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Hostovsky A, Moroz I, Katz G. Aflibercept monotherapy or bevacizumab first for diabetic macular edema. Indian J Ophthalmol 2024; 72:S260-S264. [PMID: 38271421 DOI: 10.4103/ijo.ijo_2107_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/22/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE Clinical outcome and switch patterns with bevacizumab first treatment strategy for patients with newly diagnosed neovascular age-related macular degeneration (nAMD). METHODS Retrospective observational study of the number of intravitreal injections of bevacizumab and treatment switch in patients who started intravitreal bevacizumab injections between January 1, 2016 and December 30, 2018. RESULTS From January 1 2016 to December 31 2018, 608 eyes of 565 patients started intravitreal injections of bevacizumab for a new diagnosis of nAMD. Average visual acuity (VA) at presentation was 0.60 logarithm of the minimum angle of resolution (logMAR), which improved to 0.47 after six injections (P < 0.001) and decreased to 0.63 at the last follow-up (P = 0.543). Switch of treatment was recommended for 190 eyes (31.3%), and of them, 91 patients (15%) were switched during the first 6 months and defined as primary failure of bevacizumab. The switch of treatment resulted in a statistically significant improvement in VA in the first 6 months after the switch. The gain in VA was not sustainable over time. CONCLUSION Bevacizumab first treatment strategy produced results that were comparable to previous real-world outcomes publications of ranibizumab and aflibercept treatment with low rates of failure of bevacizumab treatment. Treatment switch to second-line treatment yielded a significant VA improvement, mainly in patients with primary bevacizumab failure.
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Affiliation(s)
- Avner Hostovsky
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cohen SY, Dominguez M, Coscas F, Faure C, Baillif S, Oubraham H, Kodjikian L, Weber M. Final 4-year results of the RAINBOW real-world study: intravitreal aflibercept dosing regimens in France in treatment-naïve patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2022; 261:959-969. [PMID: 36399178 PMCID: PMC10049954 DOI: 10.1007/s00417-022-05900-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Purpose
The purpose of this study is to evaluate real-world treatment outcomes in patients with neovascular age-related macular degeneration (nAMD) treated with intravitreal aflibercept (IVT-AFL) in routine clinical practice in France.
Methods
RAINBOW (NCT02279537) was an ambispective, observational, 4-year study assessing IVT-AFL effectiveness, treatment patterns, and safety in patients with nAMD in France. Treatment-naïve patients prescribed IVT-AFL and treated according to local practice (pro re nata or treat-and-extend) were eligible. Three treatment cohorts were retrospectively identified based on their treatment pattern within the first 12 months: regular (3 initial monthly IVT-AFL injections received within 45–90 days after the first injection in month 0 and followed by injections every 2 months), irregular with the initial monthly injections, and irregular without the initial monthly injections. The primary endpoint was mean change in best-corrected visual acuity (BCVA) from baseline to month 12. The 48-month results are described here.
Results
Overall, the study included 516 patients (each with one study eye), and 30.2% of patients completed 48 months of IVT-AFL treatment. Mean change in BCVA from baseline (56.5 letters) to month 48 for patients with an assessment at both time points was + 1.1 (regular cohort, n = 47), + 0.1 (irregular cohort with initial monthly injections, n = 115), and − 1.3 letters (irregular cohort without initial monthly injections, n = 26), representing a decrease from the gains achieved at month 12. Mean number of IVT-AFL injections received by month 48 in the treatment cohorts was 14.9, 13.7, and 11.9, respectively. The safety profile of IVT-AFL was consistent with previous studies.
Conclusion
In RAINBOW, the 48-month results demonstrate a lack of long-term effectiveness of IVT-AFL treatment of nAMD due to progressive undertreatment in routine clinical practice in France. These real-world findings highlight the importance of 3 initial monthly IVT-AFL injections followed by continuous proactive treatment beyond the first year to achieve optimal functional outcomes.
Trial registration number
ClinicalTrials.gov Identifier: NCT02279537.
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Affiliation(s)
- Salomon-Yves Cohen
- Centre d'Imagerie et de Laser, Paris, France.
- Department of Ophthalmology, University Paris-Est Créteil, Paris, France.
| | | | | | - Céline Faure
- Hôpital Privé Saint Martin, Ramsay Générale de Santé, Caen, France
| | | | | | - Laurent Kodjikian
- Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- CNRS, MATEIS INSA Lyon, Université de Lyon Claude Bernard, 510, Villeurbanne, France
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Suprachoroidal delivery enables targeting, localization and durability of small molecule suspensions. J Control Release 2022; 349:1045-1051. [PMID: 35868358 DOI: 10.1016/j.jconrel.2022.05.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022]
Abstract
Drug delivery to the suprachoroidal space (SCS®) has become a clinical reality after the 2021 FDA approval of CLS-TA, a triamcinolone acetonide injectable suspension for suprachoroidal use (XIPERE®), administered via a microneedle-based device, the SCS Microinjector®. Suprachoroidal (SC) delivery facilitates targeting, compartmentalization, and durability of small molecule suspensions, thereby potentially addressing some of the efficacy, safety, and treatment burden limitations of current retinal therapies. Herein, the design features of the SCS Microinjector are reviewed, along with the biomechanics of SC drug delivery. Also presented are preclinical evaluations of SC small molecule suspensions from 4 different therapeutic classes (plasma kallikrein inhibitor, receptor tyrosine kinase inhibitor, corticosteroid, complement factor D inhibitor), highlighting their potential for durability, targeted compartmentalization, and acceptable safety profiles following microinjector-based SC delivery. The clinical evaluations of the safety, tolerability and efficacy of SC delivered triamcinolone further supports potential of SC small molecule suspensions as a clinically viable strategy for the treatment of chorioretinal diseases. Also highlighted are current limitations, key pharmacological considerations, and future opportunities to optimize the SC microinjector platform for safe, effective, and potentially long-acting drug delivery for the treatment of chorioretinal disorders.
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Rouvas A, Datseris I, Androudi S, Tsilimbaris M, Kabanarou SA, Pharmakakis N, Koutsandrea C, Charonis A, Kousidou O, Pantelopoulou G. A Real-World, Multicenter, 6-Month Prospective Study in Greece of the Effectiveness and Safety of Ranibizumab in Patients with Age-Related Macular Degeneration Who Have Inadequately Responded to Aflibercept: The “ELEVATE” Study. Clin Ophthalmol 2022; 16:2579-2593. [PMID: 35983162 PMCID: PMC9380822 DOI: 10.2147/opth.s371036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Real-world evidence on short-term outcomes of ranibizumab in wet age-related macular degeneration (wAMD) following inadequate response to aflibercept is scarce. This study aimed to evaluate the functional and anatomic effects of switching to ranibizumab in cases of wAMD previously treated with aflibercept with inadequate response. Patients and Methods Prospective, observational study performed in eight ophthalmology hospital/private clinics in Greece, enrolling consented patients with active wAMD, ≥50 years-old, who had initiated ranibizumab ≥28 days and <2 months after their last aflibercept injection. Data were collected at enrollment, and at 1, 3 and 6 months post-treatment onset (post-baseline). Results Between September-2015 and November-2017, 103 eligible patients (56.3% females; mean age: 74.8±8.6 years) were consecutively enrolled. The age at AMD diagnosis in the study eye was 71.3±8.8 years. Aflibercept (median of 5 injections received over 11.3 months) had been discontinued for anatomical (in 69.9%) and/or functional (38.8%) reasons. At baseline (median: 24.3 months after wAMD diagnosis), choroidal neovascularization was occult in 69.1% of evaluable study eyes; 60.2% of the study eyes had pigment epithelial detachment (PED); 42.7% cysts; 21.4% fibrosis; 66.0% subretinal, and 59.2% intraretinal fluid. At 6 months post-baseline: a median of 3 ranibizumab injections (range: 1–6) had been received; the best-corrected visual acuity (BCVA)≥0 letter gain rate was 81.8%; the BCVA ≥15 letter gain rate was 17.0%; BCVA gain was 3.2 letters [mean increase: 3.2±10.0 letters; median: 0.0; p = 0.002]; PED greatest basal diameter (GBD; median: 1470.5 μm) also decreased (median decrease: 114.0 μm; p = 0.019). Baseline central retinal thickness (CRT; median: 312.0 μm) remained unchanged. One patient permanently discontinued ranibizumab due to adverse event occurrence, assessed as not causally related to ranibizumab. There were no ranibizumab-related adverse reactions. Conclusion Six-month treatment with ranibizumab in aflibercept inadequate responders led to visual acuity and PED GBD improvements, with no statistically significant CRT change.
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Affiliation(s)
- Alexandros Rouvas
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Sofia Androudi
- Ophthalmology Clinic, University of Thessaly, Larissa, Greece
| | | | - Stamatina A Kabanarou
- Department of Ophthalmology, General Hospital of Athens ‘korgialenio-Benakio’, Athens, Greece
| | | | | | | | - Olga Kousidou
- Medical Department, Novartis (Hellas), Athens, Greece
- Correspondence: Olga Kousidou, Medical Department, Novartis (Hellas), National Road No. 1 12th Km, Metamorphosis, Athens, GR-144 51, Greece, Tel +30 210 289 7189, Fax +302102835053, Email
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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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Veritti D, Sarao V, Soppelsa V, Danese C, Chhablani J, Lanzetta P. Managing Neovascular Age-Related Macular Degeneration in Clinical Practice: Systematic Review, Meta-Analysis, and Meta-Regression. J Clin Med 2022; 11:jcm11020325. [PMID: 35054021 PMCID: PMC8781865 DOI: 10.3390/jcm11020325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
The use of anti-vascular endothelial growth factor (VEGF) agents has profoundly changed the prognosis of neovascular age-related macular degeneration (nAMD). As clinical experiences have accumulated, it has become mandatory to summarize data to give information that can be useful in everyday practice. We conducted a systematic review to identify randomized controlled trials (RCTs) and observational studies that reported 12-month changes in best-corrected visual acuity (BCVA) in patients with nAMD on anti-VEGF monotherapy. Data were analyzed in a random-effects meta-analysis with BCVA change as the primary outcome. Meta-regression was conducted to evaluate the impact of multiple covariates. Four hundred and twelve heterogeneous study populations (109,666 eyes) were included. Anti-VEGFs induced an overall improvement of +5.37 ETDRS letters at 12 months. Meta-regression showed that mean BCVA change was statistically greater for RCTs (p = 0.0032) in comparison with observational studies. Populations following a proactive regimen had better outcomes than those following a reactive treatment regimen. Mean BCVA change was greater in younger populations, with lower baseline BCVA and treated with a higher number of injections (p < 0.001). Our results confirm that anti-VEGFs may produce a significant functional improvement at 12 months in patients with nAMD.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
| | - Valentina Soppelsa
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Carla Danese
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA 15261, USA;
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
- Correspondence: ; Tel.: +39-04-3255-9907
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Pengfei J, Hanyu T, Qinghua P. Ranibizumab and conbercept for treating wet age-related macular degeneration in China: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27774. [PMID: 35049171 PMCID: PMC9191391 DOI: 10.1097/md.0000000000027774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 10/26/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the therapeutic effects of ranibizumab and conbercept on wet age-related macular degeneration. METHODS Randomized controlled trials comparing ranibizumab and conbercept in the treatment of wet age-related macular degeneration were searched in the PubMed, Medline, EMbase, Cochrane Library, China National Knowledge Infrastructure, Wanfang databases, and Weipu Journal. Two reviewers independently extracted the data and assessed the methodological quality. Data analysis was performed using Rev Man 5.3 software for statistical analysis. RESULTS A total of 16 randomized controlled trials, including 1018 patients, were included, and the results showed that the effect of ranibizumab on uncorrected visual acuity was not significantly different from that of conbercept (Mean difference [MD] = -.03, 95% Confidence interval [CI] [-.10-.05], P = .47), and there was no significant difference between the two drugs in the effect on best-corrected visual acuity (MD = .00, 95% CI [-.02-.03], P = .73). The effect of conbercept on intraocular pressure was better than that of ranibizumab (MD = 1.61, 95% CI [1.05-2.17], P < .001). The effect of ranibizumab on central macular thickness was not significantly different from that of conbercept (MD = 1.31, 95% CI [-3.81-6.43], P = .62). Conbercept had a better inhibitory effect on choroidal neovascularization than ranibizumab (MD = .49, 95% CI [.32-.76], P = .001). CONCLUSION The effects of ranibizumab on uncorrected visual acuity, best corrected visual acuity, and central macular thickness were not significantly different from those of conbercept. Conbercept is associated with a lower risk of increased intraocular pressure and regression of choroidal neovascularization compared with ranibizumab.
