Open
Abstract
AIM To compare outcome between patients treated using a modified treat-and-extend (mT&E) protocol and patients treated using a conventional T&E protocol. METHODS A retrospective cohort study of two groups of treatment-naïve neovascular age-related macular degeneration patients within a single centre were evaluated. One group treated using the conventional T&E protocol, with visual acuity, dilated fundus examination (DFE) and optical coherence tomography (OCT) performed at each visit. The second group treated using the mT&E protocol in which visual acuity and DFE were performed only every three visits. The main outcome measures were time spent per clinical visit, visual and anatomical outcomes measured for 36 months. RESULTS The T&E and mT&E groups included 135 eyes in 116 patients and 119 eyes in 94 patients, respectively, with similar baseline characteristics. At 36 months, the number of injections administered (7.9±2.9 vs 8.1±2.3 injections, respectively; p=0.55), the percentage of eyes that gained ≥15 Early Treatment for Diabetic Retinopathy Study (ETDRS) letters (23% vs 25.2%, respectively; p=0.39) and the percentage of eyes that lost ≥15 ETDRS letters (21.5% vs 17.7%; p=0.43, respectively) were similar between the T&E and mT&E groups. However, waiting and contact time were reduced during the OCT-only visits compared with the full visits, with an average of 41 min saved per patient encounter. CONCLUSIONS Both protocols yielded similar visual and anatomical outcomes. However, the mT&E protocol reduced the number of full visits, with considerably less time spent at the clinic.
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Affiliation(s)
| | - Yaacov Cnaany
- Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - I Chowers
- Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
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20
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Kar SS, Cetin H, Lunasco L, Le TK, Zahid R, Meng X, Srivastava SK, Madabhushi A, Ehlers JP. OCT-Derived Radiomic Features Predict Anti-VEGF Response and Durability in Neovascular Age-Related Macular Degeneration. OPHTHALMOLOGY SCIENCE 2022; 2:100171. [PMID: 36531588 PMCID: PMC9754979 DOI: 10.1016/j.xops.2022.100171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/15/2022] [Accepted: 05/12/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE No established biomarkers currently exist for therapeutic efficacy and durability of anti-VEGF therapy in neovascular age-related macular degeneration (nAMD). This study evaluated radiomic-based quantitative OCT biomarkers that may be predictive of anti-VEGF treatment response and durability. DESIGN Assessment of baseline biomarkers using machine learning (ML) classifiers to predict tolerance to anti-VEGF therapy. PARTICIPANTS Eighty-one participants with treatment-naïve nAMD from the OSPREY study, including 15 super responders (patients who achieved and maintained retinal fluid resolution) and 66 non-super responders (patients who did not achieve or maintain retinal fluid resolution). METHODS A total of 962 texture-based radiomic features were extracted from fluid, subretinal hyperreflective material (SHRM), and different retinal tissue compartments of OCT scans. The top 8 features, chosen by the minimum redundancy maximum relevance feature selection method, were evaluated using 4 ML classifiers in a cross-validated approach to distinguish between the 2 patient groups. Longitudinal assessment of changes in different texture-based radiomic descriptors (delta-texture features) between baseline and month 3 also was performed to evaluate their association with treatment response. Additionally, 8 baseline clinical parameters and a combination of baseline OCT, delta-texture features, and the clinical parameters were evaluated in a cross-validated approach in terms of association with therapeutic response. MAIN OUTCOME MEASURES The cross-validated area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were calculated to validate the classifier performance. RESULTS The cross-validated AUC by the quadratic discriminant analysis classifier was 0.75 ± 0.09 using texture-based baseline OCT features. The delta-texture features within different OCT compartments between baseline and month 3 yielded an AUC of 0.78 ± 0.08. The baseline clinical parameters sub-retinal pigment epithelium volume and intraretinal fluid volume yielded an AUC of 0.62 ± 0.07. When all the baseline, delta, and clinical features were combined, a statistically significant improvement in the classifier performance (AUC, 0.81 ± 0.07) was obtained. CONCLUSIONS Radiomic-based quantitative assessment of OCT images was shown to distinguish between super responders and non-super responders to anti-VEGF therapy in nAMD. The baseline fluid and SHRM delta-texture features were found to be most discriminating across groups.
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Key Words
- 3D, 3-dimensional
- AMD, age-related macular degeneration
- AUC, area under the receiver operating characteristic curve
- AUC-PRC, area under the precision recall curve
- IAI, intravitreal aflibercept injection
- ILM, internal limiting membrane
- IRF, intraretinal fluid
- ML, machine learning
- OCT
- QDA, quadratic discriminant analysis
- RFI, retinal fluid index
- RPE, retinal pigment epithelium
- Radiomics
- SHRM, subretinal hyperreflective material
- SRF, subretinal fluid
- SRFI, subretinal fluid index
- TRFI, total retinal fluid index
- Wet age-related macular degeneration
- mRmR, minimum redundancy maximum relevance
- nAMD, neovascular age-related macular degeneration
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Affiliation(s)
- Sudeshna Sil Kar
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Hasan Cetin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leina Lunasco
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thuy K. Le
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Zahid
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Xiangyi Meng
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Sunil K. Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
- Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, Ohio
| | - Justis P. Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
- Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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The impact of retinal fluid tolerance on the outcomes of neovascular age-related macular degeneration treated using aflibercept: A real-world study. PLoS One 2022; 17:e0271999. [PMID: 35900984 PMCID: PMC9333245 DOI: 10.1371/journal.pone.0271999] [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: 01/01/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
This study investigated the impact of retinal fluid tolerance on retinal thickness and visual acuity in patients with neovascular age-related macular degeneration after 18 months of treatment using intravitreal aflibercept. This retrospective study was based on the medical records of 90 eyes presenting persistent or recurrent retinal fluid retention after 3 months of aflibercept loading injections. We defined the fluid tolerance ratio as the sum of fluid-tolerance duration divided by the total duration of retinal fluid observed throughout the follow-up period. Eyes were categorized into strict, intermediate, and relaxed group based on their fluid tolerance ratio (= 0, <30%, > = 30%, respectively). The mean total follow-up time was 556 days. The relaxed group required fewer injections than the strict group (4.92 vs 7.50 injections, P < 0.01) and presented a similar reduction in retinal thickness (-57.50 vs -71.65 μm, P = 0.83). Nonetheless, the two groups were similar in terms of final visual acuity (logarithm of the minimum angle of resolution 0.72 vs 0.70, P = 0.95) and visual gains (4.21 vs -1.12 letters, P = 0.56). These results indicate that in the setting of limited medical resources, a fluid-tolerant approach provides comparable gains in visual acuity. Reducing the number of injections may also improve adherence to therapy.
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22
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Jia H, Lu B, Yuan Y, Yuan F, Li L, Song Y, Rong A, Zhou M, Wang F, Sun X. A Randomized, Controlled Trial of Treat-and-Extend vs. Pro Re Nata Regimen for Neovascular Age-Related Macular Degeneration. Front Med (Lausanne) 2022; 9:852519. [PMID: 35795633 PMCID: PMC9251380 DOI: 10.3389/fmed.2022.852519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare the efficacy and safety of conbercept using a treat-and-extend (T&E) regimen vs. a pro re nata (PRN) regimen in Chinese patients with neovascular age-related macular degeneration (nAMD). Methods This was a randomized, multicenter, non-inferiority study. After an initial loading phase of three consecutive monthly intravitreal injections of 0.5 mg Conbercept, the patients were treated to PRN or T&E regimen. The prespecified retreatment criteria was defined as a more than 5-letter decrease in BCVA from the previous visit or any evidence of new retinal hemorrhages, or the presence of any IRF and any SRF of more than 200 μm in height at the sub-foveal center. The primary outcome was the mean change in best-corrected visual acuity (BCVA) from baseline to 24 months, with a prespecified non-inferiority limit of -5 letters. Results From July 2016 through August 2018, 141 participants were allocated and treated (T&E, n = 69; PRN, n = 72). About one fifth of the overall participants were dropped out during the 12-month follow-up (28/141, 19.9%), and about one thirds of the overall participants were lost during the 24-month follow-up (51/141, 36%). At 2 years, mean BCVA letter improvement was + 4.0 in the T&E group vs. + 5.1 in the PRN group, and T&E regimen was not non-inferior to PRN regimen [difference, -1.169 letters; 95% confidence interval (CI): -6.864 ∼ 4.526]. Subgroup analyses also demonstrate the similar results in PCV patients, naive patients and no-naive patients. The mean decrease in central subfield thickness were 180 ± 165 μm in the T&E group and 247 ± 230 μm in the PRN group, respectively. The patients in the PRN group had required significantly fewer injections than those in the T&E group (12.4 vs. 14.6 injections, P = 0.041). The types and rates of adverse events were comparable in the two treatment groups. Conclusion These findings suggest that the T&E regimen was not non-inferior to the PRN regimen in patients with nAMD in terms of BCVA outcomes through 24 months. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02802657.
