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Patel S, Storey PP, Barakat MR, Hershberger V, Bridges WZ, Eichenbaum DA, Lally DR, Boyer DS, Bakri SJ, Roy M, Paggiarino DA. Phase I DAVIO Trial: EYP-1901 Bioerodible, Sustained-Delivery Vorolanib Insert in Patients With Wet Age-Related Macular Degeneration. OPHTHALMOLOGY SCIENCE 2024; 4:100527. [PMID: 38881599 PMCID: PMC11179418 DOI: 10.1016/j.xops.2024.100527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 06/18/2024]
Abstract
Purpose To evaluate safety and tolerability of EYP-1901, an intravitreal insert containing vorolanib, a pan-VEGF receptor inhibitor packaged in a bioerodible delivery technology (Durasert E™) for sustained delivery, in patients with wet age-related macular degeneration (wAMD) previously treated with anti-VEGF therapy. Design Phase I, multicenter, prospective, open-label, dose-escalation trial. Participants Patients with wAMD and evidence of prior anti-VEGF therapy response. Methods Patients received a single intravitreal injection of EYP-1901. Main Outcome Measures The primary objective was to evaluate safety and tolerability of EYP-1901. Secondary objectives assessed biologic activity of EYP-1901 including best-corrected visual acuity (BCVA) and central subfield thickness (CST). Exploratory analyses included reduction in anti-VEGF treatment burden and supplemental injection-free rates. Results Seventeen patients enrolled in the 440 μg (3 patients), 1030 μg (1 patient), 2060 μg (8 patients), and 3090 μg (5 patients) dose cohorts. No dose-limiting toxicity, ocular serious adverse events (AEs), or systemic AEs related to EYP-1901 were observed. There was no evidence of ocular or systemic toxicity related to vorolanib or the delivery technology. Moderate ocular treatment-emergent AEs (TEAEs) included reduced visual acuity (2/17) and retinal exudates (3/17). One patient with reduced BCVA had 3 separate reductions of 17, 18, and 16 letters, and another had a single drop of 25 letters. One severe TEAE, neovascular AMD (i.e., worsening/progressive disease activity), was reported in 1 of 17 study eyes but deemed unrelated to treatment. Mean change from baseline in BCVA was -1.8 letters and -5.4 letters at 6 and 12 months. Mean change from baseline in CST was +1.7 μm and +2.4 μm at 6 and 12 months. Reduction in treatment burden was 74% and 71% at 6 and 12 months. Of 16 study eyes, 13, 8, and 5 were injection-free up to 3, 6, and 12 months. Conclusion In the DAVIO trial (ClinicalTrials.gov identifier, NCT04747197), EYP-1901 had a favorable safety profile and was well tolerated in previously treated eyes with wAMD. Measures of biologic activity remained relatively stable following a single EYP-1901 injection. These preliminary data support ongoing phase II and planned phase III trials to assess efficacy and safety. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sunil Patel
- Retina Research Institute of Texas, West Texas Retina Consultants, Abilene, Texas
| | - Philip P Storey
- Austin Retina Associates, University of Texas Dell Medical School, Austin, Texas
| | - Mark R Barakat
- Retina Macula Institute of Arizona; University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | | | | | | | - David R Lally
- New England Retina Consultants, Springfield, Massachusetts
| | - David S Boyer
- Retina Vitreous Associates Medical Group, Los Angeles, California
| | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Monica Roy
- EyePoint Pharmaceuticals, Watertown, Massachusetts
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Bai T, Cui B, Xing M, Chen S, Zhu Y, Lin D, Guo Y, Du M, Wang X, Zhou D, Yan H. Stable inhibition of choroidal neovascularization by adeno-associated virus 2/8-vectored bispecific molecules. Gene Ther 2024:10.1038/s41434-024-00461-1. [PMID: 38961279 DOI: 10.1038/s41434-024-00461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 06/14/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
