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Guymer R, Bailey C, Chaikitmongkol V, Chakravarthy U, Chaudhary V, Finger RP, Gallego-Pinazo R, Chuan AKH, Ishida S, Lövestam-Adrian M, Parravano M, Luna Pinto JD, Schmitz-Valckenberg S, Sheth V, Souied EH, Chi GC, Gilberg F, Glittenberg C, Scheidl S, Bengus M. Rationale and Design of VOYAGER: Long-term Outcomes of Faricimab and Port Delivery System with Ranibizumab for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema in Clinical Practice. OPHTHALMOLOGY SCIENCE 2024; 4:100442. [PMID: 38304609 PMCID: PMC10831184 DOI: 10.1016/j.xops.2023.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Purpose To describe the rationale and design of the VOYAGER (NCT05476926) study, which aims to investigate the safety and effectiveness of faricimab and the Port Delivery System with ranibizumab (PDS) for neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME) in clinical practice. VOYAGER also aims to understand drivers of clinical practice treatment outcomes by gaining novel insight into the intersection of treatment regimens, decisions, anatomic outcomes, and vision. Design Primary data collection, noninterventional, prospective, multinational, multicenter clinical practice study. Participants At least 5000 patients initiating/continuing faricimab or PDS for nAMD/DME (500 sites, 31 countries). Methods Management will be per usual care, with no mandated scheduled visits/imaging protocol requirements. Using robust methodologies, relevant clinical and ophthalmic data, including visual acuity (VA), and data on treatment clinical setting/regimens/philosophies, presence of anatomic features, and safety events will be collected. Routinely collected fundus images will be uploaded to the proprietary Imaging Platform for analysis. An innovative investigator interface will graphically display the patient treatment journey with the aim of optimizing treatment decisions. Main Outcome Measures Primary end point: VA change from baseline at 12 months per study cohort (faricimab in nAMD and in DME, PDS in nAMD). Secondary end points: VA change over time and per treatment regimens (fixed, treat-and-extend, pro re nata, and other) and number. Exploratory end points: VA change in relation to presence/location of anatomic features that impact vision (fluid, central subfield thickness, fibrosis, atrophy, subretinal hyperreflective material, diabetic retinopathy severity, and disorganization of retinal inner layers) and per treatment regimen/philosophies. The impact of regional and practice differences on outcomes will be assessed as will safety. Results Recruitment commenced in November 2022 and will continue until late 2027, allowing for up to 5 years follow-up. Exploratory interim analyses are planned annually. Conclusions VOYAGER is an innovative study of retinal diseases that will assess the effectiveness and safety of faricimab and PDS in nAMD and DME and identify clinician- and disease-related factors driving treatment outcomes in clinical practices globally to help optimize vision outcomes. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Clare Bailey
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Voraporn Chaikitmongkol
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Usha Chakravarthy
- Queen’s University of Belfast, Royal Victoria Hospital, Belfast, United Kingdom
| | - Varun Chaudhary
- Department of Surgery, Hamilton Regional Eye Institute, McMaster University, Hamilton, Ontario, Canada
| | - Robert P. Finger
- Department of Ophthalmology, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | | | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Monica Lövestam-Adrian
- Department of Ophthalmology, Department of Clinical Sciences, Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | | | - Steffen Schmitz-Valckenberg
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus, Bonn, Germany
| | | | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Bührer C, Paling T, Gale R, Paulo T, Bagijn M. Cost-Effectiveness of Faricimab in the Treatment of Diabetic Macular Oedema (DMO): A UK Analysis. PHARMACOECONOMICS - OPEN 2024; 8:445-457. [PMID: 38438829 PMCID: PMC11058163 DOI: 10.1007/s41669-023-00465-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 03/06/2024]
Abstract
AIM The aim of this work was to evaluate the cost-effectiveness of faricimab against relevant therapeutic alternatives used in clinical practice for the treatment of diabetic macular oedema (DMO) in the UK. METHODS A state-transition (Markov) model, with health states based on visual acuity scores and treatment pathways, was developed to conduct cost-utility analysis of faricimab treat and extend (T&E) regimen versus ranibizumab pro re nata (PRN) and aflibercept PRN over a time horizon of 25 years. Comparison against bevacizumab PRN was considered in scenario analysis. Effectiveness data for faricimab was sourced from the pivotal YOSEMITE and RHINE double-blind randomised controlled trials, and from a network meta-analysis for comparators. Costs and (dis)utilities were taken from nationally published sources or literature. The base case included indirect costs (productivity gains, informal care) given the wider impacts of DMO on society. Sensitivity analyses were conducted. RESULTS In the base case, faricimab T&E dominated ranibizumab PRN and aflibercept PRN, being more effective and resulting in cost savings (between 0.16 and 0.36 mean QALYs gained, and £5483-9655 mean cost savings). In scenario analysis, faricimab was more effective but costlier compared with bevacizumab, with an incremental cost-effectiveness ratio (ICER) of £8898 per QALY gained. Considering only healthcare payer costs, the ICER of faricimab compared with ranibizumab PRN was £7991 per QALY gained and faricimab dominated aflibercept PRN. CONCLUSIONS Faricimab T&E has the potential to reduce the burden of vision loss on society, giving people living with DMO greater independence and contributing to increased healthcare system capacity. At a threshold of £20,000, faricimab T&E is cost-effective compared with relevant comparators, and potentially cost saving.