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Affiliation(s)
- Huixun Jia
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People’s 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
| | - Bing Lu
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People’s Hospital), Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Yuanzhi Yuan
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fei Yuan
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Li
- Department of Ophthalmology, Fudan University Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Yanping Song
- Department of Ophthalmology, Central Theater Command General Hospital, Wuhan, China
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Minwen Zhou
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People’s Hospital), Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Fenghua Wang
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People’s 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
| | - Xiaodong Sun
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People’s 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
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Kim JE, Tomkins-Netzer O, Elman MJ, Lally DR, Goldstein M, Goldenberg D, Shulman S, Benyamini G, Loewenstein A. Evaluation of a self-imaging SD-OCT system designed for remote home monitoring. BMC Ophthalmol 2022; 22:261. [PMID: 35689210 PMCID: PMC9186475 DOI: 10.1186/s12886-022-02458-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare identification rates of retinal fluid of the Notal Vision Home Optical Coherence Tomography (OCT) device (NVHO) when used by people with age-related macular degeneration (AMD) to those captured by a commercial OCT. METHODS Prospective, cross-sectional study where patients underwent commercial OCT imaging followed by self-imaging with either the NVHO 2.5 or the NVHO 3 in clinic setting. Outcomes included patients' ability to acquire analyzable OCT images with the NVHO and to compare those with commercial images. RESULTS Successful images were acquired with the NVHO 2.5 in 469/531 eyes (88%) in 264/290 subjects (91%) with the mean (SD) age of 78.8 (8.8); 153 (58%) were female with median visual acuity (VA) of 20/40. In the NVHO 3 cohort, 69 eyes of 45 subjects (93%) completed the self-imaging. Higher rates of successful imaging were found in eyes with VA ≥ 20/320. Positive percent agreement/negative percent agreement for detecting the presence of subretinal and/or intraretinal fluid when reviewing for fluid in three repeated volume scans were 97%/95%, respectively for the NVHO v3. CONCLUSION Self-testing with the NVHO can produce high quality images suitable for fluid identification by human graders, suggesting the device may be able to complement standard-of-care clinical assessments and treatments.
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Affiliation(s)
- Judy E Kim
- The Eye Institute, Medical College of Wisconsin, 925 N. 87th street, Milwaukee, WI, 53226, USA.
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - David R Lally
- Retina Research Institute at New England Retina Consultants, Springfield, MA, USA
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Comparative Efficacy of Brolucizumab in the Treatment of Neovascular Age-Related Macular Degeneration: A Systematic Literature Review and Network Meta-Analysis. Adv Ther 2022; 39:3425-3448. [PMID: 35678996 PMCID: PMC9309118 DOI: 10.1007/s12325-022-02193-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
Introduction A systematic literature review (SLR) and network meta-analysis (NMA) were conducted to evaluate the comparative efficacy of brolucizumab relative to other anti-vascular endothelial growth factor (VEGF) treatments for neovascular age-related macular degeneration (nAMD) at 1 and 2 years, and overall safety and injection frequency of each treatment. Methods An SLR identifying randomized controlled trials (RCTs) published before June 2021 according to a pre-specified protocol was followed by a Bayesian NMA to compare brolucizumab (6 mg q12w/q8w) against sham and all relevant anti-VEGF regimens. Pooled mean injection frequency, serious adverse ocular events, and discontinuation rates were estimated for each treatment regimen. Results Nineteen RCTs were included in NMA base-case analysis. Brolucizumab (6 mg q12w/q8w) with loading-phase (LP) demonstrated superior best-corrected visual acuity (BCVA) gains to sham both at year 1 (mean difference 16.8 [95%CrI 13.3, 20.4]) and year 2 (mean difference 21.2 [95%CrI 17.4, 25.0]) and was comparable to other anti-VEGFs. Brolucizumab (6 mg q12w/q8w) also showed superior retinal thickness reduction to most comparators including ranibizumab (0.5 mg q4w; year 1 mean difference − 50.1 [95%CrI − 70.3, − 29.8]; year 2 mean difference − 49.5 [95%CrI − 70.8, − 28.6]), aflibercept (2 mg q8w; year 1 mean difference − 39.7 [95%CrI − 52.9, − 26.4]; year 2 mean difference − 35.0 [95%CrI − 49.1, − 21.4]), and faricimab (6 mg q16w/q8w; year 1 mean difference − 27.6 [95%CrI − 42.3, − 12.8]). Brolucizumab (6 mg q12w/q8w) showed similar rates of treatment discontinuation and serious and overall adverse events (both years). At year 2, pooled annualized injection frequency was lowest for brolucizumab (6 mg q12w/q8w) and highest for ranibizumab (0.5 mg q4w) at 5.7 and 11.5 injections annually, respectively. Conclusion Among all licensed anti-VEGF treatments, brolucizumab showed superior reduction in retinal thickness and comparable BCVA gains and discontinuation rates, despite having the lowest injection frequency. The current study provides the most up-to-date, robust comparison of treatments for nAMD. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02193-3.
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25
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Khanani AM, Brown DM, Jaffe GJ, Wykoff CC, Adiguzel E, Wong R, Meng X, Heier JS. MERLIN: Phase 3a, Multicenter, Randomized, Double-Masked Trial of Brolucizumab in Participants With nAMD and Persistent Retinal Fluid. Ophthalmology 2022; 129:974-985. [DOI: 10.1016/j.ophtha.2022.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022] Open
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Zarranz‐Ventura J, Parrado‐Carrillo A, Nguyen V, Sararols L, Garay‐Aramburu G, Puzo M, Arruabarrena C, Figueras‐Roca M, Gillies MC, Casaroli‐Marano RP, Ventura JZ, Carrillo AP, Roca MF, Udina AM, Serra JI, Morales CB, Alforja S, Casaroli Marano RP, Ramsay LS, Londoño G, Olivera M, Bañon K, Rethati C, Calvo P, Sánchez J, Puzo M, Moreno OR, Aramburu GG, Arana AL, Moreno AG, Feijoo DR, Durana Santa Coloma ED, Echeveste MA, Barrio Lopez de Ipiña Z, Díaz IH, Arumí JG, Brosa H, Vela LS, Zapata MA, Arruabarrena C, Milner RM, Aragón F, Veiga MJAL, Lidia M, Conde G, Cid MJR, Rodríguez MIF, Almuiña P, Hortelano VAF, Gallardo JZ, Soriano RC, Escobar IL, Martín PM, Moreno JMR, González RV, Zamora MG, Valldeperas IFMX, Iturralde LB, Mira FV, Sánchez SG, Figueroa PC, Barranco JJE, Bonet MF, Marín BP, Salinas E, Guijarro MJG, García MA, Sanchís SA, Fernández JC, Grau MB, Puyuelo FJA, Grijalbo AH, Murillo AB, Dolores M, Barreda D, Rivasés GP, El Bakkali IB, Pinazo RG, Cholbi M, Marco RD, Figueroa MS, Ciancas E, José J, López G, Haskour CA, Sánchez AP, Sanz NM, Carreño E, Ventura N, Méndez PC, Vázquez CM, Borrego CT, Villoria DV, Layana AG, Viteri MS, Alonso E, Castillón Torre LJ, Muñoz PC, Sempere MET, Fátima Álvarez Gil M, García PP, Eugenia M, Bermejo M, Javier F, Mozos L, Duran MA, Barquet LA, Martín EC, Parra DL, Núñez MR, Gesto AC, Esteban JP, Pilar Ruiz del Tiempo MD, Maqueda MR, Angeles M, Periñan E, Toribio MS. Creation of a neovascular age‐related macular degeneration national database using a web‐based platform:
Fight Retinal Blindness Spain.
Report 1: Visual outcomes. Clin Exp Ophthalmol 2022; 50:312-324. [DOI: 10.1111/ceo.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/14/2022] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Javier Zarranz‐Ventura
- Hospital Clínic de Barcelona Barcelona Spain
- Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
| | - Alba Parrado‐Carrillo
- Hospital Clínic de Barcelona Barcelona Spain
- Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
| | - Vuong Nguyen
- Save Sight Institute, Sydney Medical School, University of Sydney Sydney Australia
| | - Laura Sararols
- Fundació Privada Hospital Asil Granollers Granollers Spain
| | | | - Martín Puzo
- Hospital Universitario Miguel Servet Zaragoza Spain
| | | | - Marc Figueras‐Roca
- Hospital Clínic de Barcelona Barcelona Spain
- Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
| | - Mark C. Gillies
- Save Sight Institute, Sydney Medical School, University of Sydney Sydney Australia
| | - Ricardo P. Casaroli‐Marano
- Hospital Clínic de Barcelona Barcelona Spain
- Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
- Department of Surgery, School of Medicine, Universitat de Barcelona Barcelona Spain
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Electrophysiological evaluation and 18-month follow-up of two regimens with aflibercept for neovascular age-related macular degeneration. Doc Ophthalmol 2022; 144:99-115. [PMID: 35218455 PMCID: PMC9033741 DOI: 10.1007/s10633-021-09863-7] [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: 10/27/2020] [Accepted: 12/08/2021] [Indexed: 11/22/2022]
Abstract
Purpose To compare two aflibercept treatment regimens and the electrophysiological outcome concerning cone and rod function in age-related macular degeneration (nAMD) over 18 months. Methods 41 patients with treatment-naïve nAMD were randomized 1:1 to either arm 1 or 2. Arm 1 received three consecutive monthly aflibercept injections, followed by bimonthly treatment until week 52. Thereafter, a treat-and-extend (TAE) regimen was applied. Arm 2 was treated according to a TAE protocol throughout the 18-month follow-up. We assessed visual acuity (VA), central retinal thickness (CRT), injection rate and interval, and evaluated cone and rod function with full-field and multifocal electroretinography (ffERG, mERG). Results There were no statistically significant differences in mean baseline VA, lesion type, age, gender, or symptom duration between the two arms. During the 18-month follow-up, mean VA improved in arm 1 (n = 19) from 63.5 ± 10.5 to 69.1 ± 9.2 letters; p = 0.098; and in arm 2 (n = 20) from 66.8 ± 13.6 to 73.9 ± 9.0 letters; p = .002. In both arms, mean CRT was significantly reduced; p < 0.000. At month 18, we found no significant difference in the number of injections or injection intervals between groups. Arm 1 had received 11.3 ± 1.7 injections vs. 10.9 ± 2.0 in arm 2. The mean injection interval was 9.2 ± 3.4 weeks vs. 9.5 ± 3.1, with 52% (n = 10) on the maximum 12-week interval in arm 1, and 50% (n = 10) in arm 2. The combined rod-cone a-wave amplitude significantly decreased over time; p = 0.043. The isolated rod b-wave amplitude showed a statistically significant decline; p = 0.026. The overall mERG amplitude and implicit time remained unchanged over time; p = 0.878 vs. p = 0.922. The central ring 1 mERG amplitude improved; p = 0.041, with an unaffected implicit time. Conclusions After 18 months, both treatments arms have received a similar number of injections at comparable intervals. Electrophysiological evaluation shows no signs of toxicity concerning cone function. But ffERGs for the combined and isolated rod response have declined, possibly reflecting either toxic effects of the drug to rods or the natural course of the disease itself.