Neovascular age-related macular degeneration (nAMD) causes severe visual impairment. Pigment epithelium-derived factor (PEDF), soluble CD59 (sCD59), and soluble fms-like tyrosine kinase-1 (sFLT-1) are potential therapeutic agents for nAMD, which target angiogenesis and the complement system. Using the AAV2/8 vector, two bi-target gene therapy agents, AAV2/8-PEDF-P2A-sCD59 and AAV2/8-sFLT-1-P2A-sCD59, were generated, and their therapeutic efficacy was investigated in laser-induced choroidal neovascularization (CNV) and Vldlr-/- mouse models. After a single injection, AAV2/8-mediated gene expression was maintained at high levels in the retina for two months. Both AAV2/8-PEDF-P2A-sCD59 and AAV2/8-sFLT-1-P2A-sCD59 significantly reduced CNV development for an extended period without side effects and provided efficacy similar to two injections of current anti-vascular endothelial growth factor monotherapy. Mechanistically, these agents suppressed the extracellular signal-regulated kinase and nuclear factor-κB pathways, resulting in anti-angiogenic activity. This study demonstrated the safety and long-lasting effects of AAV2/8-PEDF-P2A-sCD59 and AAV2/8-sFLT-1-P2A-sCD59 in CNV treatment, providing a promising therapeutic strategy for nAMD.
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Affiliation(s)
- Tinghui Bai
- Department of Ophthalmology, Tianjin Medical University General Hospital, Ministry of Education International Joint Laboratory of Ocular Diseases, Tianjin Key Laboratory of Ocular Trauma, Tianjin Institute of Eye Health and Eye Diseases, China-UK "Belt and Road" Ophthalmology Joint Laboratory, Tianjin, China
| | - Bohao Cui
- Department of Ophthalmology, Tianjin Medical University General Hospital, Ministry of Education International Joint Laboratory of Ocular Diseases, Tianjin Key Laboratory of Ocular Trauma, Tianjin Institute of Eye Health and Eye Diseases, China-UK "Belt and Road" Ophthalmology Joint Laboratory, Tianjin, China
| | - Man Xing
- Department of Pathogen Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Siyue Chen
- Department of Ophthalmology, Tianjin Medical University General Hospital, Ministry of Education International Joint Laboratory of Ocular Diseases, Tianjin Key Laboratory of Ocular Trauma, Tianjin Institute of Eye Health and Eye Diseases, China-UK "Belt and Road" Ophthalmology Joint Laboratory, Tianjin, China
| | - Yanfang Zhu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Ministry of Education International Joint Laboratory of Ocular Diseases, Tianjin Key Laboratory of Ocular Trauma, Tianjin Institute of Eye Health and Eye Diseases, China-UK "Belt and Road" Ophthalmology Joint Laboratory, Tianjin, China
| | - Dongxue Lin
- Department of Ophthalmology, Tianjin Medical University General Hospital, Ministry of Education International Joint Laboratory of Ocular Diseases, Tianjin Key Laboratory of Ocular Trauma, Tianjin Institute of Eye Health and Eye Diseases, China-UK "Belt and Road" Ophthalmology Joint Laboratory, Tianjin, China
| | - Yingying Guo
- Department of Pathogen Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Mei Du
- Department of Ophthalmology, Tianjin Medical University General Hospital, Ministry of Education International Joint Laboratory of Ocular Diseases, Tianjin Key Laboratory of Ocular Trauma, Tianjin Institute of Eye Health and Eye Diseases, China-UK "Belt and Road" Ophthalmology Joint Laboratory, Tianjin, China
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, the Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Xiaohong Wang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Ministry of Education International Joint Laboratory of Ocular Diseases, Tianjin Key Laboratory of Ocular Trauma, Tianjin Institute of Eye Health and Eye Diseases, China-UK "Belt and Road" Ophthalmology Joint Laboratory, Tianjin, China.