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Affiliation(s)
- Christian Bührer
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland.
| | - Thomas Paling
- Roche Products Ltd, 6 Falcon Way, Shire Park, Welwyn Garden City, UK
| | - Richard Gale
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK
- Hull York Medical School, University of York, Heslington, York, UK
| | - Tatiana Paulo
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland
| | - Marloes Bagijn
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland
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Yayla U, Sevik MO, Karabaş VL, Şahin Ö, Özkaya A, Yenerel NM, Açıkalın Öncel B, Kaplan FB, Önder Tokuç E, Kanar HS, Kutlutürk Karagöz I, Başaran Emengen E, Demirciler Sönmez A, Aykut A, Limon U, Bozkurt E, Özsoy Saygın I, Aydoğan Gezginaslan T, Aydın Öncü Ö, Türkseven Kumral E, Erçalık NY, Çelik E. Real-World Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in Türkiye: MARMASIA Study Group Report No. 1. Turk J Ophthalmol 2023; 53:356-368. [PMID: 38126607 PMCID: PMC10750085 DOI: 10.4274/tjo.galenos.2023.56249] [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: 03/04/2023] [Accepted: 05/27/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives This study aimed to report the demographic and clinical characteristics of diabetic macular edema (DME) patients treated with intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGF) and provide an overview of outcomes during routine clinical practice in Türkiye. Materials and Methods This retrospective, real-world study included 1,372 eyes (854 patients) treated with a pro re nata protocol by 21 ophthalmologists from 8 tertiary clinics on the Asian side of the Marmara region of Türkiye (MARMASIA Study Group). Five cohort groups were established by collecting the patients' baseline and 3, 6, 12, 24, and 36-month follow-up data, where each subsequent cohort may include the previous. Changes in best-corrected visual acuity (BCVA, approximate ETDRS letters) and central macular thickness (CMT, μm), number of visits and IVI, and rates of anti-VEGF switch and intravitreal dexamethasone implant (IDI) combination were evaluated. Results The 3, 6, 12, 24, and 36-month cohorts included 1372 (854), 1352 (838), 1185 (722), 972 (581), and 623 (361) eyes (patients), respectively. The mean baseline BCVA and CMT were 51.4±21.4 letters and 482.6±180.3 μm. The mean changes from baseline in BCVA were +7.6, +9.1, +8.0, +8.6, and +8.4 letters, and in CMT were -115.4, -140.0, -147.9, -167.3, and -215.4 μm at the 3, 6, 12, 24, and 36-month visits (p<0.001 for all). The median cumulative number of anti-VEGF IVI was 3.0, 3.0, 5.0, 7.0, and 9.0, respectively. The overall anti-VEGF switch and IDI combination rates were 18.5% (253/1372 eyes) and 35.0% (480/1372 eyes), respectively. Conclusion This largest real-life study of DME from Türkiye demonstrated BCVA gains inferior to randomized controlled trials, mainly due to the lower number of IVI. However, with the lower baseline BCVA and higher IDI combination rates in our cohorts, these gains were relatively superior to other real-life study counterparts.