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Thoongsuwan S, Hanutsaha P, Chantarasorn Y, Ruamviboonsuk P, Vongkulsiri S, Kungwanpongpun P. Treatment Outcome of Wet Age-Related Macular Degeneration Management in Thailand: A Retrospective Real-World Study (TOWER Study). Ophthalmol Ther 2022; 11:739-757. [PMID: 35149964 PMCID: PMC8927559 DOI: 10.1007/s40123-022-00471-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/26/2022] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION To present real-world outcomes of neovascular age-related macular degeneration (nAMD) management in Thailand. METHODS This multicenter retrospective study reviewed medical records of naive nAMD patients diagnosed from 1 January 2016 until 31 December 2018. The patients received at least one intravitreal anti-vascular endothelial growth factor (VEGF) treatment and had captured visual acuity (VA) at baseline and at month 12. Treatment outcomes were assessed at month 12, 24, and 36. The primary outcome was a mean change in VA from baseline to month 12. RESULTS Five hundred seventy-two (572) eyes were included in this study and of these eyes, 222 and 96 had 2- and 3-year follow-up periods, respectively. At month 12, the mean improvement of VA (ETDRS letter) was six letters (P < 0.0001), and central retinal thickness (CRT) decreased on average by 104 microns (P < 0.0001). However, visual improvement by 0.1 letters at month 36 did not show statistical significance. The presence of fluid was found in approximately half of patients throughout the study period (45.98%, 48.85%, and 50.91% at month 12, 24, and 36, respectively). Mean number of injections (SD) was 6.06 (3.00), 3.44 (2.94), and 2.71 (3.07) for years 1, 2, and 3, respectively. The mean number of visits (SD) in year 1 was 9.01 (2.60) and declined to 5.67 (2.69) in year 2 and 4.93 (2.49) in year 3. Patients who had an average injection interval of ≤ 8 weeks were 74.46% in year 1, 51.28% in year 2, and 45.24 in year 3; 35.31% of patients were lost to follow-up. CONCLUSIONS This analysis reflects real-world nAMD management with significant improvement of outcomes. At the same time, the study reveals unmet needs in anti-VEGF therapy in nAMD including persistent disease activities, inadequacy of available treatment, and lack of treatment adherence leading to visual deterioration in the long-term.
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Affiliation(s)
- Somanus Thoongsuwan
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prut Hanutsaha
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Yodpong Chantarasorn
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Sritatath Vongkulsiri
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
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Matsubara H, Matsui Y, Miyata R, Ichio A, Chujo S, Enomoto H, Sugimoto M, Kondo M. Effects of suspension of anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration in clinical setting. Graefes Arch Clin Exp Ophthalmol 2022; 260:1867-1876. [PMID: 35094126 PMCID: PMC9061688 DOI: 10.1007/s00417-021-05526-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/20/2021] [Accepted: 12/14/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose To investigate the outcomes of a suspension of anti-vascular endothelial growth factor (anti-VEGF) treatments in the eyes with neovascular age-related macular degeneration (nAMD). Methods This was a retrospective study that examined eyes having no exudation for 48 weeks while undergoing intravitreal anti-VEGF injections every 12 to 16 weeks. The rate and time of recurrences, best-corrected visual acuity (BCVA), central subfield thickness (CST), number of visits, and reactivity to anti-VEGF were determined after the suspension of the anti-VEGF treatments. Results In 34 eyes of 34 patients, 17 eyes (50.0%) had a recurrence during the 24-month follow-up period. The median time of a recurrence was 10 months. The BCVA was maintained for 24 months after the suspension regardless of the development of any recurrences. In 41.7% of the eyes that resumed treatment, the duration of exudation suppression by the anti-VEGF therapy was shorter than 12 weeks during the 12 months after restarting the anti-VEGF treatments. There was a significant increase in the number of visits during the first year after beginning the suspension versus during the 1 year before the suspension (non-recurrence group; P = 0.007, recurrence group; P = 0.001). Conclusion Although one-half of the eyes had a recurrence within 24 months after a suspension of anti-VEGF treatment, the BCVA was maintained after a resumption of the anti-VEGF treatments. However, the number of hospital visits increases regardless of the recurrences and the lesion stability is altered by the anti-VEGF suspension. Clinicians should explain both the advantages and disadvantages of anti-VEGF suspension to nAMD patients.
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Lai TT, Chen TC, Yang CH, Yang CM, Ho TC, Hsieh YT. Treat-and-Extend vs. Pro Re Nata Regimen of Ranibizumab for Diabetic Macular Edema—A Two-Year Matched Comparative Study. Front Med (Lausanne) 2022; 8:781421. [PMID: 35145975 PMCID: PMC8821911 DOI: 10.3389/fmed.2021.781421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/06/2021] [Indexed: 01/20/2023] Open
Abstract
Purpose To compare 2-year treatment outcomes of ranibizumab using treat-and-extend (T&E) or pro re nata (PRN) regimens for diabetic macular edema (DME) in clinical settings. Methods We retrospectively enrolled 34 patients (34 eyes) with DME treated with ranibizumab using the T&E regimen, and 34 patients (34 eyes) treated with ranibizumab using the PRN regimen and matched to cases in the treat-and-extend group by baseline best-corrected visual acuity (BCVA) and central foveal thickness (CFT). BCVA and CFT changes, number of injections and recurrence of macular edema over 2 years were compared between the groups. Results The average BCVA gain in the T&E and PRN groups was 16.2 and 7.6 ETDRS letters at 2 years (p = 0.011), respectively. The mean CFT reduction was 145.5 ± 127.3 and 97.3 ± 152.5 μm in the T&E and PRN groups at 2 years (p = 0.035), respectively. The T&E group had a higher proportion of patients with BCVA gain ≥ 15 letters at months 18 (p = 0.015) and 24 (p = 0.029) than the PRN group. During the 2-year treatment periods, the T&E group received more injections than the PRN group (11.0 ± 3.2 vs. 6.2 ± 2.0; p < 0.001), while the PRN group had more recurrence of macular edema than the T&E group (71 vs. 41%; p = 0.015). Conclusions After 2-year ranibizumab treatment for DME, better visual and anatomical improvement and less recurrence of macular edema were achieved in the T&E group, with more injections administered.
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Affiliation(s)
- Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Yi-Ting Hsieh
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Cheng CK, Chen SJ, Chen JT, Chen LJ, Chen SN, Chen WL, Hsu SM, Lai CH, Sheu SJ, Wu PC, Wu WC, Wu WC, Yang CM, Yeung L, Chen TC, Yang CH. Optimal approaches and criteria to treat-and-extend regimen implementation for Neovascular age-related macular degeneration: experts consensus in Taiwan. BMC Ophthalmol 2022; 22:25. [PMID: 35033037 PMCID: PMC8760882 DOI: 10.1186/s12886-021-02231-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/23/2021] [Indexed: 11/12/2022] Open
Abstract
The management of neovascular age-related macular degeneration (nAMD) has taken a major stride forward with the advent of anti-VEGF agents. The treat-and-extend (T&E) approach is a refined management strategy, tailoring to the individual patient’s disease course and treatment outcome. To provide guidance to implementing anti-VEGF T&E regimens for nAMD in resource-limited health care systems, an advisory board was held to discuss and generate expert consensus, based on local and international guidelines, current evidence, as well as local experience and reimbursement policies. In the experts’ opinion, treatment of nAMD should aim to maximize and maintain visual acuity benefits while minimizing treatment burden. Based on current evidence, treatment could be initiated with 3 consecutive monthly injections. After the initial period, treatment interval may be extended by 2 or 4 weeks each time for the qualified patients (i.e. no BCVA loss ≥5 ETDRS letters and dry retina), and a maximum interval of 16 weeks is permitted. For patients meeting the shortening criteria (i.e. any increased fluid with BCVA loss ≥5 ETDRS letters, or presence of new macular hemorrhage or new neovascularization), the treatment interval should be reduced by 2 or 4 weeks each time, with a minimal interval of 4 weeks. Discontinuation of anti-VEGF may be considered for those who have received 2–3 consecutive injections spaced 16 weeks apart and present with stable disease. For these individuals, regular monitoring (e.g. 3–4 months) is recommended and monthly injections should be reinstated upon signs of disease recurrence.