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, the Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.
| | - Dongming Zhou
- Department of Pathogen Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Ministry of Education International Joint Laboratory of Ocular Diseases, Tianjin Key Laboratory of Ocular Trauma, Tianjin Institute of Eye Health and Eye Diseases, China-UK "Belt and Road" Ophthalmology Joint Laboratory, Tianjin, China.
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Bressler NM, Kaiser PK, Do DV, Nguyen QD, Park KH, Woo SJ, Sagong M, Bradvica M, Kim MY, Kim S, Sadda SR. Biosimilars of anti-vascular endothelial growth factor for ophthalmic diseases: A review. Surv Ophthalmol 2024; 69:521-538. [PMID: 38521423 DOI: 10.1016/j.survophthal.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
The development of intravitreally injected biologic medicines (biologics) acting against vascular endothelial growth factor (VEGF) substantially improved the clinical outcomes of patients with common VEGF-driven retinal diseases. The relatively high cost of branded agents, however, represents a financial burden for most healthcare systems and patients, likely resulting in impaired access to treatment and poorer clinical outcomes for some patients. Biosimilar medicines (biosimilars) are clinically equivalent, potentially economic alternatives to reference products. Biosimilars approved by leading health authorities have been demonstrated to be similar to the reference product in a comprehensive comparability exercise, generating the totality of evidence necessary to support analytical, pre-clinical, and clinical biosimilarity. Anti-VEGF biosimilars have been entering the field of ophthalmology in the US since 2022. We review regulatory and scientific concepts of biosimilars, the biosimilar development landscape in ophthalmology, with a specific focus on anti-VEGF biosimilars, and discuss opportunities and challenges facing the uptake of biosimilars.
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Affiliation(s)
- Neil M Bressler
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter K Kaiser
- Cole Eye Institute, 9500 Euclid Avenue, Desk i3, Cleveland, OH, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, the Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, the Republic of Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Yeungnam Eye Center, Yeungnam University Hospital, Daegu, the Republic of Korea
| | - Mario Bradvica
- Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
| | | | | | - SriniVas R Sadda
- Doheny Eye Institute, Pasadena, CA, USA; Department of Ophthalmology, University of California-Los Angeles, Los Angeles, CA, USA.
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Dyachkova Y, Dunger-Baldauf C, Barbier N, Devenport J, Franzén S, Kazeem G, Künzel T, Mancini P, Mordenti G, Richert K, Ridolfi A, Saure D. Do You Want to Stay Single? Considerations on Single-Arm Trials in Drug Development and the Postregulatory Space. Pharm Stat 2024. [PMID: 38923796 DOI: 10.1002/pst.2412] [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: 12/06/2023] [Revised: 04/03/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Single-arm trials (SATs), while not preferred, remain in use throughout the drug development cycle. They may be accepted by regulators in particular contexts (e.g., in oncology or rare diseases) when the potential effects of new treatments are very large and placebo treatment is unethical. However, in the postregulatory space, SATs are common, and perhaps even more poorly suited to address the questions of interest. In this manuscript, we review regulatory and HTA positions on SATs; challenges posed by SATs to address research questions beyond regulators, evolving statistical methods to provide context for SATs, case studies where SATs could and could not address questions of interest, and communication strategies to influence decision making and optimize study design to address evidence needs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Daniel Saure
- Boehringer Ingelheim Europe GmbH, Ingelheim, Germany
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Sunaga T, Maeda M, Saulle R, Ng SM, Sato MT, Hasegawa T, Mason AN, Noma H, Ota E. Anti-vascular endothelial growth factor biosimilars for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2024; 6:CD015804. [PMID: 38829176 PMCID: PMC11146280 DOI: 10.1002/14651858.cd015804.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