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Affiliation(s)
- Uğur Yayla
- University of Health Sciences Türkiye, Derince Training and Research Hospital, Clinic of Ophthalmology, Kocaeli, Türkiye
| | - Mehmet Orkun Sevik
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Veysel Levent Karabaş
- Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Türkiye
| | - Özlem Şahin
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Abdullah Özkaya
- Memorial Şişli Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Nursal Melda Yenerel
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Banu Açıkalın Öncel
- University of Health Sciences Türkiye, Fatih Sultan Mehmet Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Fatih Bilgehan Kaplan
- University of Health Sciences Türkiye, Fatih Sultan Mehmet Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Ecem Önder Tokuç
- Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Türkiye
| | - Hatice Selen Kanar
- University of Health Sciences Türkiye, Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Işıl Kutlutürk Karagöz
- University of Health Sciences Türkiye, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Ece Başaran Emengen
- Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Türkiye
| | - Ayşe Demirciler Sönmez
- University of Health Sciences Türkiye, Fatih Sultan Mehmet Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Aslan Aykut
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Utku Limon
- University of Health Sciences Türkiye, Ümraniye Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Erdinç Bozkurt
- University of Health Sciences Türkiye, Ümraniye Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Işılay Özsoy Saygın
- University of Health Sciences Türkiye, Ümraniye Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Tuğba Aydoğan Gezginaslan
- University of Health Sciences Türkiye, Ümraniye Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Özlem Aydın Öncü
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Esra Türkseven Kumral
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Nimet Yeşim Erçalık
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Erkan Çelik
- Sakarya University Faculty of Medicine, Department of Ophthalmology, Sakarya, Türkiye
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Faes L, Mishra AV, Lipkova V, Balaskas K, Quek C, Hamilton R, Held U, Sim D, Sivaprasad S, Fu DJ. Visual and Anatomical Outcomes of a Single Intravitreal Dexamethasone in Diabetic Macular Edema: An 8 Year Real-World Study. J Clin Med 2023; 12:3878. [PMID: 37373573 DOI: 10.3390/jcm12123878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
IMPORTANCE Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetes mellitus. Intravitreal dexamethasone is a treatment option for patients unsuitable for or non-responsive to anti-angiogenic agents. OBJECTIVE To quantify visual and anatomical outcomes from an initial intravitreal dexamethasone injection over the expected 6-month period of dexamethasone release by the implant. Design and enrolment: This is a retrospective cohort study using electronic medical records of patients reviewed between 1 January 2012 and 1 April 2022. SETTING A tertiary eye-care center in London, United Kingdom; Moorfields Eye Hospital National Healthcare System Foundation Trust. PARTICIPANTS The cohort comprised 418 adult patients with DME who received an initial treatment of 700 µg intravitreal dexamethasone in the study period. Of these, 240 patients met the inclusion criteria of ≥2 hospital visits following initial injection (≥1 beyond 6 months) and no previous ocular corticosteroid treatment or missing assessment at baseline. EXPOSURE(S) Intravitreal dexamethasone implant (700 µg). MAIN OUTCOME(S) AND MEASURE(S) Probability of a positive visual outcome, defined as ≥5 or ≥10 Early Treatment Diabetic Retinopathy Study (ETDRS)-letter gain after treatment when compared to baseline (Kaplan-Meier models). RESULTS From the initial intravitreal dexamethasone injection alone, we observed a >75% chance of gaining ≥5 ETDRS letters and >50% chance of gaining ≥10 ETDRS letters within 6 months. There was less than a 50% chance of sustaining either positive visual outcome beyond 4 months. CONCLUSIONS AND RELEVANCE Most patients can be expected to have a positive visual outcome following an initial injection of dexamethasone implants that subsides within 4 months. Real-world re-treatment was observed to be delayed until after visual benefits were lost in half of the cohort. Further research will be needed to study the effects of delays in re-treatment.
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Affiliation(s)
- Livia Faes
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Amit V Mishra
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | | | - Konstantinos Balaskas
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Chrystie Quek
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Robin Hamilton
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8057 Zurich, Switzerland
| | - Dawn Sim
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
- Genentech Roche, 1 DNA Way, South San Francisco, CA 940980, USA
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Dun Jack Fu
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK
- Kings College London, London WC2R 2LS, UK
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Accelerating ophthalmic artificial intelligence research: the role of an open access data repository. Curr Opin Ophthalmol 2020; 31:337-350. [PMID: 32740059 DOI: 10.1097/icu.0000000000000678] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Artificial intelligence has already provided multiple clinically relevant applications in ophthalmology. Yet, the explosion of nonstandardized reporting of high-performing algorithms are rendered useless without robust and streamlined implementation guidelines. The development of protocols and checklists will accelerate the translation of research publications to impact on patient care. RECENT FINDINGS Beyond technological scepticism, we lack uniformity in analysing algorithmic performance generalizability, and benchmarking impacts across clinical settings. No regulatory guardrails have been set to minimize bias or optimize interpretability; no consensus clinical acceptability thresholds or systematized postdeployment monitoring has been set. Moreover, stakeholders with misaligned incentives deepen the landscape complexity especially when it comes to the requisite data integration and harmonization to advance the field. Therefore, despite increasing algorithmic accuracy and commoditization, the infamous 'implementation gap' persists. Open clinical data repositories have been shown to rapidly accelerate research, minimize redundancies and disseminate the expertise and knowledge required to overcome existing barriers. Drawing upon the longstanding success of existing governance frameworks and robust data use and sharing agreements, the ophthalmic community has tremendous opportunity in ushering artificial intelligence into medicine. By collaboratively building a powerful resource of open, anonymized multimodal ophthalmic data, the next generation of clinicians can advance data-driven eye care in unprecedented ways. SUMMARY This piece demonstrates that with readily accessible data, immense progress can be achieved clinically and methodologically to realize artificial intelligence's impact on clinical care. Exponentially progressive network effects can be seen by consolidating, curating and distributing data amongst both clinicians and data scientists.
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