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Affiliation(s)
- Cheng-Kuo Cheng
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Ophthalmology, School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Ophthalmology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Lee-Jen Chen
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan.,Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Hsiung Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.,Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chang Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Chuan Wu
- Department of Ophthalmology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.,Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, No.8, Chung Shan S. Rd. (Zhongshan S. Rd.), Zhongzheng Dist., Taipei, 100226, Taiwan
| | - Ling Yeung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, No.8, Chung Shan S. Rd. (Zhongshan S. Rd.), Zhongzheng Dist., Taipei, 100226, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, No.8, Chung Shan S. Rd. (Zhongshan S. Rd.), Zhongzheng Dist., Taipei, 100226, Taiwan.
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Khanani AM, Guymer RH, Basu K, Boston H, Heier JS, Korobelnik JF, Kotecha A, Lin H, Silverman D, Swaminathan B, Willis JR, Yoon YH, Quezada-Ruiz C. TENAYA and LUCERNE. OPHTHALMOLOGY SCIENCE 2021; 1:100076. [PMID: 36246941 PMCID: PMC9559073 DOI: 10.1016/j.xops.2021.100076] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/30/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022]
Abstract
Purpose To describe the design and rationale of the phase 3 TENAYA (ClinicalTrials.gov identifier, NCT03823287) and LUCERNE (ClinicalTrials.gov identifier, NCT03823300) trials that aimed to assess efficacy, safety, and durability of faricimab, the first bispecific antibody for intraocular use, which independently binds and neutralizes both angiopoietin-2 and vascular endothelial growth factor-A (VEGF-A) versus aflibercept in patients with neovascular age-related macular degeneration (nAMD). Design Identical, global, double-masked, randomized, controlled, phase 3 clinical trials. Participants Adults with treatment-naïve nAMD. Methods These trials were designed to evaluate patients randomized to receive faricimab 6.0 mg up to every 16 weeks after 4 initial every-4-week doses or aflibercept 2.0 mg every 8 weeks after 3 initial every-4-week doses. The initial doses in the faricimab arm were followed by individualized fixed treatment intervals up to week 60, based on disease activity assessment at weeks 20 and 24, guided by central subfield thickness, best-corrected visual acuity (BCVA), and investigator assessment. The primary efficacy end point was BCVA change from baseline averaged over weeks 40, 44, and 48. Secondary end points included the proportion of patients receiving every-8-week, every-12-week, and every-16-week faricimab and anatomic outcomes. Safety outcomes included incidence and severity of ocular and nonocular adverse events. From week 60, faricimab-treated patients followed a personalized treatment interval (PTI), a novel protocol-driven treat-and-extend regimen with interval adjustment from every 8 weeks to every 16 weeks based on individualized treatment response measured by anatomic criteria, functional criteria, and investigator assessment of patients’ disease activity. Main Outcome Measures Rationale for trial design and PTI approach. Results The TENAYA and LUCERNE trials were the first registrational trials in nAMD to test fixed dosing regimens up to every 16 weeks based on patients' disease activity in year 1 and incorporate a PTI paradigm during year 2. The PTI approach was designed to tailor treatment intervals to individual patient needs, to reflect clinical practice treatment practice, and to reduce treatment burden. Conclusions The innovative trial design rationale for the TENAYA and LUCERNE trials included maximizing the benefits of angiopoietin-2 blockade through dosing up to every 16 weeks and PTI regimens based on patients' disease activity while fulfilling health authority requirements for potential registrational efforts.
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Affiliation(s)
- Arshad M. Khanani
- Sierra Eye Associates, Reno, Nevada
- Reno School of Medicine, University of Nevada, Reno, Nevada
| | - Robyn H. Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Karen Basu
- Roche Products (Ireland) Limited, Dublin, Ireland
| | | | | | - Jean-François Korobelnik
- Ophthalmology Department, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
- University of Bordeaux, INSERM, BPH, U1219, Bordeaux, France
| | | | - Hugh Lin
- Genentech, Inc., South San Francisco, California
| | | | | | | | - Young Hee Yoon
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Carlos Quezada-Ruiz
- Genentech, Inc., South San Francisco, California
- Clinica de Ojos Garza Viejo, San Pedro Garza Garcia, Nuevo Leon, Mexico
- Correspondence: Carlos Quezada-Ruiz, MD, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080.
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Daien V, Finger RP, Talks JS, Mitchell P, Wong TY, Sakamoto T, Eldem BM, Korobelnik JF. Evolution of treatment paradigms in neovascular age-related macular degeneration: a review of real-world evidence. Br J Ophthalmol 2021; 105:1475-1479. [PMID: 33130553 PMCID: PMC8543219 DOI: 10.1136/bjophthalmol-2020-317434] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 10/03/2020] [Indexed: 11/20/2022]
Abstract
The aim of this work was to evaluate the contribution of real-world evidence (RWE) in changing anti-vascular endothelial growth factor (VEGF) therapy treatment practices and improving real-world treatment strategies for neovascular age-related macular degeneration (nAMD).A PubMed literature search was performed to review the large number of English-language studies conducted to investigate the real-world effectiveness of anti-VEGF (aflibercept and ranibizumab) treatment paradigms available for nAMD.The evidence for pro re nata (PRN), treat-and-extend (T&E) and fixed bimonthly dosing regimens for anti-VEGF treatment of nAMD were reviewed and findings are summarised. RWE demonstrated that T&E regimens optimise visual outcomes while reducing burden on patients, clinics and physicians, compared with both fixed-dose and PRN regimens.RWE has helped to develop and improve real-world treatment strategies in nAMD, with the aim of optimising visual outcomes and reducing treatment burden in clinical practice. Of the various regimens, a T&E regimen is most likely to adequately balance clinical outcomes and treatment burden for patients with nAMD.
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Affiliation(s)
- Vincent Daien
- Department of Ophthalmology, Gui de Chauliac Hospital, Montpellier, France
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - James S Talks
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Bora M Eldem
- Faculty of Medicine, Ophthalmology Department, Hacettepe University, Ankara, Turkey
| | - Jean-François Korobelnik
- Service D'ophtalmologie, CHU de Bordeaux, Bordeaux, France
- Bordeaux Population Health Research Center, University of Bordeaux, Talence, France
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Barresi C, Borrelli E, Fantaguzzi F, Grosso D, Sacconi R, Bandello F, Querques G. Complications Associated with Worse Visual Outcomes in Patients with Exudative Neovascular Age-Related Macular Degeneration. Ophthalmologica 2021; 244:512-522. [PMID: 34517374 DOI: 10.1159/000519518] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neovascular age-related macular degeneration (AMD) represents a leading cause of vision loss in older subjects. The introduction of anti-vascular endothelial growth factor therapy has enormously improved the visual prognosis in these patients. SUMMARY However, severe complications may still occur in this disease and their development may significantly affect short- and long-term visual outcomes. Key Messages: In this article, we provided a review of these complications, highlighting their distinctive signs or symptoms and focusing on the current evidence of treatment. To place the complications related to neovascular AMD in a proper context, this review deals with core components essential for proper comprehension of neovascular AMD that includes pathogenesis, clinical signs, and basic principles of treatment.
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Affiliation(s)
- Costanza Barresi
- Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Borrelli
- Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Fantaguzzi
- Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Grosso
- Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Sacconi
- Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
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Visual acuity outcomes of anti-VEGF treatment for neovascular age-related macular degeneration in clinical trials. Jpn J Ophthalmol 2021; 65:741-760. [PMID: 34491474 DOI: 10.1007/s10384-021-00869-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/05/2021] [Indexed: 12/26/2022]
Abstract
Anti-VEGF treatment for neovascular age-related macular degeneration (nAMD) has been evaluated in clinical trials. To select the best anti-VEGF drug and the best treatment regimen for nAMD, a thorough understanding of the characteristics of each anti-VEGF drug and treatment regimen is essential. In this review, we summarized visual acuity (VA) changes in 30 previous clinical trials of anti-VEGF treatment for nAMD. In most studies, ranibizumab, aflibercept, and brolucizumab improved the VA by 6 to 12 letters from the baseline VA of 50-65 letters and maintained the VA improvement regardless of the treatment regimen; the VA improved from 0.2-0.4 to 0.3-0.7 in Snellen equivalents. The improvement was rapid during the first month and became slower after the second injection, and 60% to 90% of the VA improvement was attained within the first 3 months. The upper limit of the VA improvement should be determined according to eyes with nAMD themselves, not according to anti-VEGF drugs or treatment regimens. Since a fixed regimen can result in overtreatment, whilst a pro re nata regimen can result in insufficient treatment, a treat-and-extend regimen would be optimal to treat nAMD. Insufficient treatment fails to improve VA to the upper limit and/or to maintain the improved VA, whereas overtreatment can cause macular atrophy. One study reported no difference in the risk of macular atrophy between ranibizumab and aflibercept, whilst many studies have suggested that aflibercept causes more choroidal thinning, one of the risk factors for macular atrophy, than does ranibizumab. Further evaluation of drugs and regimens should be performed from the viewpoint of complications and minimum number of injections required to improve and maintain VA.