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Hussain RM, Shaukat BA, Ciulla LM, Berrocal AM, Sridhar J. Vascular Endothelial Growth Factor Antagonists: Promising Players in the Treatment of Neovascular Age-Related Macular Degeneration. Drug Des Devel Ther 2021; 15:2653-2665. [PMID: 34188445 PMCID: PMC8232378 DOI: 10.2147/dddt.s295223] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
Neovascular age-related macular degeneration (nAMD) treatment has been revolutionized by the introduction of vascular endothelial growth factor antagonists (anti-VEGF), but the need for frequent intravitreal injections poses a heavy burden to patients and physicians. Evolving anti-VEGF therapies include longer duration agents, approaches that target multiple pathways, topical anti-VEGF agents, sustained-release, and genetic therapies. Abicipar pegol, a designed ankyrin repeat protein (DARPin), demonstrated the ability to maintain stable visual acuity with 12-week dosing, but was not approved by the FDA due to higher than usual rates of intraocular inflammation. Conbercept, a recombinant anti-VEGF fusion protein, has been approved in China, and is in Phase 3 trials globally. KSI-301 is an anti-VEGF antibody biopolymer conjugate that allowed 66% of nAMD patients to maintain at least a 6-month treatment-free interval in Phase 1b studies. OPT-302, an inhibitor of VEGF-C/D, will be tested in phase 3 studies that compare anti-VEGF-A monotherapy against combination therapy with OPT-302. Faricimab is a bispecific anti-VEGF/Ang-2 antibody that upregulates the Tie-2 signaling pathway and promotes vascular stability; it is undergoing phase 3 trials with potential for 12- or 16-week dosing. PAN-90806 is a topical anti-VEGF agent that showed the ability to reduce injection frequency by 79% compared to ranibizumab monotherapy in a phase 1/2a trial. Sustained-release anti-VEGF therapies include the ranibizumab Port Delivery System (in phase 3 studies), GB-102 (Phase 2b), OTX-TKI (phase 1), and Durasert (preclinical). Suprachoroidal delivery of the tyrosine kinase inhibitor, axitinib, is in preclinical studies. Genetic therapies in phase 1 studies include RGX-314 and ADVM-022, which introduce a viral vector that modifies the retina's cellular apparatus to create an anti-VEGF biofactory, potentially serving as a one-time treatment. Further investigation is warranted for drugs and delivery systems that hope to advance visual outcomes and reduce treatment burden of nAMD.
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Affiliation(s)
| | - Bilal A Shaukat
- Retina Associates Ltd, Elmhurst, IL, USA
- Department of Ophthalmology, Cook County Hospital, Chicago, IL, USA
| | - Lauren M Ciulla
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136,USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136,USA
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9
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REAL-WORLD EFFECTIVENESS AND SAFETY OF RANIBIZUMAB TREATMENT IN PATIENTS WITH AND WITHOUT POLYPOIDAL CHOROIDAL VASCULOPATHY: Twelve-Month Results From the LUMINOUS Study. Retina 2021; 40:1529-1539. [PMID: 31385918 PMCID: PMC7392585 DOI: 10.1097/iae.0000000000002624] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Supplemental Digital Content is Available in the Text. Twelve-month results from LUMINOUS support the use of ranibizumab as an effective first-line therapy for polypoidal choroidal vasculopathy. Higher baseline visual acuity and adequate injection frequency were associated with better visual acuity outcomes. No new safety signals were identified. Purpose: To evaluate the real-world effectiveness and safety of intravitreal ranibizumab 0.5 mg in treatment-naive patients with and without polypoidal choroidal vasculopathy (PCV). Methods: Assessment of neovascular age-related macular degeneration patients with or without PCV after 12 months of ranibizumab treatment during the LUMINOUS study. Outcome measures were visual acuity and central retinal thickness changes from baseline and the rate of ocular adverse events. Results: At baseline, 572 and 5,644 patients were diagnosed with and without PCV, respectively. The mean visual acuity gain from baseline at Month 12 in the PCV and non-PCV groups was +5.0 and +3.0 letters, respectively; these gains were achieved with a mean of 4.4 and 5.1 ranibizumab injections. Eighty percent of PCV patients and 72.2% of non-PCV patients who had baseline visual acuity ≥73 letters maintained this level of vision at Month 12; 20.6% and 17.9% of patients with baseline visual acuity <73 letters achieved visual acuity ≥73 letters in these groups. Greater reductions in central retinal thickness from baseline were also observed for the PCV group versus the non-PCV group. The rate of serious ocular adverse events was 0.7% (PCV group) and 0.9% (non-PCV group). Conclusion: LUMINOUS confirms the effectiveness and safety of ranibizumab in treatment-naive patients with PCV.
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Couturier A, Kodjikian L, Baillif S, Conart JB, Dot C, Delyfer MN, Matonti F, Caillaux V, Bousquet E, Robinet A, Massé H, Uzzan J, Mrejen S, Semoun O. [Treatment of exudative age-related macular degeneration: Consensus of French experts for first-line treatment selection and the importance of long-term risk/benefit ratio]. J Fr Ophtalmol 2021; 44:937-946. [PMID: 34147276 DOI: 10.1016/j.jfo.2021.01.001] [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: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.
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Affiliation(s)
- A Couturier
- Université de Paris, service d'ophtalmologie, assistance publique hôpitaux de Paris, hôpital Lariboisière, Paris, France
| | - L Kodjikian
- Service d'ophtalmologie, hôpital universitaire Croix-Rousse, hospices Civils de Lyon, université Lyon I, Lyon, France; CNRS UMR 5510 Mateis, Villeurbanne, France
| | - S Baillif
- Service d'ophtalmologie, hôpital universitaire Pasteur 2, université Côte d'Azur, Nice, France
| | - J-B Conart
- Service d'ophtalmologie, CHRU Nancy, Vandoeuvre-lès-Nancy, France; Institut de la Vision, Inserm, UMR_S 968, CNRS, Sorbonne Université, Paris, France
| | - C Dot
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, 69003 Lyon, France; École du Val de Grâce, Paris, France
| | - M-N Delyfer
- Service d'ophtalmologie, centre hospitalier universitaire de Bordeaux, université de Bordeaux, Inserm, Bordeaux population health research centre, team LEHA, UMR 1219, 33000 Bordeaux, France
| | - F Matonti
- Centre Monticelli Paradis, Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, 433, bis rue Paradis, 13008 Marseille, France
| | - V Caillaux
- Centre explore vision Paris, Rueil Malmaison, France; Service d'ophtalmologie, assistance publique hôpitaux de Paris, hôpital Lariboisière, Paris, France
| | - E Bousquet
- OphtalmoPôle de Paris, hôpital Cochin, assistance publique hôpitaux de Paris, université de Paris, Paris, France
| | - A Robinet
- Centre ophtalmologique ophtasiam, clinique Pasteur-Lanrose, Brest, France
| | - H Massé
- Service d'ophtalmologie, centre hospitalier universitaire de Nantes, Nantes, France
| | - J Uzzan
- Clinique Mathilde, Rouen, France
| | - S Mrejen
- Centre d'Imagerie et de Laser, Paris, France
| | - O Semoun
- Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, université Paris Est Créteil, 40, avenue de Verdun, 94000 Créteil, France; Centre ophtalmologique du Panthéon, Paris, France.
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11
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Kodjikian L, Mehanna CJ, Cohen SY, Devin F, Razavi S, Querques G, Massin P, Coscas F, Souied E. The role of future treatments in the management of neovascular age-related macular degeneration in Europe. Eur J Ophthalmol 2021; 31:2179-2188. [PMID: 34053331 DOI: 10.1177/11206721211018348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anti-vascular endothelial growth factor (VEGF) agents have transformed the management of patients with neovascular age-related macular degeneration (nAMD) over the past two decades. However, as more long-term real-world data become available, it is clear that treatment outcomes are inferior to those reported in large, controlled clinical trials. This is largely driven by undertreatment, that is, not maintaining a consistent injection frequency to achieve sustained VEGF suppression, whether due to patient non-compliance, an important injection burden, or non/incomplete anatomical response. Newer therapeutic advances under evaluation hold promise in achieving more, for less. We review the latest drugs currently in or having successfully finished phase III clinical trials, and determine their potential place in the management of patients with nAMD in Europe.
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Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Claude Bernard University Lyon 1, Lyon, Rhône-Alpes, France.,UMR-CNRS 5510 Mateis Laboratory, University Lyon 1, Villeurbanne, France
| | - Carl Joe Mehanna
- Intercommunal Hospital of Créteil, Paris-Est University, Créteil, France
| | | | - François Devin
- Center Monticelli-Paradis, Juge Clinic, Marseille, France
| | - Sam Razavi
- St. Exupery Ophthalmic Center, Saint Cyr sur Loire, France
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Lombardy, Italy
| | - Pascale Massin
- Ophthalmic Center of Breteuil, Paris, Île-de-France, France
| | | | - Eric Souied
- Intercommunal Hospital of Créteil, Paris-Est University, Créteil, France
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Banaee T, Alwan S, Kellogg C, Kornblau I, El-Annan J. PRN Treatment of Neovascular AMD with Cycles of Three Monthly Injections. J Ophthalmic Vis Res 2021; 16:178-186. [PMID: 34055255 PMCID: PMC8126743 DOI: 10.18502/jovr.v16i2.9081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 01/16/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose To report the one and two year outcome of cycles of three, monthly anti-VEGF injections given upon reactivation of the disease in eyes with neovascular age-related macular degeneration (nAMD). Methods Retrospective study of naïve nAMD cases with more than one year of follow-up, treated with a protocol of cycles of three monthly injections of anti-VEGF drugs upon reactivation. Visual acuity (VA) and central macular thickness (CMT) are the main outcome measures. Results Twenty-six patients with a mean age of 78.15 ± 9.29 years (57.7% female) were included. The mean follow-up was 30.89 ± 6.95 months. Treatment started with bevacizumab in all patients but in six patients was switched to aflibercept due to inadequate response to intravitreal bevacizumab injection. The mean VA at baseline and at 12 and 24 months was 53.87 ± 21.84, 60.54 ± 21.13, and 53.68 ± 27.16 ETDRS letters, respectively. Patients gained a mean of 6.67± 13.7 (p = 0.013, 95% CI= 0.60 to 12.65) and 0.77±15.21 (p = 0.4, 95% CI: –5.65 to 7.2) letters at 12 and 24 months. CMT at baseline, 12, and 24 months was 403.55 ± 147.59, 323.95 ± 79.58, and 298.59 ± 77.161 µm, respectively. The number of injections in the first and second years were 7.65 ± 2.64 and 5.52 ± 3.01, respectively. Three eyes (12.5%) lost >15 letters at 24 months. Conclusion This protocol can stabilize or improve vision in 87.5% of nAMD patients and can reduce the number of visits.