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Yu HJ, Fuller D, Anand R, Fuller T, Munoz J, Moore C, Kim RS, Schefler AC. Two-year results for ranibizumab for radiation retinopathy (RRR): a randomized, prospective trial. Graefes Arch Clin Exp Ophthalmol 2021; 260:47-54. [PMID: 34463842 DOI: 10.1007/s00417-021-05281-2] [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: 03/09/2021] [Revised: 06/04/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To assess the efficacy of a treat-and-extend strategy with intravitreal ranibizumab for radiation-related macular edema. METHODS Forty eyes with radiation-induced macular edema and decreased visual acuity were enrolled in the phase IIb, prospective clinical trial and randomized into 3 cohorts: (A) monthly ranibizumab, (B) monthly ranibizumab with targeted retinal photocoagulation (TRP), or (C) as-needed ranibizumab and TRP. In year 2, all subjects entered a treat-and-extend protocol for ranibizumab. The primary outcome measure was mean change in early treatment diabetic retinopathy study (ETDRS) best-corrected visual acuity (BCVA) from baseline. RESULTS Through year 1, the mean change in ETDRS BCVA was significantly different between the three cohorts (p < 0.001); cohort A saw the largest gain with + 4.0 letters. Significant anatomic improvements were also seen in all cohorts. Comparatively, through year 2, cohorts A, B, and C had a mean change in ETDRS BCVA of - 1.9, - 3.9, and + 1.3 letters, respectively; additionally, no significant differences were found in absolute ETDRS BCVA across time (ANOVA, p = 0.123). Overall, 90% of eyes maintained VA 20/200 or better and 33.3% of subjects gained at least one line of vision. There were no significant differences in mean central macular thickness for any cohort compared to baseline (p = 0.09). The presence of retinal hemorrhage and intraretinal exudates stayed consistent from year 1 to year 2 for all cohorts. CONCLUSIONS Among eyes with radiation-related macular edema, a treat-and-extend regimen with ranibizumab may not result in as many visual and anatomic improvements as monthly injections. However, treat-and-extend still may prevent serious visual complications compared to historical controls. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02222610.
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Affiliation(s)
- Hannah J Yu
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA
| | | | | | | | - Jose Munoz
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA
| | - Chelsey Moore
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA
| | - Ryan S Kim
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA.,McGovern Medical School, Houston, TX, USA
| | - Amy C Schefler
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA. .,Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Ste. 750, Houston, TX, 77030, USA.
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Moisseiev E, Tsai YL, Herzenstein M. Treatment of Neovascular Age-Related Macular Degeneration: An Economic Cost-Risk Analysis of Anti-Vascular Endothelial Growth Factor Agents. Ophthalmol Retina 2021; 6:205-212. [PMID: 34454123 DOI: 10.1016/j.oret.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To find the best cost-effective neovascular age-related macular degeneration (nAMD) treatment to improve vision while avoiding complications. The model is based on a cost-risk tradeoff analysis from policymakers' perspective. DESIGN A powerful and flexible simulation modeled outcomes of 2 years of treatment with the 4 commonly used anti-vascular endothelial growth factor drugs (bevacizumab, ranibizumab, aflibercept, and brolucizumab) across 3 injection protocols, building on prior findings that these drugs are noninferior. The model incorporates blinding complications, their management, and associated costs to society. Each option and several what-if scenarios were simulated 1,000 times with 100,000 hypothetical patients. PARTICIPANTS One hundred thousand simulated patients using data from published clinical trials. METHOD Case- and eye-specific cost-risk economic analysis. MAIN OUTCOME MEASURES Costs of nAMD treatment per patient and number of eyes that become blind as a result of treatment over 2 years. RESULTS Using published prices and fees, the injection protocol that follows published clinical studies, results showed that the mean±standard deviation cost per patient were $16,859 ± $3.65, $32,949 ± $3.27, $39,831 ± $3.80, and $53,056 ± $2.99 for bevacizumab, brolucizumab, aflibercept, and ranibizumab, respectively. The numbers±standard deviations of treated eyes that became blind were 108 ± 10.18, 694 ± 26.66, 168 ± 12.83, and 108 ± 10.52, respectively. We further provide a lower bound (when all patients are maximally extended) and upper bound (when no patient is extended) to these numbers. For brolucizumab, the upper bound is the 2-month interval injection protocol. CONCLUSIONS Taking a policymaking perspective, this study suggested that bevacizumab is the preferred first-line therapy. Recommendation for second-line therapy depends on the extent of the policymaker's risk aversion because of the tradeoff between cost and risk of blindness as a result of treatment. If risk neutral, the least expensive option (brolucizumab) is preferred. But if policymakers are moderately to highly risk averse, then aflibercept or ranibizumab are preferred. Because medical advances and different costs may change our findings, we provide a free application (https://eye-inj.shinyapps.io/calc/) for readers who wish to use different cost structures. Simulating outcomes is an innovative approach, unique in ophthalmology, and presents a significant opportunity because it can be adapted easily to different settings (using different costs, risks, and protocols) and to other diseases (e.g., diabetic macular edema), to ultimately improve wide-scale decision-making and use of funds.
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Affiliation(s)
- Elad Moisseiev
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yi-Lin Tsai
- Lerner College of Business and Economics, University of Delaware, Newark, Delaware
| | - Michal Herzenstein
- Lerner College of Business and Economics, University of Delaware, Newark, Delaware
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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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Kaiser PK, Wykoff CC, Singh RP, Khanani AM, Do DV, Patel H, Patel N. RETINAL FLUID AND THICKNESS AS MEASURES OF DISEASE ACTIVITY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2021; 41:1579-1586. [PMID: 33949342 PMCID: PMC8297539 DOI: 10.1097/iae.0000000000003194] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Retinal fluid and thickness are important anatomical features of disease activity in neovascular age-related macular degeneration, as evidenced by clinical trials that have used these features for inclusion criteria, retreatment criteria, and outcome measures of the efficacy of intravitreal injections of anti-vascular endothelial growth factor agents. METHODS A literature review of anatomical measures of disease activity was conducted. RESULTS Treatment goals for neovascular age-related macular degeneration include improving/maintaining vision by drying the retina, and several analyses have evaluated the relationship between visual function and anatomy. The change in retinal thickness has been found to correlate with the change in the visual acuity, and variation in retinal thickness may predict visual acuity outcomes. In addition, specific fluid compartments may have different prognostic values. For example, the presence of intraretinal fluid has been associated with poorer visual acuity, whereas the presence of subretinal fluid has been associated with better visual acuity. Retinal fluid and thickness are important for selecting dosing interval durations in clinical trials and clinical practice. CONCLUSION Retinal thickness and retinal fluid are common anatomical measures of disease activity in neovascular age-related macular degeneration. Further research is required to fully elucidate the relationship between anatomical features and visual outcomes in neovascular age-related macular degeneration.
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Affiliation(s)
- Peter K. Kaiser
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Charles C. Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas;
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Arshad M. Khanani
- Sierra Eye Associates, Reno, Nevada
- University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Diana V. Do
- Byers Eye Institute, Stanford University, Palo Alto, California; and
| | - Hersh Patel
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Nikhil Patel
- Novartis Pharmaceuticals, East Hanover, New Jersey
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Ehlers JP, Clark J, Uchida A, Figueiredo N, Babiuch A, Talcott KE, Lunasco L, Le TK, Meng X, Hu M, Reese J, Srivastava SK. Longitudinal Higher-Order OCT Assessment of Quantitative Fluid Dynamics and the Total Retinal Fluid Index in Neovascular AMD. Transl Vis Sci Technol 2021; 10:29. [PMID: 34003963 PMCID: PMC7995350 DOI: 10.1167/tvst.10.3.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the feasibility of assessing quantitative longitudinal fluid dynamics and total retinal fluid indices (TRFIs) with higher-order optical coherence tomography (OCT) for neovascular age-related macular degeneration (nAMD). Methods A post hoc image analysis study was performed using the phase II OSPREY clinical trial comparing brolucizumab and aflibercept in nAMD. Higher-order OCT analysis using a machine learning−enabled fluid feature extraction platform was used to segment intraretinal fluid (IRF) and subretinal fluid (SRF) volumetric components. TRFI, the proportion of fluid volume against total retinal volume, was calculated. Longitudinal fluid metrics were evaluated for the following groups: all subjects (i.e. treatment agnostic), brolucizumab, and aflibercept. Results Mean IRF and SRF volumes were significantly reduced from baseline at each timepoint for all groups. Fluid feature extraction allowed high-resolution assessment of quantitative fluid burden. A greater proportion of brolucizumab participants achieved true zero and minimal fluid (total fluid volume between 0.0001 and 0.001mm3) versus aflibercept participants at week 40. True zero fluid during q12 brolucizumab dosing was achieved in 36.6% to 38.5%, similar to the 25.6% to 38.5% during the corresponding q8 aflibercept cycles. TRFI was significantly reduced from baseline in all groups. Conclusions Higher-order OCT analysis demonstrates the feasibility of fluid feature extraction and longitudinal volumetric fluid burden and TRFI characterization in nAMD, supporting a unique opportunity for fluid burden assessment and the impact on outcomes. Translational Relevance Detection and characterization of disease activity is vital for optimal treatment of nAMD. Longitudinal assessment of fluid dynamics and the TRFI provide important proof of concept for future automated tools in characterizing disease activity.