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Affiliation(s)
- Touka Banaee
- University of Texas Medical Branch in Galveston, Texas, USA
| | - Shadan Alwan
- University of Texas Medical Branch in Galveston, Texas, USA
| | - Clint Kellogg
- University of Texas Medical Branch in Galveston, Texas, USA
| | - Ilyse Kornblau
- University of Texas Medical Branch in Galveston, Texas, USA
| | - Jaafar El-Annan
- University of Texas Medical Branch in Galveston, Texas, USA.,University of Texas at MD Anderson, Houston, Texas, USA.,Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
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13
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Ogura Y, Iida T, Lee WK, Cheung CMG, Mitchell P, Leal S, Schmelter T, Ishibashi T. Efficacy and safety of intravitreal aflibercept for polypoidal choroidal vasculopathy: 96-week outcomes in the Japanese subgroup of the PLANET study. Jpn J Ophthalmol 2021; 65:344-353. [PMID: 33474611 DOI: 10.1007/s10384-020-00805-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/31/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of intravitreal aflibercept (IVT-AFL) versus IVT-AFL plus rescue photodynamic therapy (IVT-AFL + rPDT) in the subgroup of Japanese patients with polypoidal choroidal vasculopathy (PCV) enrolled in the PLANET study. STUDY DESIGN A 96-week, double-masked, sham-controlled phase-3b/4 randomized clinical trial conducted at multiple centers from May 2014 to August 2016. PATIENTS AND METHODS Patients with PCV (BCVA 73-24 ETDRS letters [20/40-20/320 Snellen]) received 3 initial monthly doses of IVT-AFL 2 mg. At week 12, the patients were randomly assigned 1:1 to IVT-AFL + sham PDT or IVT-AFL + rPDT. Patients not requiring rescue received IVT-AFL every 8 weeks; those requiring rescue received IVT-AFL monthly plus sham/active PDT. Following week 52, the treatment intervals could be extended > 8 weeks. RESULTS The baseline demographics for the 159 Japanese patients were balanced. At week 96, the mean BCVA change was + 9.7 (IVT-AFL) versus + 9.5 letters (IVT-AFL + rPDT) (least-squares mean difference of - 0.3; 95% CI, - 3.7 to 3.1); the mean central subfield thickness reduction was - 148.0 µm versus - 145.9 µm. Overall, 17.1% of the patients required rescue PDT. At week 96, 25.0% (IVT-AFL) and 37.9% (IVT-AFL + rPDT) of the patients had complete polyp regression; 84.1% (IVT-AFL) and 88.4% (IVT-AFL + rPDT) of the patients had no evidence of active polyps. The mean number of injections (weeks 52-96) were 4.6 (IVT-AFL) and 4.5 (IVT-AFL + rPDT). Overall, 36.0% (IVT-AFL) and 33.8% (IVT-AFL + rPDT) of the patients experienced ocular treatment-emergent adverse events. CONCLUSION IVT-AFL monotherapy was efficacious for the treatment of Japanese patients with PCV, and the addition of rescue PDT did not show additional benefits.
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Affiliation(s)
- Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS, National University of Singapore, Singapore, Singapore
| | - Paul Mitchell
- University of Sydney, Westmead Institute for Medical Research, Sydney, Australia
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Abstract
PURPOSE To determine the dose-response characteristics of the antivascular endothelial growth factor agents ranibizumab and aflibercept in neovascular age-related macular degeneration using published randomized trials and observational series. METHODS Literature review of published series from 2006 to 2018 as determined from electronic searches of PubMed and the Cochrane Library. Data extracted included treatment strategy, frequency, and first year visual acuity response. Monthly or bimonthly treatment schedules were classified as Fixed, pro re nata studies as PRN, treat and extend as TE, and when no strategy was listed, as Variable. RESULTS Of 2062 citations retrieved, 96 were deemed eligible; these 96 citations provided 120 data points of dose frequency versus visual acuity change in Year 1 of treatment. The dose-response curve was nonlinear, but a log transform of the number of injections per year yielded a linear relationship defined by the expression, Letters of Improvement = -6.66 + 15.7*log (number of injections Year 1). After accounting for the number of injections neither the drug used (ranibizumab or aflibercept) nor the strategy used (Fixed, pro re nata, treat and extend, or Variable) were significant predictors of acuity change. As a group, studies using the pro re nata approach had the lowest number of injections and the worst acuity improvements as a treatment strategy. CONCLUSION There seems to be a predictable, mathematically defined relationship between dose frequency and visual acuity change at 1 year in neovascular age-related macular degeneration. The performance of current treatment efforts, as suggested by reported series and Medicare claims data, seems to be substandard.
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15
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Korobelnik JF, Delcourt C, Creuzot-Garcher C, Melaine A, Chassetuillier J, Lejeune A, Bénard S, Dupont-Benjamin L. Real-life management of neovascular age-related macular degeneration (nAMD) in France: a nationwide observational study using retrospective claims data. J Med Econ 2021; 24:1087-1097. [PMID: 34420480 DOI: 10.1080/13696998.2021.1971416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is standard care for neovascular age-related macular degeneration (nAMD), but the recommended monthly injection regimen is burdensome. Evidence suggests low injection/monitoring frequencies in clinical practice and suboptimal vision outcomes. This observational cohort study uses administrative claims data from the French national healthcare system to assess anti-VEGF treatment patterns and nAMD-specific healthcare resource demands and costs. PATIENTS AND METHODS nAMD patients ≥50 years initiating intravitreal ranibizumab, aflibercept or bevacizumab treatment (2014‒2015), and propensity score-matched non-nAMD patients (controls), were identified from the Echantillon Généraliste de Bénéficiaires database. Outcomes of interest included anti-VEGF treatment patterns, and healthcare resource utilization and associated costs of patients vis-à-vis controls over 24 months. RESULTS Study patients (n = 355) received (mean) 5.2 and 2.4 anti-VEGF injections over 0‒12 and 12‒24 months, respectively. Most patients (79.0%) remained on their initial anti-VEGF agent; among treatment switchers, the most common transition was from ranibizumab to aflibercept. During follow-up, nAMD patients were more likely than controls to require ophthalmology visits (99.7% vs. 44.8%), ocular procedures (optical coherence tomography/angiography/fundoscopy) (96.9% vs. 27.2%), cataract surgery (13.0% vs. 6.7%), and medical transports (38.0% vs. 31.9%). Mean numbers of ophthalmology visits (25.1 vs. 1.2) and medical transports (6.0 vs. 3.5) were higher (p<.01) among nAMD patients. Total reimbursed costs were two-fold higher for nAMD patients than controls (mean €16,799 vs. €8,255) due to higher treatment costs (€6,847 vs. €1,156), medical fees (€1,858 vs. €295), hospital fees (€6,396 vs. €5,235), and transport costs (€358 vs. €259). Excess total healthcare cost was (mean) €5,279 and €7,918 over the first 12 and 24 months of treatment, respectively. CONCLUSIONS Current intravitreal anti-VEGF treatment and monitoring requirements place a considerable economic burden on the French healthcare system. New intravitreal therapies with extended dosing intervals and predictable efficacy might reduce demand for ophthalmology services.
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Affiliation(s)
- Jean-François Korobelnik
- Department of Ophthalmology, University Hospital Center of Bordeaux, Bordeaux, France
- University of Bordeaux, INSERM, 'Bordeaux Population Health Research Center' (BPH), UMR1219, Bordeaux, France
| | - Cécile Delcourt
- University of Bordeaux, INSERM, 'Bordeaux Population Health Research Center' (BPH), UMR1219, Bordeaux, France
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16
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Kiss S, Campbell J, Almony A, Shih V, Serbin M, LaPrise A, Wykoff CC. Management and Outcomes for Neovascular Age-Related Macular Degeneration. Ophthalmology 2020; 127:1179-1188. [DOI: 10.1016/j.ophtha.2020.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022] Open
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17
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Hussain RM, Weng CY, Wykoff CC, Gandhi RA, Hariprasad SM. Abicipar pegol for neovascular age-related macular degeneration. Expert Opin Biol Ther 2020; 20:999-1008. [DOI: 10.1080/14712598.2020.1782379] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | - Christina Y. Weng
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | - Charles C. Wykoff
- Retina Consultants of Houston, Blanton Eye Institute, Department of Ophthalmology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Seenu M. Hariprasad
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, USA
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18
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Avitabile T, Boscia F, Dell’Erba A, Introini U, Lanzetta P, Locatelli P, Ricci F, Staurenghi G, Varano M, Zotti F. Definition of indicators of appropriateness in the management of neovascular age-related macular degeneration: An expert opinion. Eur J Ophthalmol 2020; 30:795-804. [DOI: 10.1177/1120672120915685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Wet age-related macular degeneration is a chronic condition culminating, in most cases, in blindness. The introduction of anti-angiogenic agents in 2006 has represented a major breakthrough in the treatment of the disease, but timely and effective treatment with regular follow-up and monitoring is mandatory to stabilize and preserve visual acuity. In clinical practice, however, appropriate therapy provision is frequently challenged by economic and organizational issues that result in suboptimal visual outcomes and increased incidence of legal blindness. International Guidelines have defined a diagnostic and therapeutic pathway to ensure the best practice in wet age-related macular degeneration management, but reference parameters to evaluate and compare the performance of Retina Centers are lacking. To address the appropriateness of wet age-related macular degeneration management in Italy, a multidisciplinary panel of ten experts gathered in three meetings. They defined three sets of indicators and relative benchmark values that each Center should comply with to ensure patients optimal care already from the first access: (a) clinical intervention indicators, to determine the possible Center’s deviation from the diagnostic and therapeutic pathway; (b) outcome indicator, to evaluate the socioeconomic impact of the healthcare systems’ performance; (c) management indicators, to test the size of the gap between the Center’s supply and demand. Once the indicators have been analyzed, healthcare systems can plan actions to improve appropriateness and monitor their effects. However, to put this in practice, a concerted effort by all parts involved in healthcare provision is required, together with adequate systems to analyze clinical and administrative documentation.
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Affiliation(s)
| | - Francesco Boscia
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Alessandro Dell’Erba
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Bari, Italy
| | - Ugo Introini
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Paolo Lanzetta
- Department of Medicine—Ophthalmology, University of Udine, Udine, Italy
| | - Paolo Locatelli
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Federico Ricci
- UNIT Retinal Diseases, Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Giovanni Staurenghi
- Ophthalmology Clinic, Department of Biomedical and Clinical Sciences “Luigi Sacco,” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Fiorenza Zotti
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Bari, Italy
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19
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Weber M, Kodjikian L, Coscas F, Faure C, Aubry I, Dufour I, Cohen SY. Impact of intravitreal aflibercept dosing regimens in treatment-naïve patients with neovascular age-related macular degeneration in routine clinical practice in France: results from the RAINBOW study. BMJ Open Ophthalmol 2020; 5:e000377. [PMID: 32518833 PMCID: PMC7254134 DOI: 10.1136/bmjophth-2019-000377] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/28/2020] [Accepted: 02/13/2020] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate 12-month outcomes in treatment-naïve patients with neovascular (wet) age-related macular degeneration (AMD) stratified by intravitreal aflibercept (IVT-AFL) regimen. Methods and analysis Patients included in the 12-month interim analysis of Real life of intravitreal Aflibercept In FraNce: oBservatiOnal Study in Wet AMD (RAINBOW), a 4-year, ongoing observational study conducted in France, were stratified by IVT-AFL dosing regimen. Safety (n=593) and effectiveness (n=428) data were analysed. Regimens included a regular cohort (three initial monthly IVT-AFL injections and ≥6 injections) and irregular cohorts (<6 injections) with and without three initial monthly injections. The main outcome measure was mean gain in best-corrected visual acuity (BCVA) at 12 months. Results Mean number of IVT-AFL injections was 6.0 (all patients, n=513), 7.2 (regular cohort, n=102), 6.1 (irregular cohort with three initial monthly injections, n=266) and 5.2 (irregular cohort without three initial monthly injections, n=60). Overall mean gain in BCVA at 12 months was 5 letters; +7.1 letters (regular cohort) and +5.6 letters (irregular cohort with three initial monthly injections), both p<0.001 versus baseline, and –1.1 letters (irregular cohort without three initial monthly injections), p=0.669. Improvements in BCVA were also significantly greater in the regular cohort (p<0.001) and irregular cohort with three initial monthly injections (p=0.003) compared with the irregular cohort without three initial monthly injections. Ocular and non-ocular adverse events were reported in 14.7% and 17.4% of all patients, respectively. Conclusion Treatment-naïve patients with neovascular AMD receiving three initial monthly injections followed by regular or irregular injections over 12 months experienced better visual acuity outcomes than those receiving irregular treatment without three initial monthly injections. Trial registration number NCT02279537.
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Affiliation(s)
| | | | | | - Céline Faure
- Clinique Saint-Martin, Ramsay Générale de Santé, Caen, France
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20
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Crowell SR, Wang K, Famili A, Shatz W, Loyet KM, Chang V, Liu Y, Prabhu S, Kamath AV, Kelley RF. Influence of Charge, Hydrophobicity, and Size on Vitreous Pharmacokinetics of Large Molecules. Transl Vis Sci Technol 2019; 8:1. [PMID: 31695962 PMCID: PMC6827426 DOI: 10.1167/tvst.8.6.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/24/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose Development of therapeutics for retinal disease with improved durability is hampered by inadequate understanding of pharmacokinetic (PK) drivers following intravitreal injection. Previous work shows that hydrodynamic radius is correlated with vitreal half-life over the range of 3 to 7 nm, and that charge and hydrophobicity influence systemic clearance. Better understanding the molecular attributes affecting vitreal elimination half-life enables improved design of therapeutics and enhances clinical translatability. Methods Impacts of charge and hydrophobicity on vitreal PK in the rabbit were systematically assessed using antibody and antibody fragment (Fab) variant series, including ranibizumab, altered through amino acid changes in hypervariable regions of the light chain. The impact of molecule size on vitreal PK was assessed in the rabbit, nonhuman primate, and human for a range of molecules (1–45 nm, net charge −1324 to +22.9 in rabbit), including published and internal data. Results No correlation was observed between vitreal PK and charge or hydrophobicity. Equivalent rabbit vitreal PK was observed for ranibizumab and its variants with isoelectric points (pI) in the range of 6.8 to 10.2, and hydrophobicities of the variable domain unit (FvHI) between 1009 and 1296; additional variant series had vitreal PK similarly unaffected by pI (5.4–10.2) and FvHI (1004–1358). Strong correlations were observed between vitreal half-life and hydrodynamic radius for preclinical species (R2 = 0.8794–0.9366). Conclusions Diffusive properties of soluble large molecules, as quantified by hydrodynamic radius, make a key contribution to vitreal elimination, whereas differences in charge or hydrophobicity make minor or negligible contributions. Translational Relevance These results support estimation of vitreal elimination rates based on molecular size in relevant preclinical species and humans.
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Affiliation(s)
- Susan R Crowell
- Preclinical and Translational Pharmacokinetics and Pharmacodynamics, Genentech, South San Francisco, CA, USA
| | - Kathryn Wang
- Drug Delivery, Genentech, South San Francisco, CA, USA
| | - Amin Famili
- Drug Delivery, Genentech, South San Francisco, CA, USA
| | - Whitney Shatz
- Protein Chemistry, Genentech, South San Francisco, CA, USA
| | - Kelly M Loyet
- Biochemical and Cellular Pharmacology, Genentech, South San Francisco, CA, USA
| | - Vincent Chang
- Bioanalytical Sciences, Genentech, South San Francisco, CA, USA
| | - Yanqiu Liu
- Bioanalytical Sciences, Genentech, South San Francisco, CA, USA
| | - Saileta Prabhu
- Preclinical and Translational Pharmacokinetics and Pharmacodynamics, Genentech, South San Francisco, CA, USA
| | - Amrita V Kamath
- Preclinical and Translational Pharmacokinetics and Pharmacodynamics, Genentech, South San Francisco, CA, USA
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21
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Wong TY, Ogura Y, Lee WK, Iida T, Chen SJ, Mitchell P, Gemmy Cheung CM, Zhang Z, Leal S, Ishibashi T. Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy: Two-Year Results of the Aflibercept in Polypoidal Choroidal Vasculopathy Study. Am J Ophthalmol 2019; 204:80-89. [PMID: 30849345 DOI: 10.1016/j.ajo.2019.02.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE We sought to evaluate longer-term efficacy and safety of intravitreal aflibercept monotherapy (IAI) vs IAI plus rescue photodynamic therapy (rPDT) in patients with polypoidal choroidal vasculopathy (PCV). DESIGN This was a prospective multicenter, double-masked, sham-controlled randomized clinical study across 62 centers. METHODS In this phase 3b/4 study, patients with PCV with best-corrected visual acuity of 73-24 Early Treatment Diabetic Retinopathy Study letters (20/40-20/320 Snellen equivalent) received IAI 2 mg every 4 weeks until week 12, when they were randomized 1:1 to receive IAI or IAI plus rPDT if rescue criteria were met. Patients not requiring rescue received IAI every 8 weeks; those requiring rescue received IAI every 4 weeks plus sham/active PDT. At week 52 (the primary endpoint), IAI was noninferior to IAI plus rPDT. After week 52, treatment intervals could be extended beyond 8 weeks at the investigators' discretion. Noninferiority of IAI vs IAI plus rPDT for mean best-corrected visual acuity change from baseline to week 96 was evaluated. RESULTS Over 96 weeks, 54 patients (17.0%) met rescue criteria. At week 96, IAI was noninferior to IAI plus rPDT in terms of Early Treatment Diabetic Retinopathy Study letters gained (+10.7 vs +9.1, P = .48). Proportions of patients with complete polyp regression (33.1% vs 29.1%) or without active polyps (82.1% vs 85.6%) were similar. In year 2, the mean number of injections was 4.6 in both arms. No new safety signals were observed. CONCLUSION IAI monotherapy was noninferior to IAI with rescue PDT up to 96 weeks, and functional and anatomical improvements achieved at 52 weeks were maintained. Few patients required rescue PDT, which provided no additional visual benefit.
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Affiliation(s)
- Tien Yin Wong
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, National University of Singapore, Singapore.
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Won Ki Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University Taipei, Taiwan
| | - Paul Mitchell
- University of Sydney, Sydney, New South Wales, Australia (Westmead Institute for Medical Research)
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, National University of Singapore, Singapore
| | | | | | - Tatsuro Ishibashi
- Department of Ophthalmology, Kyushu University Hospital, Fukuoka, Japan
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22
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Al-Khersan H, Hussain RM, Ciulla TA, Dugel PU. Innovative therapies for neovascular age-related macular degeneration. Expert Opin Pharmacother 2019; 20:1879-1891. [PMID: 31298960 DOI: 10.1080/14656566.2019.1636031] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Investigational anti-VEGF treatments for neovascular age-related macular degeneration (nAMD) aim to improve visual outcomes and reduce treatment burden; these include long-acting agents, combination strategies, topical agents, sustained-release, and genetic therapies. Areas covered: The authors provide a comprehensive review of investigational therapies for nAMD, focusing on therapies currently in clinical trial. Expert opinion: Long-acting anti-VEGF agents have demonstrated promising results in phase 3 studies, and include Brolucizumab, a single-chain antibody fragment, and Abicipar, a designed ankyrin repeat protein (DARPin). Other unique anti-VEGF agents in current trials include Conbercept - a fusion protein of the VEGF receptor domains, KSI-301 - an anti-VEGF antibody biopolymer conjugate, and OPT-302 - an inhibitor of VEGF-C/D. Strategies to activate the Tie-2 receptor, some in combination with VEGF inhibition, are of interest, with recent trials of Faricimab, ARP-1536, and nesvacumab. Topical anti-VEGF ± anti-PDGF agents, such as pazopanib, squalamine lactate, regorafenib, and LHA510 have shown limited efficacy and/or have not been advanced, although PAN-90806 continues to advance with promising initial results. Sustained-release anti-VEGF treatments, to address treatment burden, include the ranibizumab Port Delivery System, GB-102, NT-503, hydrogel depot, Durasert, and ENV1305. Similarly, genetic therapies, including RGX-314 and ADVM-022, aim to provide sustained anti-VEGF expression from the retina.
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Affiliation(s)
- Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Rehan M Hussain
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Thomas A Ciulla
- Department of Ophthalmology, Indiana University School of Medicine , Indianapolis , IN , USA.,Retina Service, Midwest Eye Institute , Indianapolis , IN , USA.,Clearside Biomedical , Alpharetta , GA , USA
| | - Pravin U Dugel
- Retinal Consultants of Arizona , Phoenix , Arizona.,USC Roski Eye Institute, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA
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Ciulla TA, Hussain RM, Pollack JS, Williams DF. Visual Acuity Outcomes and Anti-Vascular Endothelial Growth Factor Therapy Intensity in Neovascular Age-Related Macular Degeneration Patients: A Real-World Analysis of 49 485 Eyes. Ophthalmol Retina 2019; 4:19-30. [PMID: 31324588 DOI: 10.1016/j.oret.2019.05.017] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study assessed anti-vascular endothelial growth factor (VEGF) therapy intensity and its relationship with visual acuity (VA) change in real-world neovascular age-related macular degeneration (nAMD) patients. DESIGN This retrospective analysis was performed on a large database of aggregated, longitudinal, de-identified electronic medical records from a geographically and demographically diverse sample of patients of United States retina specialists (Vestrum Health Retina Database). PARTICIPANTS Treatment-naïve nAMD patients who underwent anti-VEGF injections between January 1, 2012, and October 31, 2016, were eligible if follow-up data were available before October 31, 2017. METHODS Age, gender, anti-VEGF treatment type, number of treatments, and VA were extracted from the database. MAIN OUTCOME MEASURE Mean VA change assessed at 1 year and stratified based on number of anti-VEGF injections received over 1 year. RESULTS In this analysis, 49 485 eyes were included. The mean age was 80.9 years, and 64% were female. Mean baseline VA was 53.8 letters (Snellen equivalent, 20/80). At 1 year, after a mean of 7.3 anti-VEGF injections, there was a mean gain of 1 letter (0.95 letter; 95% confidence interval [CI] for change in VA, +0.77 to +1.13 letter; P < 0.001). When stratified by anti-VEGF agent, the mean VA changes were nearly identical at 1 year. There was a linear relationship between mean letters gained and mean number of injections, between 4 and 10 injections over 1 year, with 4 or fewer or 10 or more injections associated with loss of vision or a plateau, respectively. Greater mean 1-year change in VA also trended with worse baseline VA; those patients with better VA at presentation tended to be particularly vulnerable to vision loss. Those who received the fewest injections tended to be older and have worse baseline VA. CONCLUSIONS Real-world nAMD patients receive fewer anti-VEGF injections and experience worse visual outcomes compared with patients receiving fixed, frequent therapy in randomized controlled trials. Mean change in VA correlates with treatment intensity at 1 year, but with ceiling effects related to treatment intensity and baseline VA. Older patients and those with poor baseline VA may be particularly prone to undertreatment.