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Affiliation(s)
- Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Julie Clark
- Formerly Novartis Pharmaceuticals, East Hanover, NJ, USA
| | - Atsuro Uchida
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Natalia Figueiredo
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy Babiuch
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Katherine E Talcott
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Leina Lunasco
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thuy K Le
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ming Hu
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Jamie Reese
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
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von der Burchard C, Moltmann M, Tode J, Ehlken C, Sudkamp H, Theisen-Kunde D, König I, Hüttmann G, Roider J. Self-examination low-cost full-field OCT (SELFF-OCT) for patients with various macular diseases. Graefes Arch Clin Exp Ophthalmol 2021; 259:1503-1511. [PMID: 33346888 PMCID: PMC8166739 DOI: 10.1007/s00417-020-05035-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/22/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The treatment guidelines for many macular diseases rely on frequent monitoring with optical coherence tomography (OCT). However, the burden of frequent disease control leads to low therapy adherence in real life. OCT home monitoring would address this issue but requires an inexpensive and self-operable device. With self-examination low-cost full-field OCT (SELFF-OCT), our group has introduced a novel technology that may fulfill both requirements. In this pilot study, we report the initial experiences with a clinical prototype. METHODS Fifty-one patients with different macular diseases were recruited in a cross-sectional study. The most common diseases were age-related macular degeneration (AMD; 39/51), diabetic macular edema (DME; 6/51), and retinal vein occlusion (RVO; 3/51). Patients received a short training in device usage and then performed multiple self-scans with the SELFF-OCT device. For comparison, scans with a standard clinical spectral domain (SD-)OCT were taken. RESULTS After a brief training, 77% of the patients were able to successfully acquire images that were clinically gradable. No significant influence on success could be found for age (p = 0.08) or BCVA (p = 0.97). Relevant disease biomarkers in the most common retinal diseases could be detected. CONCLUSIONS SELFF-OCT was used successfully for retinal self-examination and in the future could be used for retinal home monitoring. Future improvements in technology are expected to improve success rates and image quality. TRIAL REGISTRATION The Trial was registered in the German Trial Register under the number DRKS00013755 on 14.03.2018.
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Affiliation(s)
- Claus von der Burchard
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Moritz Moltmann
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Jan Tode
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christoph Ehlken
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Helge Sudkamp
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Dirk Theisen-Kunde
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Inke König
- Institute of Medical Biometry and Statistics, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Gereon Hüttmann
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
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Yu JS, Carlton R, Agashivala N, Hassan T, Wykoff CC. Brolucizumab vs aflibercept and ranibizumab for neovascular age-related macular degeneration: a cost-effectiveness analysis. J Manag Care Spec Pharm 2021; 27:743-752. [PMID: 34057392 PMCID: PMC10390922 DOI: 10.18553/jmcp.2021.27.6.743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of blindness worldwide and is the most common cause of blindness in developed countries. Despite antivascular endothelial growth factor (anti-VEGF) therapy demonstrating improvements in visual and anatomical outcomes, unmet needs remain. Brolucizumab-dbll (ie, brolucizumab), a VEGF inhibitor for treatment of neovascular (wet) AMD and recently approved by the FDA for its treatment of wet AMD, attempts to mitigate treatment burden through less frequent injections. OBJECTIVE: To assess the incremental cost-effectiveness of brolucizumab compared with aflibercept and ranibizumab, given similar costs per injection and the potential for longer dosing intervals based on phase 3 clinical trial data. METHODS: A Markov model was developed to model the treatment of wet AMD patients with brolucizumab vs aflibercept and vs ranibizumab over a lifetime time horizon (base case) and 5-year time horizon (scenario analysis). The Markov model consisted of 3 primary health states: on treatment, off treatment, and death. Markov substates (5 total) described visual acuity (VA) ranging from no vision impairment to blindness. These VA-based substates were defined by best-corrected visual acuity (BCVA) values measured using Early Treatment Diabetic Retinopathy Study letters. Fixed-dosing regimens for each therapy were included in the model: dosing every 4 weeks (q4w) for the first 3 months followed by dosing q8w/q12w for brolucizumab, dosing q4w for the first 3 months followed by dosing q8w for aflibercept, and q4w for ranibizumab. RESULTS: In the base case, brolucizumab was less costly than aflibercept ($63,614 vs $72,189), and brolucizumab generated 0.0079 more quality-adjusted life-years (QALYs) than aflibercept (4.580 vs 4.572). Lower total costs with brolucizumab were driven by reduced drug costs ($56,432 vs $64,057), reduced administration costs ($6,013 vs $6,825), and reduced monitoring costs ($1,168 vs $1,306). When evaluating the cost-effectiveness of brolucizumab over a 5-year time horizon, brolucizumab was less costly than aflibercept ($44,644 vs $50,772) and generated an additional 0.0049 QALYs (2.953 vs 2.948). Additionally, brolucizumab was less costly than ranibizumab ($63,614 vs $128,163) and generated 0.0078 more QALYs than ranibizumab (4.580 vs 4.572) in the base case. Lower total costs with brolucizumab were driven by reduced drug costs ($56,432 vs $114,516), reduced administration costs ($6,013 vs $11,541), and reduced monitoring costs ($1,168 vs $2,107). When evaluating the cost-effectiveness of brolucizumab over a 5-year time horizon, brolucizumab was less costly than ranibizumab ($44,644 vs $89,665), and brolucizumab generated an additional 0.0046 QALYs (2.953 vs 2.948). CONCLUSIONS: Brolucizumab can be cost saving and cost-effective compared with aflibercept and ranibizumab in the treatment of wet AMD. DISCLOSURES: Novartis Pharmaceuticals Corporation provided funding to Xcenda for the cost-effectiveness analysis and preparation of this manuscript. Carlton is an employee of Xcenda. Agashivala is employed by Novartis Pharmaceuticals Corporation; Yu was an employee of Novartis Pharmaceutical Corporation at the time of this study. Hassan reports personal fees from iOPEN, BVI/Visitrec, ArcticDx, Bayer, F. Hoffmann-La Roche Ltd, Broadspot, BMC, Katalyst Surgical, Alcon, Vitreq, Surgicube, personal Ocugenix, Regeneron, Allergan, Oculus Surgical, Novartis, Genentech, and Eyepoint, unrelated to this work. Wykoff reports personal fees from Corcept Therapeutics, DORC, EyePoint, Gyroscope, IVERIC Bio, Merck, Notal Vision, ONL Therapeutics, Oxurion, Palatin, PolyPhotonix, Takeda, Thea Open Innovation; grants from Aerie Pharmaceuticals, Aldeyra, Gemini Therapeutics, Graybug Vision, IONIS Pharmaceutical, LMRI, Mylan, Neurotech Pharmaceuticals, Outlook Pharmaceuticals, Samsung Bioepis, Senju, Taiwan Liposome Company, Xbrane BioPharma, Santen; and grants and personal fees from Adverum, Allergan, Apellis, Chengdu Kanghong Biotechnologies (KHB), Clearside Biomedical, Genentech, Kodiak Sciences, NGM Biopharmaceuticals, Novartis, Opthea, Recens Medical, Regenxbio, Roche, and Regeneron, unrelated to this work. This research was presented as a virtual poster at the AMCP 2020 Annual Meeting, April 2020.
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Affiliation(s)
- Justin S Yu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Tarek Hassan
- Oakland University William Beaumont School of Medicine and Associated Retinal Consultants, Royal Oak, MI
| | - Charles C Wykoff
- Retina Consultants of Houston, Retina Consultants of America, and Blanton Eye Institute and Houston Methodist Hospital, Houston, TX
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Horner F, Lip PL, Mohammed BR, Fusi-Rubiano W, Gokhale E, Mushtaq B, Chavan R. Comparing Effectiveness of Three Different Anti-VEGF Treatment Regimens for Neovascular Age-Related Macular Degeneration: Two Years' Real-World Clinical Outcomes. Clin Ophthalmol 2021; 15:1703-1713. [PMID: 33935487 PMCID: PMC8080302 DOI: 10.2147/opth.s305141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare and report the 2-year treatment outcomes from 3 different anti-VEGF treatment regimens in treating neovascular aged-related macular degeneration (nAMD): Ranibizumab pro re nata (Ranibizumab-PRN); Ranibizumab treat and extend (Ranibizumab-T&E); Aflibercept fixed first year dosing (7 injections) with treat and extend in subsequent year (Aflibercept-Fixed). Methods All treatment-naïve nAMD patients who completed 24 months of monitoring from a single treatment center were included. Patients received the initial loading dose of three injections (4-weekly interval), followed by one of the 3 treatment regimens. Primary outcomes were changes in visual acuity (VA) and central retinal thickness (CRT). Secondary outcome was number of injections required in each year. Data analysis included last observation carried forward (LOCF) for patients with incomplete year-2 follow-up. Results A total of 249 eyes (230 patients) were studied: 121 Ranibizumab-PRN; 65 Ranibizumab-T&E, and 63 Aflibercept-Fixed. Baseline median VA (ETDRS letters) for Ranibizumab-PRN, Ranibizumab-T&E, and Aflibercept-Fixed was 53.9, 61.1, and 54.9 letters, achieving final VA of 54.9, 65.1, and 65.1 letters, respectively. Hence, the number of letters increased at the end of 24 months for each group was +1.0 (Ranibizumab-PRN), +4.0 (Ranibizumab-T&E), highest +10.2 in Aflibercept-Fixed group. Median number of injections over 2 years (year-1/year-2) was 5/1 for Ranibizumab-PRN, 9/6 for Ranibizumab-T&E, and 7/5 for Aflibercept-Fixed. Both Ranibizumab-T&E and Aflibercept-Fixed also shared the same reduction of median CRT (115 µm), higher than Ranibizumab-PRN (83 µm). Conclusion We report VA improvement from all three different treatment regimens with both Aflibercept-Fixed and Ranibizumab-T&E regimens achieving the same higher final VA. Aflibercept-Fixed dosing may have more favorable efficacy with the highest VA gain and comparatively lower dosing frequency whereas Ranibizumab-T&E may be more efficient than Ranibizumab-PRN regimen, according to our study.