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Affiliation(s)
- Thomas A Ciulla
- Indiana University School of Medicine and Midwest Eye Institute, Indianapolis, Indiana.
| | - Rehan M Hussain
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - John S Pollack
- Rush University Medical Center and Illinois Retina Associates, Chicago, Illinois; Vestrum Health, Naperville, Illinois
| | - David F Williams
- Vestrum Health, Naperville, Illinois; VitreoRetinal Surgery, PA, Minneapolis, Minnesota
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Kumluang S, Ingsrisawang L, Sangroongruangsri S, Chaikledkaew U, Ratanapakorn T, Ruamviboonsuk P, Taweebanjongsin W, Choovuthayakorn J, Thoongsuwan S, Hanutsaha P, Kulvichit K, Ratanapojnard T, Wongsawad W, Leelahavarong P, Teerawattananon Y. A real-world study of effectiveness of intravitreal bevacizumab and ranibizumab injection for treating retinal diseases in Thailand. BMC Ophthalmol 2019; 19:82. [PMID: 30922350 PMCID: PMC6439979 DOI: 10.1186/s12886-019-1086-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/06/2019] [Indexed: 01/05/2023] Open
Abstract
Background To evaluate the effectiveness of intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) in actual practice for treating patients with retinal diseases in Thailand. Methods A prospective, multi-centre, observational study was conducted among eight hospitals in their ophthalmology outpatient departments. Participants consisted of patients who had previously not received any IVB or IVR treatment between 2013 and 2014. The primary outcome measurement was the change in best-corrected visual acuity (BCVA) at the end of the follow-up period compared to baseline. Results There were 1629 treatment-naïve patients for the pro re nata (PRN) treatment pattern and 226 treatment-naive patients for the three-injections (3Inj) treatment pattern. BCVA improvements were found in 35% of the PRN group and 47% of the 3Inj group; however, it was not clinically meaningful between the IVB and IVR groups (P-value = 0.568 for PRN, P-value = 0.103 for 3Inj). A multivariable logistic regression (using the propensity score) showed that positive factors associated with vision improvement for the PRN pattern were the number of drug injections, having retinal vein occlusion, and under 60 years of age, while good BCVA at baseline was a negative predictive factor. For the 3Inj pattern, under 60 years of age and baseline BCVA were statistically significant predictors. Nonetheless, diabetes mellitus (DM) without other comorbidities was a statistically significant predictor of low response to vision improvement compared to DM with other comorbidities. Conclusions This study was the first observational, prospective study to evaluate the real-life effectiveness of IVB and IVR in Thailand. The majority of participants who used IVB or IVR showed improvements in BCVA after treatment. Further evaluation such as long-term follow-ups and subsequent comparison of effectiveness between IVB and IVR should be investigated due to the limited sample of IVR patients. Trial registration Thai Clinical Trial Registry TCTR20141002001. Registered 02 October 2014 (retrospectively registered).
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Affiliation(s)
- Suthasinee Kumluang
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Lily Ingsrisawang
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand.
| | - Sermsiri Sangroongruangsri
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.,Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.,Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Tanapat Ratanapakorn
- Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - 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
| | - Kittisak Kulvichit
- Vitreo-Retina Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thitiporn Ratanapojnard
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Warapat Wongsawad
- Department of Ophthalmology, Mettapracharak (Wat Rai Khing) Hospital, Nakornprathom, Thailand
| | - Pattara Leelahavarong
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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Guo MY, Etminan M, Cheng JZ, Zafari Z, Maberley DAL. One-Year Effectiveness Study of Intravitreous Ranibizumab in Wet (Neovascular) Age-Related Macular Degeneration: A Meta-Analysis. Pharmacotherapy 2018; 38:197-204. [PMID: 29286545 DOI: 10.1002/phar.2079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The clinical efficacy of ranibizumab has been examined by a large number of prospective and retrospective studies to date. This meta-analysis was conducted to summarize the current body of evidence on visual acuity (VA) changes with use of ranibizumab in the treatment of wet (neovascular) age-related macular degeneration (wAMD). METHODS A literature review of multiple electronic databases (EMBASE, MEDLINE, MedMEME) was conducted to find randomized controlled trials (RCTs) and observational studies that reported changes in VA while patients with wAMD were on ranibizumab. Study factors analyzed were baseline patient characteristics, study type, sample size, and 12-month change in VA. Data were pooled in a meta-analysis with VA change as the main outcome. Data were then stratified by study design and a meta-regression was conducted to assess 12-month VA change against baseline VA and age. RESULTS A total of 42 studies were included for analysis. An overall increase of 5.58 letters (95% confidence interval [CI]: 4.42-6.75; p heterogeneity, < 0.001) was shown with use of ranibizumab compared to baseline. Improvements in VA were larger for RCTs, at 7.71 letters (95% CI: 6.66-8.76; p heterogeneity, 0.013), compared to observational studies, at 4.85 letters (95% CI: 3.32-6.38; p heterogeneity, < 0.001). The meta-regression showed a significant decrease in effect size between baseline VA and 12-month VA change. CONCLUSION This meta-analysis suggests visual improvements at 12 months of 0.5-mg ranibizumab use in patients with wAMD. A higher gain in VA was observed when pooling results from RCTs compared to those in observational studies.
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Affiliation(s)
- Michael Y Guo
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmine Z Cheng
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zafar Zafari
- Mailman School of Public Health, Columbia University, New York, New York
| | - David A L Maberley
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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26
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Özkaya A, Karabaş L, Alagöz C, Alkın Z, Artunay Ö, Bölükbaşı S, Demir G, Demir M, Demircan A, Erden B, Erdoğan G, Erdoğan M, Eriş E, Kaldırım H, Onur İU, Osmanbaşoğlu Ö, Özdoğan Erkul S, Öztürk M, Perente İ, Sarıcı K, Sayın N, Yaşa D, Yılmaz İ, Yılmazabdurrahmanoğlu Z. Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1. Turk J Ophthalmol 2018; 48:232-237. [PMID: 30405944 PMCID: PMC6216527 DOI: 10.4274/tjo.31697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/11/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients. Materials and Methods Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year. Results Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 μm (range: 91-1582), 330±115 μm (range: 99-975), and 332±114 μm (range: 106-1191), respectively. Conclusion The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen.
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Affiliation(s)
- Abdullah Özkaya
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Levent Karabaş
- Bosphorus Retina Study Group.,Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Turkey
| | - Cengiz Alagöz
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Zeynep Alkın
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Özgür Artunay
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Selim Bölükbaşı
- Bosphorus Retina Study Group.,Okmeydanı Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Gökhan Demir
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Mehmet Demir
- Bosphorus Retina Study Group.,Şişli Etfal Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Ali Demircan
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Burak Erden
- Bosphorus Retina Study Group.,Okmeydanı Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Gürkan Erdoğan
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Mehmet Erdoğan
- Bosphorus Retina Study Group.,Kanuni Sultan Süleyman Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Erdem Eriş
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Havva Kaldırım
- Bosphorus Retina Study Group.,Bağcılar Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - İsmail Umut Onur
- Bosphorus Retina Study Group.,Bakırköy Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Özen Osmanbaşoğlu
- Bosphorus Retina Study Group.,İstanbul Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Sezin Özdoğan Erkul
- Bosphorus Retina Study Group.,İstanbul Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Mine Öztürk
- Bosphorus Retina Study Group.,Haseki Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - İrfan Perente
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Kübra Sarıcı
- Bosphorus Retina Study Group.,Kanuni Sultan Süleyman Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Nihat Sayın
- Bosphorus Retina Study Group.,Kanuni Sultan Süleyman Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Dilek Yaşa
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - İhsan Yılmaz
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
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Tick S, Cornut PL, De Bats F, Wolf B, Souied EH, Cohen SY. [Update from France Macula Federation: Treatment of Wet AMD]. J Fr Ophtalmol 2018; 41:862-867. [PMID: 30361178 DOI: 10.1016/j.jfo.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE To update the recommendations of the France Macula Federation for treatment of wet age-related macular degeneration (AMD). METHODS Analysis of literature and expert opinion. RESULTS The FFM recommends initiating anti-VEGF therapy as soon as possible after diagnosis of exudative AMD. There has been no major change in the last several years concerning the procedure of intravitreal injection itself. However, the litigious points are discussed: simultaneous bilateral injection; antibiotic therapy; medico-legal aspects. All anti-VEGF strategies possess advantages and limitations. The strategy should be left to the ophthalmologists' preference. However, the chosen strategy should be explained to patients and strictly followed. CONCLUSION The treatment of wet-AMD is more precisely codified than before. However, various strategies still coexist.
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Affiliation(s)
- S Tick
- Centre hospitalier national d'ophtalmologie des XV-XX, 28, rue de Charenton, 75012 Paris, France; Centre ophtalmologique Vincennes, 17, bis rue des Meuniers, 94300 Vincennes, France
| | - P-L Cornut
- Centre pôle vision, clinique du Val d'Ouest, Croix rousse, 39, chemin de la Vernique, 69130 Écully, France
| | - F De Bats
- Centre pôle vision, clinique du Val d'Ouest, Croix rousse, 39, chemin de la Vernique, 69130 Écully, France; Hôpital de la Croix-Rousse, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - B Wolf
- Centre ophtalmologique de la maison rouge, 6, rue de l'Église, 67000 Strasbourg, France
| | - E H Souied
- Service d'ophtalmologie et université Paris Est, 61, avenue du Général de Gaulle, 94000 Créteil, France
| | - S Y Cohen
- Service d'ophtalmologie et université Paris Est, 61, avenue du Général de Gaulle, 94000 Créteil, France; Centre ophthalmologique d'imagerie et de laser, 11, rue Antoine Bourdelle, 75015 Paris, France.
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WRINKLED VASCULARIZED RETINAL PIGMENT EPITHELIUM DETACHMENT PROGNOSIS AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY. Retina 2018; 38:1100-1109. [PMID: 28520639 DOI: 10.1097/iae.0000000000001698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Neovascular age-related macular degeneration (nAMD) is frequently associated with vascularized pigment epithelial detachment (v-PED). We observed a peculiar characteristic of v-PED characterized by small lacy folds of the retinal pigment epithelium, appearing as a wrinkled PED (w-PED) on spectral domain optical coherence tomography (SD-OCT). Our purpose was to describe the visual prognosis and number of intravitreal injections in w-PED compared with non-w-PED. METHODS In this retrospective, case-control series, we reviewed retrospectively medical records of 52 eyes of 51 patients who were consecutively included between November 1 and 30, 2015 with a previous minimum 3-year follow-up. Inclusion criteria were: neovascular age-related macular degeneration, affected with w-PED. Baseline characteristics, best-corrected visual acuity (BVCA), number of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF IVT) and maximal recurrence-free interval, that is, without intravitreal anti-vascular endothelial growth factor injection, were analyzed. A w-PED was defined as a v-PED ≥200 μm in height on SD-OCT imaging, presenting with at least 4 small lacy folds on the surface of the retinal pigment epithelium. Patients were compared with a control group, that is, patients harboring PED without wrinkle shape (non-w-PED). All patients had been treated by intravitreal anti-vascular endothelial growth factor injection of either ranibizumab (IVR) or aflibercept (IVA) using a pro re nata (PRN) protocol after three initial monthly treatments, with a minimum of follow-up of 3 years. RESULTS Two groups of patients were compared, w-PED (29 eyes, from 29 patients), and non-w-PED (23 eyes from 22 patients). In the w-PED group, mean BCVA evolved from 0.28 (±0.18) log MAR (20/40, range 20/25-20/63) at baseline, to 0.29 (±0.21) log MAR (20/40, range 20/25-20/63) at 1 year (P = 0.41), 0.34 (±0.26) log MAR (20/40, range 20/25-20/80) at 2 years (P = 0.49), 0.35 (±0.28) log MAR (20/40, range 20/25-20/80) at 3 years (P = 0.54). In the non-w-PED group, mean BCVA was 0.40 (±0.28) log MAR (20/50, range 20/25-20/100) at baseline and decreased to 0.48 (±0.46) log MAR (20/63, range 20/20-20/160) at 1 year (P = 0.19), 0.48 (±0.35) log MAR (20/63, range 20/25-20/125) at 2 years (P = 0.02), 0.60 (±0.38) log MAR (20/80, range 20/32-20/200) at 3 years (P = 0.002). In the w-PED group, the mean maximal documented recurrence-free interval was 7.87 (±2.94) months at Year 1, 13.5 (±7.52) at Year 2 and 14.78 (±10.70) at Year 3, versus 4.59 (±2.95) months at Year 1, 7.83 (±6.62) at Year 2, 8.57 (±11.18) at Year 3 in the non-w-PED group (P = 0.0004; 0.0101; 0.0168 respectively at Years 1, 2 and 3). DISCUSSION The evolution of v-PED after intravitreal anti-vascular endothelial growth factor injection is still difficult to predict despite intense clinical research in this topic. In our study, we noticed that w-PED might be a phenotypic prognosis factor for better visual acuity and longer maximal recurrence-free interval.
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Mehta H, Tufail A, Daien V, Lee AY, Nguyen V, Ozturk M, Barthelmes D, Gillies MC. Real-world outcomes in patients with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor inhibitors. Prog Retin Eye Res 2018; 65:127-146. [DOI: 10.1016/j.preteyeres.2017.12.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 12/13/2022]
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Ciulla TA, Huang F, Westby K, Williams DF, Zaveri S, Patel SC. Real-world Outcomes of Anti-Vascular Endothelial Growth Factor Therapy in Neovascular Age-Related Macular Degeneration in the United States. Ophthalmol Retina 2018; 2:645-653. [PMID: 31047372 DOI: 10.1016/j.oret.2018.01.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 11/29/2017] [Accepted: 01/11/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Real-world visual outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) have been reported in cohorts outside of the United States. This study sought to assess the relationship between presenting visual acuity (VA) and visual outcomes, as well as the potential impact of loss to follow-up, in real-world anti-VEGF-treated nAMD patients from the United States. DESIGN Retrospective study of aggregated, longitudinal electronic medical records obtained from a geographically diverse sample of US retina specialists and included in the Vestrum Health Retina Database. PARTICIPANTS Inclusion criteria were a diagnosis of nAMD, no previous treatment, and ≥3 monthly anti-VEGF injections in the first 4 months from diagnosis in patients diagnosed between January 2011 and July 2013. METHODS To model loss to follow-up, mutually exclusive cohorts of nAMD patients with loss to follow-up after specific time points of 6 and 12 months (i.e., no follow-up beyond) were compared with a separate cohort of patients who completed 24 months of follow-up ending prior to July 2015 (n = 2213). MAIN OUTCOME MEASURE VA outcomes were assessed on each cohort as a whole, with additional stratification by baseline VA. RESULTS The 6-, 12-, and 24-month cohorts received means of 5.4, 7.3, and 12.1 injections and showed no change, no change, and a mean change of +3.1 letters from baseline (95% confidence interval 1.8-4.4 letters, P < 0.01), respectively. When stratified by baseline VA, nearly all groups lose VA at their respective follow-up periods, except for those with baseline VA of 20/200 or worse. CONCLUSIONS Real-world nAMD patients in the United States receive fewer anti-VEGF injections and experience worse visual outcomes compared with patients in randomized clinical trials, consistent with non-US studies. Patients with better VA at presentation tend to be particularly vulnerable to vision loss. Compared with other patients, those ultimately lost to follow-up have worse visual outcomes at, or prior to, their final visit, suggesting that loss to follow-up may lead to overestimation of visual outcomes in clinical studies of nAMD.
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Affiliation(s)
| | | | | | - David F Williams
- VitreoRetinal Surgery, PA, Minneapolis, Minnesota; Vestrum Health, Naperville, Illinois
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Westborg I, Granstam E, Rosso A, Albrecht S, Karlsson N, Lövestam-Adrian M. Treatment for neovascular age-related macular degeneration in Sweden: outcomes at seven years in the Swedish Macula Register. Acta Ophthalmol 2017; 95:787-795. [PMID: 28834299 DOI: 10.1111/aos.13539] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/25/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To present Swedish Macula Register (SMR) data regarding treatment of neovascular age-related macular degeneration (AMD) in clinical practice since 2008. METHODS A retrospective register-based study was conducted. Evaluation of baseline demographics, visual outcome and number of injections during this period is presented. RESULTS Mean age at diagnosis was 79 ± (SD) 8 years; 65% were female. The proportion of patients with <2 months' duration of symptoms increased from 26% in 2008 to 41% in 2014 (p = 0.001). Mean visual acuity (VA) at baseline increased from 54.3 ± 15.0 early treatment diabetic retinopathy study (ETDRS) letters in 2008 to 57.8 ± 15.6 letters in 2014 (CI95 2.6; 4.3; p < 0.001). Mean VA after 1 year of treatment increased from 57.8 ± 17.7 ETDRS letters for patients who started the treatment in 2008 to 62.8 ± 16.4 ETDRS letters in patients starting treatment in 2014 (CI95 2.67; 4.64; p < 0.001). During all study years, the proportion of patients with an improvement in VA of between 5 and 15 letters was around 30%, while 14% had VA improvement of more than 15 letters. The mean number of injections during the first treatment year increased from 4.3 ± 1.9 in 2008 to 5.9 ± 2.9 in 2014 (CI95 1.40; 1.67; p < 0.001). Seven-year follow-up of 322 eyes showed a mean change of -1 letters from baseline, with a mean of 21 injections for the entire period. CONCLUSION The duration of symptoms before treatment decreased, while VA at baseline and after 1 year of treatment increased over the years and so did the number of injections. Long-term follow-up demonstrated stable VA.
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Affiliation(s)
- Inger Westborg
- Department of Clinical Sciences; Umeå University Hospital; Umeå Sweden
| | - Elisabet Granstam
- Centre for Clinical Research; Uppsala University; County Council of Västmanland; Västerås Sweden
| | - Aldana Rosso
- Department of Radiology; Institution of Translational Medicine; Lund University; Malmö Sweden
| | | | - Niklas Karlsson
- Department of Ophthalmology; Örebro University Hospital; Örebro Sweden
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Westborg I, Rosso A. Risk Factors for Discontinuation of Treatment for Neovascular Age-Related Macular Degeneration. Ophthalmic Epidemiol 2017; 25:176-182. [DOI: 10.1080/09286586.2017.1397701] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Inger Westborg
- Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden
| | - Aldana Rosso
- Centre of Registers South, Skåne University Hospital, Lund, Sweden, and Radiology Diagnostics, Institution of Translational Medicine, Lund University, Malmö, Sweden
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Jain N, Yadav NK, Jayadev C, Srinivasan P, Mohan A, Shetty BK. The ARMOUR Study: Anti-VEGF in Neovascular AMD--Our Understanding in a Real-World Indian Setting. Asia Pac J Ophthalmol (Phila) 2017; 6:488-492. [PMID: 29057640 DOI: 10.22608/apo.2017125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The aim of our study was to share our experience with anti-vascular endothelial growth factor (anti-VEGF) injections in the treatment of neovascular age-related macular degeneration (nAMD) in a real-world setting. DESIGN A retrospective, observational study. METHODS Patients of Indian origin with nAMD receiving anti-VEGF with a minimum follow-up of 12 months were enrolled in this study. In group 1, patients were treated on a pro re nata (PRN) basis; in group 2, patients received a loading dose (3 injecti Results: Overall, we observed that 77.31% (92/119 eyes) of patients either maintained or had improved visual acuity at 12 months' follow-up. Similar visual outcome was observed in both groups. The average number of injections given in group 1 was 4.98 and in group 2 was 3.7. CDVA at 12 months was significantly correlated with type of drug molecule, CSFT at 3 and 12 months, baseline visual acuity, and CDVA at 3 months. CONCLUSIONS PRN treatment with significantly fewer injections achieved similar anatomical and functional outcomes when compared with the loading dose group. The results of this study need to be validated with a larger study group and a longer follow-up.
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Affiliation(s)
- Nimesh Jain
- Vitreo-Retina Department, Narayana Nethralaya, Bangalore, India
| | | | - Chaitra Jayadev
- Vitreo-Retina Department, Narayana Nethralaya, Bangalore, India
| | | | - Ashwin Mohan
- Vitreo-Retina Department, Narayana Nethralaya, Bangalore, India
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RISK FOR LOW VISUAL ACUITY AFTER 1 AND 2 YEARS OF TREATMENT WITH RANIBIZUMAB OR BEVACIZUMAB FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2017; 37:2035-2046. [DOI: 10.1097/iae.0000000000001431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zerbib J, Bourhis A, Cornut PL, De Bats F, Grenet T, Gualino V, Halfon J, Massé H, Srour M, Streho M, Tick S, Wolff B, San Nicolas N. [Management of wet AMD in France in 2015]. J Fr Ophtalmol 2017; 40:723-730. [PMID: 29055730 DOI: 10.1016/j.jfo.2017.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE AND CONTEXT Intravitreal administration of anti-VEGF agents, available in France since 2007, allows stabilization and improvement in visual acuity in wet age-related macular degeneration (AMD). In the past few years, the management of this disease has evolved in terms of both diagnostic methods and treatment schedules, which have been adapted to the pathophysiology of AMD. The goal of this survey, performed in a representative sample of French ophthalmologists, was to describe the evolution of medical practices one year after a similar survey (Massé et al., J Fr Ophtalmol 2016; 39: 40-7). METHOD The survey was performed from December, 2014 to March, 2015 in 191 ophthalmologists (53 general ophthalmologists and 98 retina specialists) with an on-line questionnaire. This questionnaire was designed by a committee of ophthalmologists to describe practices concerning screening, diagnosis, treatment and follow-up of wet AMD. RESULTS An initial intravitreal injection of an anti-VEGF agent was usually performed within 10 days after the diagnosis of wet AMD by 98% of ophthalmologists and within 5 days by 63%. The treatment protocols favored by retina specialists were pro re nata (PRN) for 58%, Observe and Plan for 25% and Treat and Extend for 17%. Bilateral intravitreal injections were performed on the same day by 46% of retina specialists, mostly for the convenience of the patient and because of the low infectious risk. The initial protocol was maintained by one third of retina specialists throughout the course of treatment, while two thirds of them reported that they reassessed the protocol on average after 5 months. CONCLUSION This survey on the practices of the ophthalmologists in wet AMD highlights an improvement in the time course of patient management and an evolution of treatment schedules toward individualized protocols.