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Affiliation(s)
- Faye Horner
- Birmingham & Midland Eye Centre, Birmingham, UK
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McClard CK, Wang R, Windham V, Munoz J, Gomez S, Fried S, Saroj N, Regillo C, Wykoff CC, Strutt AM. Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections (QUALITII): Development of a patient-reported measure to assess treatment burden of repeat intravitreal injections. BMJ Open Ophthalmol 2021; 6:e000669. [PMID: 33912685 PMCID: PMC8031709 DOI: 10.1136/bmjophth-2020-000669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 01/22/2023] Open
Abstract
Objective To understand patient burden of treatment of repeated intravitreal injections (IVI) in the management of exudative retinal diseases. Methods and analysis Participants were sampled from a large urban retina specialty practice in Houston, Texas, USA, based on history of ongoing receipt of IVI. The 50-item Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections questionnaire was developed to evaluate the patient experience including discomfort, anxiety, inconvenience and satisfaction. Categorial principal components analysis (CATPCA) was performed to assess construct validity and internal consistency. A subset of these items was used to establish a measure of total treatment burden, referred to as the IVI Treatment Burden Score (TBS). Results 142 patients participated in this study. CATPCA analysis revealed five dimensions of patient burden: disruption of normal routine or capacity, anxiety, frequency of visits, chronicity of disease and perceived treatment value or satisfaction. Together, these dimensions accounted for 67% of variance explained. Cronbach's alpha was 0.97. The most frequently cited cause of discomfort was the feeling after anaesthetic wore off. The most common source of anxiety was fear of injection and associated discomfort or pain. Regarding inconvenience, patients reported temporary postinjection debilitation, requiring an average of 8 hours for recovery per treatment. The most frequently identified sources of satisfaction were confidence in the provider or treatment and interactions with staff. Conclusions Understanding and quantifying the patient burden associated with repeated IVI for exudative retinal diseases can reveal opportunities to improve delivery methods. The TBS could serve to inform strategies to maximise treatment adherence and optimise patient experiences.
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Affiliation(s)
- Cynthia K McClard
- Ophthalmology, Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA.,The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Rui Wang
- Ophthalmology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Jose Munoz
- Retina Consultants of Texas, Houston, Texas, USA
| | - Samuel Gomez
- Retina Consultants of Texas, Houston, Texas, USA
| | - Sagit Fried
- Ben Gurion University of the Negev, Beersheba, Israel
| | | | - Carl Regillo
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Charles Clifton Wykoff
- Retina Consultants of Texas, Retina Consultants of America; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
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Brown GC, Brown MM, Rapuano SB, Boyer D. A Cost-Benefit Analysis of VEGF-Inhibitor Therapy for Neovascular Age-Related Macular Degeneration in the United States. Am J Ophthalmol 2021; 223:405-429. [PMID: 32681907 DOI: 10.1016/j.ajo.2020.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To perform a societal cost-benefit analysis comparing intravitreal bevacizumab (Avastin), ranibizumab (Lucentis), and aflibercept (Eylea) monotherapies for treating neovascular age-related macular degeneration (NVAMD). DESIGN Cost-benefit analysis. METHODS Center for Value-Based Medicine using published clinical trial and Medicare data. PATIENT POPULATION 168,400 estimated 2018 U.S. patients with new-onset NVAMD. Procedure(s): cost-benefit analysis using 2018 U.S. real dollars. OUTCOME MEASUREMENTS 11-year direct ophthalmic medical costs expended for bevacizumab, ranibizumab, and aflibercept monotherapies were compared with ophthalmic and nonophthalmic direct medical, direct nonmedical, and indirect medical (productivity) costs saved by the therapies. RESULTS Bevacizumab monotherapy had an individual, 11-year $14,772 treatment cost and net $357,680 societal return (11-year 2,421% return on investment [ROI]). Ranibizumab therapy cost $106,582 and returned $265,870 to society (249% ROI), whereas aflibercept treatment cost $61,811 and returned $310,611 to society (503% ROI). The 2018 NVAMD overall treatment cohort, 11-year net societal gain was $28.5 billion to patients and insurers, with $24.2 billion (84.9%) coming from bevacizumab therapy, $0.7 billion (2.5%) from ranibizumab therapy, and $3.6 billion (12.6%) from aflibercept therapy. Substituting bevacizumab for ranibizumab and aflibercept in the 2018 new-onset NVAMD patients would save an estimated $1.343 billion over 11 years. Vascular endothelial growth factor-inhibitor (VEGF-I) therapy in 2018 should contribute $12.2 billion to the Gross Domestic Product over 11 years. Late treatment would decrease this by 78% to $2.7 billion. CONCLUSIONS Intravitreal NVAMD bevacizumab, ranibizumab and aflibercept monotherapies accrue considerable financial, ROIs to patients and insurers as they increase national wealth.
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Affiliation(s)
- Gary C Brown
- Center for Value-Based Medicine, Hilton Head, South Carolina, USA; Wills Eye Hospital, Jefferson Medical University, Philadelphia, Pennsylvania, USA; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Melissa M Brown
- Center for Value-Based Medicine, Hilton Head, South Carolina, USA; Wills Eye Hospital, Jefferson Medical University, Philadelphia, Pennsylvania, USA; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sara B Rapuano
- Center for Value-Based Medicine, Hilton Head, South Carolina, USA; Wills Eye Hospital, Jefferson Medical University, Philadelphia, Pennsylvania, USA
| | - David Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, California, USA
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Starr MR, Xu D, Boucher N, Saroj N, Patel LG, Ammar M, Pandit RR, Jenkins TL, Ho AC. Characterizing Progression to Neovascular AMD in Fellow Eyes of Patients Treated With Intravitreal Anti-VEGF Injections. Ophthalmic Surg Lasers Imaging Retina 2021; 52:123-128. [PMID: 34038686 DOI: 10.3928/23258160-20210302-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to assess the real-world incidence of conversion to bilateral neovascular age-related macular degeneration (nAMD) following treatment initiation of nAMD in the initial eye. PATIENTS AND METHODS This was a retrospective cohort of electronic health records from retinal centers across the United States (Vestrum Database) of all patients with unilateral nAMD treated with anti-vascular endothelial growth factor therapy. RESULTS A total of 22,553 patients with unilateral nAMD were included. Fellow eyes of 8,522 patients (38%) converted to nAMD. Among these, 2,639 (12%), 2,030 (9%), and 1,802 (8%) patients converted in Years 1, 2, and 3, respectively, after diagnosis in the first eye. Fellow eyes had better vision at conversion and 1 year following conversion. CONCLUSIONS The fellow eye should be monitored at regular intervals to detect signs of neovascularization. Fellow eyes presented with significantly better vision at diagnosis than the initial eye and maintained better visual acuity with less injections. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:123-128.].
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Garweg JG, Gerhardt C. Disease stability and extended dosing under anti-VEGF treatment of exudative age-related macular degeneration (AMD) - a meta-analysis. Graefes Arch Clin Exp Ophthalmol 2021; 259:2181-2192. [PMID: 33528645 PMCID: PMC8352813 DOI: 10.1007/s00417-020-05048-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess disease stability (absence of intra- and/or subretinal fluid) and the portion of eyes being capable to extend their treatment interval to ≥ 12 weeks in exudative age-related macular degeneration (AMD). METHODS A systematic literature search was performed in NCBI, PubMed, CENTRAL, and ClinicalTrials.gov to identify clinical studies reporting treatment outcomes for ranibizumab, aflibercept, and brolucizumab in exudative AMD under a treat-and-extend protocol and a follow-up of ≥ 12 months. Weighted mean differences and subgroup comparisons were used to integrate the different studies. RESULTS This meta-analysis refers to 29 published series, including 27 independent samples and 5629 patients. In the pooled group, disease stability was reported in 62.9% and 56.0%, respectively, after 12 and 24 months of treatment, whereas treatment intervals were extended to ≥ 12 weeks in 37.7% and 42.6%, respectively. Ranibizumab, aflibercept, and brolucizumab differed regarding their potential to achieve disease stability (56.3%, 64.5%, and 71.5% after 12, and 50.0%, 52.7% and 75.7% after 24 months; p = < 0.001) and to allow an interval extension to ≥ 12 weeks (28.6%, 34.2%, and 53.3% after 12, and 34.2%, 47.7%, and 41.7% after 24 months; p = < 0.001). CONCLUSION The portion of eyes achieving disease stability regressed in the second year, whereas the portion of eyes under a ≥ 12-week interval increased. This discrepancy may reflect the challenges in balancing between under-treatment and a reduced treatment burden.
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Affiliation(s)
- Justus G Garweg
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland. .,Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland.
| | - Christin Gerhardt
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
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Oshima Y, Ishibashi Y, Umeda N, Nagata T, Yoshida S, Uchio E, Kondo H, Sonoda KH, Ishibashi T. Correlation between improvement in visual acuity and QOL after Ranibizumab treatment for age-related macular degeneration patients: QUATRO study. BMC Ophthalmol 2021; 21:58. [PMID: 33485320 PMCID: PMC7825175 DOI: 10.1186/s12886-021-01816-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/12/2021] [Indexed: 12/27/2022] Open
Abstract
Background To evaluate the correlation between visual acuity improvement and vision-related QOL after ranibizumab treatment in Japanese patients with AMD. Methods In this one-year prospective, interventional, open-label, multicenter study involving four sites, patients with neovascular AMD were enrolled and observed for 12 months. Treatment-naïve patients received 0.5 mg ranibizumab as needed after three initial monthly doses. The best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at every visit. Evaluations with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and patient satisfaction questionnaire were performed at baseline and 3 and 12 months after initial treatment. The primary endpoint was change in BCVA and QOL 3 months after ranibizumab treatment. QOL outcomes were also assessed in the better and poor BVCA subgroups. Results The study enrolled 100 patients. The mean logMAR BCVA after treatment improved significantly from 0.43 to 0.30 at 3 months (p< 0.0001), and 0.28 at 12 months (p< 0.0001). The mean NEI-VFQ-25 composite scores improved from 79.48 to 84.13 at 3 months (p< 0.0001), and 86.0 at 12 months (p< 0.0001). The 3 and 12-month changes in NEI-VFQ-25 score and BCVA showed significant correlation. In the poor baseline visual acuity group (decimal BCVA ≤0.5), there was a significant correlation between the changes in the NEI-VFQ-25 score and BCVA (p=0.02) but not in the better baseline visual acuity group (decimal BCVA > 0.6, p=0.1) at 3 months. There were no significant differences in the satisfaction questionnaire score from baseline to at 3 months (p=0.54) and 12 months (p=0.23). The average CMT improved significantly from 340 to 264 μm at 3 months (p< 0.0001) and to 268 μm at 12 months (p< 0.0001). Conclusions Intravitreal ranibizumab treatment resulted in improvement in visual acuity, anatomical change, and visual function change in Japanese AMD patients. Significant improvement was seen in patient visual function, and this was correlated with changes in VA, except immediately after loading dose treatment in patients with higher baseline VA. The patients’ satisfaction with the treatment remained unchanged during the study period. Trial registration This study is registered at UMIN Clinical Trials Registry (UMIN000012013). Registered October 10, 2013, as prospective study.
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Affiliation(s)
- Yuji Oshima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Yumi Ishibashi
- Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan
| | - Naoyasu Umeda
- Department of Ophthalmology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tatsuo Nagata
- Department of Ophthalmology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroyuki Kondo
- Department of Ophthalmology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuro Ishibashi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Nahen K, Benyamini G, Loewenstein A. Evaluation of a Self-Imaging SD-OCT System for Remote Monitoring of Patients with Neovascular Age Related Macular Degeneration. Klin Monbl Augenheilkd 2020; 237:1410-1418. [DOI: 10.1055/a-1271-6834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Background The treatment of patients with neovascular age-related macular degeneration (nAMD) requires frequent office visits to identify fluid in the retina that requires treatment. Frequent office-based examinations using optical coherence tomography (OCT) are a burden on patients and their care givers. The development of OCT systems that can be self-operated by patients at home offers the potential for precise remote monitoring and improved individualized therapy.
Patients/Material and Methods An investigational spectral domain OCT system (Notal Vision Home OCT, NVHO) for automatic patient-guided self-imaging intended for commercialization was evaluated in a total of 69 study participants with neovascular age-related macular degeneration with regard to image quality and usability. An artificial intelligence-based algorithm was used to identify, quantify and map intra- and subretinal fluids.
Results Successful imaging with the NHVO was performed in all patients and in 93% of the enrolled eyes. The positive percent agreement and negative percent agreement for detection of fluid, intraretinal fluid, and subretinal fluid in at least one of three consecutive NHVO images was 97/95%, 96/94% and 100/98%, respectively, when compared to commercial in-office OCT systems. In 1.4% of the recorded eyes, fluid was only detected outside of the central 10 × 10° field of view but seen on a commercial OCT system with a larger field of view. The device operation for scanning their own eyes without assistance was rated by 95% of patients as easy. The analysis and depiction of fluid distribution and volume in a longitudinal case study illustrated the acute nature and anti-VEGF therapy response of nAMD.
Conclusion The evaluated OCT system for home use meets the requirements for self-controlled imaging by nAMD patients with regard to image quality, field of view and usability. Image analysis based on artificial intelligence can potentially support clinicians in the assessment and utilization of large amounts of data generated by daily home OCT imaging.
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Affiliation(s)
- Kester Nahen
- Corporate Leadership, Notal Vision Inc, Manassas, Virginia, United States
| | | | - Anat Loewenstein
- Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Kertes PJ, Galic IJ, Greve M, Williams G, Baker J, Lahaie M, Sheidow T. Efficacy of a Treat-and-Extend Regimen With Ranibizumab in Patients With Neovascular Age-Related Macular Disease: A Randomized Clinical Trial. JAMA Ophthalmol 2020; 138:244-250. [PMID: 31917441 PMCID: PMC6990694 DOI: 10.1001/jamaophthalmol.2019.5540] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Although the Canadian Treat-and-Extend Analysis Trial With Ranibizumab in Patients With Neovascular Age-Related Macular Disease (CANTREAT) reported herein and the Treat and Extend study provided data to show noninferiority of treat-and-extend (T&E) at 12 months, to date there are few data on 24-month T&E trials compared with monthly dosing. Objective To compare the efficacy of ranibizumab using a T&E regimen to monthly dosing in treatment-naive patients with neovascular age-related macular degeneration (nAMD) after 24 months. Design, Setting, and Participants A randomized, open-label, multicenter, noninferiority intention-to-treat trial with a margin of -5 letters in best-corrected visual acuity (BCVA) from baseline to 12 months between groups was conducted at 27 treatment centers in Canada. Participants included 580 patients with treatment-naive choroidal neovascularization secondary to AMD. The study was conducted from May 8, 2013, to August 28, 2018, and data analysis was performed between August 29 and September 12, 2018. Interventions Patients with nAMD were randomized 1:1 to receive intravitreal ranibizumab, 0.5 mg, in either a T&E or monthly dosing regimen. Main Outcomes and Measures Mean change in BCVA in Early Treatment of Diabetic Retinopathy Study letters from baseline to month 24. Results Of the 580 randomized patients, 350 were women (60.3%) and 547 were white (94.3%). Mean (SD) age was 78.8 (7.8) years. By the end of month 24, 466 of the 580 randomized patients (80.3%) had completed the study and participants in the T&E arm received a mean of 17.6 injections compared with 23.5 injections for the monthly arm, for a difference of 5.9 injections and visits over 2 years (95% CI, 5.4-6.5; P < .001). The mean (SD) BCVA improvement was not worse with the T&E arm, 6.8 (14.1) letters vs 6.0 (12.6) letters, compared with the monthly arm (difference, 0.9; 95% CI, -1.6 to 3.3; P = .21). There was a gain of 15 or more letters in 25.5% of the T&E group and 23.1% of the monthly treatment group (difference, 2.4%; 95% CI, -6.8% to 11.6%; P = .59) and a loss of 15 or more letters in 6.5% of the T&E group and 5.8% of the monthly treatment group (difference, -0.7%; 95% CI, -9.9% to 8.5%; P = .85). Conclusions and Relevance These findings suggest that change in vision from baseline is not worse with a T&E compared with a monthly regimen of ranibizumab for nAMD through 24 months, achieving clinically meaningful improvements in BCVA despite fewer injections and visits. Trial Registration ClinicalTrials.gov identifier: NCT02103738.
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Affiliation(s)
- Peter J Kertes
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Ivan J Galic
- Montreal Retina Institute, Montreal, Québec, Canada.,Department of Ophthalmology & Visual Sciences, McGill University, Montreal, Québec, Canada
| | - Mark Greve
- Alberta Retina Consultants, Edmonton, Alberta, Canada.,Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff Williams
- Calgary Retina Consultants, Calgary, Alberta, Canada.,Department of Surgery, Section Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Jason Baker
- Novartis Pharmaceuticals Canada Inc, Dorval, Québec, Canada
| | - Marcel Lahaie
- Novartis Pharmaceuticals Canada Inc, Dorval, Québec, Canada
| | - Tom Sheidow
- Ivey Eye Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada
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