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Affiliation(s)
- J Zerbib
- Nice Rétina, 5, rue Eugène-Emmanuel, 06000 Nice, France.
| | - A Bourhis
- Polyclinique Atlantique, avenue Claude-Bernard, BP 40419, 44819 Saint-Herblain cedex, France
| | - P L Cornut
- Centre ophtalmologique pôle vision, clinique du Val-d'Ouest, 39, chemin de la Vernique, 69130 Écully, France
| | - F De Bats
- Centre ophtalmologique pôle vision, clinique du Val-d'Ouest, 39, chemin de la Vernique, 69130 Écully, France
| | | | - V Gualino
- Clinique Honoré-Cave, 406, boulevard Montauriol, 82017 Montauban, France
| | - J Halfon
- Cabinet d'ophtalmologie des Halles-de-Tours, 13, place Gaston-Paillhou, 37000 Tours, France
| | - H Massé
- Centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - M Srour
- Centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France
| | - M Streho
- Explore Vision, 4, rue Grandes-Terres, 92500 Rueil-Malmaison, France
| | - S Tick
- Hôpital des Quinze-Vingts, 28, rue de Charenton, 75571 Paris cedex, France
| | - B Wolff
- Centre ophtalmologique, Maison-Rouge, 6, rue de l'Église, 67000 Strasbourg, France; Fondation Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France
| | - N San Nicolas
- Novartis France, 2 et 4, rue Lionel-Terray, BP 308, 92506 Rueil-Malmaison cedex, France
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Holden SE, Currie CJ, Owens DR. Evaluation of the clinical effectiveness in routine practice of fluocinolone acetonide 190 µg intravitreal implant in people with diabetic macular edema. Curr Med Res Opin 2017; 33:5-17. [PMID: 28881149 DOI: 10.1080/03007995.2017.1366645] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of the Iluvien Clinical Evidence study in the UK (ICE-UK) was to assess the real-world effectiveness of fluocinolone acetonide (FAc) 190 µg intravitreal implant for the treatment of clinically significant chronic diabetic macular edema (DME) in routine clinical practice. METHODS This retrospective study collected data from patient medical records in 13 ophthalmology centers for people with DME prescribed FAc intravitreal implant between April 1, 2013 and April 15, 2015. Visual acuity (VA) and intraocular pressure (IOP) measurements were collected for 12 months prior to and after implant. RESULTS Two hundred and eight people, contributing 233 eyes, treated with FAc implant were included. Mean age was 68.1 years and 62% were male. In the 12 months prior to FAc implant, VA declined. Median (interquartile range, IQR) VA was 0.66 (0.48-1.00) LogMAR units (equivalent to 52.0 ETDRS letters) at implant, improving to 0.60 (0.38-0.90) LogMAR units (55.0 letters) at 12 months post-implant (p < 0.001). In total, 44%, 30%, and 18% of people achieved an improvement in ETDRS score of ≥5, ≥10, and ≥15 letters, respectively, over the same period. A small but significant (p < .001) increase in median IOP was observed (median = 15.0, IQR = 13.0-18.0 mmHg at implant to 18.0, 15.0-21.0 mmHg at 12 months). In the 12 months following implant, additional IOP-lowering therapy was prescribed in 15% of subjects previously not requiring such therapy. CONCLUSION Following FAc implant, an overall significant improvement in VA was observed over a period of 12 months, accompanied by a significant but small increase in IOP.
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Affiliation(s)
- Sarah E Holden
- a Global Pharmacoepidemiology, Pharmatelligence , Cardiff , UK
| | - Craig J Currie
- a Global Pharmacoepidemiology, Pharmatelligence , Cardiff , UK
- b Institute of Population Medicine , Cardiff University , Cardiff , UK
| | - David R Owens
- c School of Medicine , Swansea University , Swansea , UK
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Krivosic V, Philippakis E, Couturier A, Dupas B, Erginay A, Desmettre T, Streho M, Bonnin S, Mane V, Jouvaud S, Gualino V, Durand D, Tadayoni R. [A "fast track" to improve management of neovascular age related macular degeneration]. J Fr Ophtalmol 2017; 40:642-647. [PMID: 28865938 DOI: 10.1016/j.jfo.2017.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/20/2017] [Accepted: 03/06/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the role of a fast track for management of patients with neovascular age- related macular degeneration (nARMD) treated by intravitreal injection of anti-VEGF. PATIENTS The records of 100 patients in the chronic maintenance phase of intravitreal anti-VEGF followed in the fast track and 63 patients followed in the standard protocol for at least 12 months were retrospectively analyzed. METHOD Patients in the fast track underwent visual acuity (VA) testing by ETDRS, optical coherence tomography (OCT) and a physician assessment. The injection was performed the same day whenever possible. The primary endpoint to evaluate patient adherence was the time between the ideal date of visit or injection prescribed by the physician and the actual date of administration. RESULTS The mean time between the ideal date of visit or injection prescribed by the physician and the actual date of administration was 4.1±7.5 days for the patients followed in the fast track and 5.6±18.7 days for the patients followed in the standard protocol. Mean VA remained stable for the patients followed in the fast track: 20/50 (20/800 to 20/20) at baseline vs. 20/50 (20/800 to 20/16) at the conclusion of follow-up. It dropped from 40/50 at baseline to 20/63 at the conclusion of follow-up for the patients followed in the standard protocol. CONCLUSION In the context of a fast track, it was possible to improve the adherence of nARMD patients and maintain their VA gain or stabilization achieved after the induction phase.
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Affiliation(s)
- V Krivosic
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France; Centre ophtalmologique de l'Odéon, 113, boulevard Saint-Germain, 75006 Paris, France.
| | - E Philippakis
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - A Couturier
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - B Dupas
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - A Erginay
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - T Desmettre
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - M Streho
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - S Bonnin
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - V Mane
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - S Jouvaud
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - V Gualino
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - D Durand
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
| | - R Tadayoni
- Service d'ophtalmologie, hôpital Lariboisière, université Paris-Diderot, Sorbonne-Paris-Cité, AP - HP, 2, rue, Ambroise-Paré, 75010 Paris, France
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Heimes B, Gunnemann F, Ziegler M, Gutfleisch M, Spital G, Pauleikhoff D, Lommatzsch A. [Compliance of age related macular degeneration patients undergoing anti-VEGF therapy : Analysis and suggestions for improvement]. Ophthalmologe 2017; 113:925-932. [PMID: 27272633 DOI: 10.1007/s00347-016-0275-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Activity-based treatment regimens with anti-vascular endothelial growth factor (anti-VEGF) are currently the gold standard for treatment of exudative age-related macular degeneration (nAMD). Whereas injection frequencies of approximately seven injections in the first year and six in the second year are expected with a pro re nata (PRN) regimen, retrospective real life observations have recorded significantly reduced numbers of injections. This study was carried out to investigate the reasons for the reduction in follow-up control appointments and to find out whether a telemedicine network could influence the motivation and compliance for regular control examinations and treatment. MATERIAL AND METHODS The patient collective included 210 eyes from 191 patients with nAMD treated by anti-VEGF therapy in 2010 and 2011. The activity-based anti-VEGF treatment, control examinations and treatment intervals were performed according to the guidelines over a mean follow-up of 2 years. In another collective of 100 eyes from 100 patients with treatment of nAMD 2 groups were observed: 1 group with patients for whom control examinations were carried out close to home including an online transmission of the results to the treating retinal center and another group in which the patients had to be examined in the treatment center. RESULTS After 140 weeks 50 % of the patients in the first collective regularly attended control examinations and after 1 year the number was 79 %. After 2 years the probability of continuous supervision is given for only 62 % of the patients, whereas in 38 % the treatment was terminated. Of these patients treatment was terminated in 8 % due to valid criteria, whereas in 30 % of the patients the termination was unintentional. The main reason (38 %) for an unintentional termination of examination and treatment was the frequent and long journey. Patients in the second collective had a significantly higher compliance with respect to the control examinations (p < 0.001) and number of injections (p = 0.02) over the period of nearly 2 years due to the introduction of electronic transmission of images. CONCLUSION A long-term therapy of nAMD in the clinical routine can be achieved by a close relationship with the ophthalmologist, continuous follow-up controls and therapy cycles. A close telemedical networking between the ophthalmologist and the treatment center can lead to better patient compliance. Furthermore, the construction of such platforms represents a challenge not only for the treatment of nAMD but also for other diseases.
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Affiliation(s)
- B Heimes
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland.
| | - F Gunnemann
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - M Ziegler
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - M Gutfleisch
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - G Spital
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - D Pauleikhoff
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - A Lommatzsch
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
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Bracha P, Moore NA, Ciulla TA. Induced pluripotent stem cell-based therapy for age-related macular degeneration. Expert Opin Biol Ther 2017; 17:1113-1126. [PMID: 28664762 DOI: 10.1080/14712598.2017.1346079] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In age-related macular degeneration (AMD), stem cells could possibly replace or regenerate disrupted pathologic retinal pigment epithelium (RPE), and produce supportive growth factors and cytokines such as brain-derived neurotrophic factor. Induced pluripotent stem cells (iPSCs)-derived RPE was first subretinally transplanted in a neovascular AMD patient in 2014. Areas covered: Induced PSCs are derived from the introduction of transcription factors to adult cells under specific cell culture conditions, followed by differentiation into RPE cells. Induced PSC-derived RPE cells exhibit ion transport, membrane potential, polarized VEGF secretion and gene expression that is similar to native RPE. Despite having similar in vitro function, morphology, immunostaining and microscopic analysis, it remains to be seen if iPSC-derived RPE can replicate the myriad of in vivo functions, including immunomodulatory effects, of native RPE cells. Historically, adjuvant RPE transplantation during CNV resections were technically difficult and complicated by immune rejection. Autologous iPSCs are hypothesized to reduce the risk of immune rejection, but their production is time-consuming and expensive. Alternatively, allogenic transplantation using human leukocyte antigen (HLA)-matched iPSCs, similar to HLA-matched organ transplantation, is currently being investigated. Expert opinion: Challenges to successful transplantation with iPSCs include surgical technique, a pathologic subretinal microenvironment, possible immune rejection, and complications of immunosuppression.
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Affiliation(s)
- Peter Bracha
- a Glick Eye Institute, Department of Ophthalmology , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Nicholas A Moore
- a Glick Eye Institute, Department of Ophthalmology , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Thomas A Ciulla
- a Glick Eye Institute, Department of Ophthalmology , Indiana University School of Medicine , Indianapolis , IN , USA.,b Retina Service , Midwest Eye Institute , Indianapolis , IN , USA
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Schroeder M, Rung L, Lövestam-Adrian M. No improvement in injection frequency or in visual outcome over time in two cohorts of patients from the same Swedish county treated for wet age-related macular degeneration. Clin Ophthalmol 2017; 11:1105-1111. [PMID: 28652696 PMCID: PMC5472435 DOI: 10.2147/opth.s130182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Although ranibizumab has been used for the treatment of wet age-related macular degeneration (AMD) since 2007, real-world studies still report undertreatment resulting in a less favorable visual outcome. In this study, two different time cohorts of patients treated with ranibizumab for wet AMD in routine care were analyzed to observe whether there was a change over time regarding visual outcome, injection frequency, and quality of life (QoL). Methods We compared patients with treatment-naïve wet AMD in two observational follow-up cohorts 2007–2010 (n=50 patients) and 2009–2013 (n=26). After a loading dose of three intravitreal ranibizumab injections, the patients were treated under the pro re nata regimen. Visual acuity (VA) was examined by Early Treatment Diabetic Retinopathy Study (ETDRS) charts. The National Eye Institute Visual Functioning Questionnaire 25 was answered by patients at baseline and at 37±7 months (cohort 1) and at 45±4 months (cohort 2). Results At baseline, the cohorts were homogeneous considering mean age (76±7 vs 75±8 years), mean VA (53±14 vs 52±15 ETDRS letters), and mean self-reported symptom duration (14±11 vs 13±11 weeks). Mean VA decreased in both cohorts over time, from 53±14 to 45±24 letters (P=0.011) and from 52±15 to 46±22 letters (P=0.175), respectively. The patients received a mean of 8±5 and 9±7 injections, respectively. The mean composite score change from baseline to follow-up decreased in cohort 1 from 64±21 to 59±25 scores (P=0.04) but increased in cohort 2 from 64±28 to 67±23 scores (P=0.38). Conclusion We could not demonstrate any improvement in the number of injections in two different time cohorts of patients treated with ranibizumab for wet AMD in a Swedish county. Visual outcomes decreased after 3 years of follow-up, but QoL scores were divergent.
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Affiliation(s)
- Marion Schroeder
- Division of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
| | - Lena Rung
- Department of Ophthalmology, Helsingborg Hospital, Helsingborg, Sweden
| | - Monica Lövestam-Adrian
- Division of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
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LONG-TERM OUTCOMES AND INCIDENCE OF RECURRENCE OF NEOVASCULARIZATION IN TREATED EXUDATIVE AGE-RELATED MACULAR DEGENERATION. Retina 2017; 37:951-961. [DOI: 10.1097/iae.0000000000001282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Duval MV, Rougier MB, Delyfer MN, Combillet F, Korobelnik JF. [Real life visual and anatomic outcomes of aflibercept treatment for treatment-naive patients with exudative age-related macular degeneration]. J Fr Ophtalmol 2017; 40:270-278. [PMID: 28341388 DOI: 10.1016/j.jfo.2016.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022]
Abstract
Anti-VEGF therapies have revolutionized the treatment of neovascular age-related macular degeneration (AMD). PURPOSE The goal of this study was to evaluate the "real life" visual and anatomical outcomes of aflibercept treatment for treatment-naive patients with exudative AMD. METHODS This was a retrospective study of patients treated with aflibercept in the department of Ophthalmology at the University Hospital of Bordeaux between November 2013 and July 2015. The follow-up period varied from 3months to 2years. All patients received an induction phase with 3monthly intravitreal injections (IVT) followed by personalized monitoring. ETDRS best-corrected visual acuity (BCVA), fundus examination and OCT were performed at each visit. Data were collected at day 0, 3 months, 6, 9, 12months, 18 and 24months. RESULTS Forty-three eyes of forty patients, mean age 77.7years, were included, with a minimum of 3months follow-up. Twenty-five eyes were followed for 1year; 5 eyes for two years. At baseline, the mean BCVA was 55.7 letters. Patients received 7.5 injections on average the first year and 2.6 the 2nd year. The mean gain of visual acuity was +7.3 letters at 3 months, +6.2 letters at 12 months, and +6.8 letters at 2years. Anatomically, the OCT data showed a decline of all parameters. The central macular thickness decreased by 118.3μm at 3months, 136.4μm at 12months and 65.5μm at 2years. CONCLUSION Aflibercept can achieve effective visual and anatomical outcomes with results, which approach the pivotal studies, despite the use of personalized protocols and longer monitoring intervals.
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Affiliation(s)
- M-V Duval
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Rabat-Leon, 33000 Bordeaux, France.
| | - M-B Rougier
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Rabat-Leon, 33000 Bordeaux, France
| | - M-N Delyfer
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Rabat-Leon, 33000 Bordeaux, France; University Bordeaux, ISPED, 33000 Bordeaux, France; Inserm, U1219, Bordeaux Population Health Research Center, 33000 Bordeaux, France
| | - F Combillet
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Rabat-Leon, 33000 Bordeaux, France
| | - J-F Korobelnik
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Rabat-Leon, 33000 Bordeaux, France; University Bordeaux, ISPED, 33000 Bordeaux, France; Inserm, U1219, Bordeaux Population Health Research Center, 33000 Bordeaux, France
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43
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Marakis TP, Koutsandrea C, Chatzistefanou KI, Tountas Y. Treatment satisfaction of patients with neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents. Int Ophthalmol 2017; 38:565-576. [PMID: 28285389 DOI: 10.1007/s10792-017-0492-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the psychometric properties of the Greek Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) and evaluate the factors that influence treatment satisfaction of patients with neovascular age-related macular degeneration (nAMD). METHODS The MacTSQ was translated into Greek and administered to 176 patients. All patients completed the SF-12 Health Survey and the Macular disease Dependent Quality of Life Questionnaire (MacDQoL) and underwent vision measurements. For test-retest reliability, a subset of 19 participants completed the MacTSQ twice, two weeks apart. Stepwise multiple linear regression analyses were performed to identify predictors of treatment satisfaction. Change in MacTSQ scores over time was assessed on 83 patients who completed the MacTSQ at a follow-up visit, one year later. RESULTS The intraclass correlation coefficients between the first and second test-retest administration ranged from 0.88 to 0.98 for the items and total score. Internal reliability of the total score was adequate (Cronbach's a = 0.837). Principal component analysis revealed three subscales (effectiveness, information provision and convenience, impact). The MacTSQ score showed significant correlations with SF-12 summary scales and MacDQoL scores (ρ = 0.16-0.27). The most important factor that determined the satisfaction was mental health. Distance visual acuity (VA) in better eye was the best predictor of the effectiveness subscale, and the total number of injections was a negative predictor for the convenience subscale. Treatment satisfaction increased at one-year follow-up, despite the deterioration in distance VA. CONCLUSIONS The Greek MacTSQ is a reliable and valid instrument for assessing nAMD patients' perceptions of treatment satisfaction, especially using its three new subscales. Treatment satisfaction is multifactorial and was primarily determined by patients' mental health status.
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Affiliation(s)
- Theodoros P Marakis
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece.
| | - Chrysanthi Koutsandrea
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Klio I Chatzistefanou
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Yannis Tountas
- Department of Hygiene and Epidemiology, Center for Health Services Research, University of Athens Medical School, Athens, Greece
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Prise en charge individualisée des patients atteints de DMLA exsudative, le protocole IOI : injection–observation–individualisation. J Fr Ophtalmol 2017; 40:169-176. [DOI: 10.1016/j.jfo.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 01/24/2023]
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45
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Jaffe GJ, Ciulla TA, Ciardella AP, Devin F, Dugel PU, Eandi CM, Masonson H, Monés J, Pearlman JA, Quaranta-El Maftouhi M, Ricci F, Westby K, Patel SC. Dual Antagonism of PDGF and VEGF in Neovascular Age-Related Macular Degeneration. Ophthalmology 2017; 124:224-234. [DOI: 10.1016/j.ophtha.2016.10.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/06/2016] [Accepted: 10/08/2016] [Indexed: 01/20/2023] Open
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46
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Ranibizumab for vascularized pigment epithelial detachment: 1-year anatomic and functional results. Graefes Arch Clin Exp Ophthalmol 2016; 255:743-751. [DOI: 10.1007/s00417-016-3564-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 02/01/2023] Open
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47
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Gillies MC, Nguyen V, Daien V, Arnold JJ, Morlet N, Barthelmes D. Twelve-Month Outcomes of Ranibizumab vs. Aflibercept for Neovascular Age-Related Macular Degeneration: Data from an Observational Study. Ophthalmology 2016; 123:2545-2553. [DOI: 10.1016/j.ophtha.2016.08.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/12/2016] [Accepted: 08/14/2016] [Indexed: 02/06/2023] Open
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48
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Gualino V, Baillif S, Kodjikian L. [Management algorithm of age-related macular degeneration with aflibercept: Real-life application]. J Fr Ophtalmol 2016; 39:872-879. [PMID: 27789040 DOI: 10.1016/j.jfo.2016.09.001] [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: 07/31/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Abstract
Aflibercept is indicated in France for wet age-related macular degeneration (wAMD) since November 2013. Its official dosage consists in administrating one monthly intravitreal injection (IVT) during three months followed by one control visit and one IVT every two months the first year. In 2015, a group of French ophthalmologists, specialized in wAMD management, established a therapeutic algorithm to optimize naive patient management with aflibercept in order to obtain visual acuity gain. It indicates that official administration scheme is adapted for 80% of patients and that an adaptation of therapeutic scheme is needed for others. These experts recommended mostly the use of personalized proactive administration scheme. Since, aflibercept clinical use has significantly grown with interventional observational studies which results are now available. Use of aflibercept and of personalized proactive administration schemes allow in real-life obtaining important visual acuity gain, which is consistent with the established algorithm.
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Affiliation(s)
- V Gualino
- Clinique Honoré Cave, 406, boulevard Montauriol, 82017 Montauban, France.
| | - S Baillif
- Service d'ophtalmologie, hôpital Pasteur 2, centre hospitalo-universitaire de Nice, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - L Kodjikian
- Service d'ophtalmologie, hôpital de la Croix-Rousse, groupement hospitalier Nord, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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49
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Boulanger-Scemama E, Sayag D, Ha Chau Tran T, Quaranta-El Maftouhi M, Rumen F, Creuzot-Garcher C, Blanco Garavito R, Jung C, Souied E. [Ranibizumab and exudative age-related macular degeneration: 5-year multicentric functional and anatomical results in real-life practice]. J Fr Ophtalmol 2016; 39:668-674. [PMID: 27609025 DOI: 10.1016/j.jfo.2016.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE The goal of this study was to evaluate five year functional and anatomical outcomes of wet AMD patients treated with ranibizumab according to a pro re nata (PRN) regimen in real-life practice. METHODS A retrospective, multicentric chart review of 201 eyes of 201 patients who underwent their first ranibizumab intravitreal injection (IVT) between January 1, 2007 and December 31, 2008 was performed. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on SD-OCT, number of IVT and follow-up visits were collected at baseline and during the entire follow-up period of 5 years. RESULTS Mean BCVA at baseline was 52.3±16.5 letters. Mean BCVA change from baseline was respectively +2.8, +2.5, +1.8, -0.6 at 1, 2, 3, 4 years of follow-up. At year 5, 43% of eyes had a stable or improved letter score (≥0 letter gain), whereas 29% declined by 15 letters or more, with an overall significant mean decline of 2.8 letters (P<0.05). No correlation was observed between final visual outcome and age, baseline BCVA, type of neovascularization, naive status, number of IVT or number of follow-up visits. On SD-OCT, mean CMT was 293±96μm at baseline and was significantly reduced compared to baseline at each year end-point (P<0.005). The mean number of IVT was 15±10.4 at year 5, with 55% of eyes still being under active treatment. CONCLUSION PRN ranibizumab in real-life practice improved or stabilized visual acuity over 4 years. During the 5th year, progressive decline of visual acuity was observed.
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Affiliation(s)
- E Boulanger-Scemama
- Service d'ophtalmologie, université Paris Est Créteil, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - D Sayag
- Centre Explore Vision, 75001 Paris, France
| | - T Ha Chau Tran
- Service d'ophtalmologie, groupement des hôpitaux catholique de Lille, université catholique de Lille, 59000 Lille, France
| | | | - F Rumen
- Centre Atlantique de la Vision, 17140 La Rochelle, France
| | | | - R Blanco Garavito
- Service d'ophtalmologie, université Paris Est Créteil, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - C Jung
- Centre de recherche clinique, université Paris Est Créteil, CHI de Créteil, 94000 Créteil, France
| | - E Souied
- Service d'ophtalmologie, université Paris Est Créteil, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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