RATIONALE Neovascular age-related macular degeneration (AMD) is a progressive eye disease characterized by choroidal neovascularization (CNV) and is a leading cause of vision loss and disability worldwide. Although intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is an effective treatment option that helps to prevent vision loss or to improve visual acuity in people with neovascular AMD, treatment imposes a significant financial burden on patients and healthcare systems. A biosimilar is a biological product that has been developed to be nearly identical to a previously approved biological product. The use of biosimilars may help reduce costs and so may increase patient access to effective biologic medicines with similar levels of safety to the drugs on which they are based. OBJECTIVES To assess the benefits and harms of anti-VEGF biosimilar agents compared with their corresponding anti-VEGF agents (i.e. the reference products) that have obtained regulatory approval for intravitreal injections in people with neovascular AMD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases, and two trials registries together with reference checking and contact with study authors to identify studies that are included in the review. The latest search date was 2 June 2023. ELIGIBILITY CRITERIA We included randomized controlled trials (RCTs) that compared approved anti-VEGF biosimilars with their reference products for treating the eyes of adult participants (≥ 50 years) who had an active primary or recurrent choroidal neovascularization lesion secondary to neovascular AMD. OUTCOMES Our outcomes were: best-corrected visual acuity (BCVA), central subfield thickness (CST), vision-related quality of life, serious ocular and non-ocular adverse events (AE), treatment-emergent adverse events (TEAEs), anti-drug antibodies (ADAs), and serum concentrations of biosimilars and reference drugs. RISK OF BIAS We assessed the risk of bias (RoB) for seven outcomes reported in a summary of findings table by using the Cochrane RoB 2 tool. SYNTHESIS METHODS We synthesized results for each outcome using meta-analysis, where possible, by calculating risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for dichotomous outcomes and continuous outcomes, respectively. Where this was not possible due to the nature of the data, we summarized the results narratively. We used GRADE to assess the certainty of evidence for prespecified outcomes. INCLUDED STUDIES We included nine parallel-group multi-center RCTs that enrolled a total of 3814 participants (3814 participating eyes), with sample sizes that ranged from 160 to 705 participants per study. The mean age of the participants in these studies ranged from 67 to 76 years, and the proportion of women ranged from 26.5% to 58.7%. Ranibizumab (Lucentis) was the reference product in seven studies, and aflibercept (Eyelea) was the reference product in two others. All the included studies had been supported by industry. The follow-up periods ranged from 12 to 52 weeks (median 48 weeks). Five studies (56%) were conducted in multi-country settings across Europe, North America and Asia, two studies in India, and one each in Japan and the Republic of Korea. We judged all the included studies to have met high methodological standards. SYNTHESIS OF RESULTS With regard to efficacy, our meta-analyses demonstrated that anti-VEGF biosimilars for neovascular AMD resulted in little to no difference compared with the reference products for BCVA change at 8 to 12 weeks (MD -0.55 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, 95% CI -1.17 to 0.07; 8 studies, 3603 participants; high-certainty evidence) and the proportion of participants who lost fewer than 15 letters in BCVA at 24 to 48 weeks (RR 0.99, 95% CI 0.98 to 1.01; 7 studies, 2658 participants; moderate-certainty evidence). Almost all participants (96.6% in the biosimilar group and 97.0% in the reference product group) lost fewer than 15 letters in BCVA. The evidence from two studies suggested that there was no evidence of difference between biosimilars and reference products in vision-related quality of life measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) summary scores at 24 to 48 weeks (MD 0.82, 95% CI -0.70 to 2.35; 2 studies, 894 participants; moderate-certainty evidence). With regard to the safety profile, meta-analyses also revealed little to no difference between anti-VEGF biosimilars and the reference products for the proportion of participants who experienced serious ocular AEs (RR 1.24, 95% CI 0.68 to 2.26; 7 studies, 3292 participants; moderate-certainty evidence), and for TEAEs leading to investigational product discontinuation or death (RR 0.96, 95% CI 0.63 to 1.46; 8 studies, 3497 participants; moderate-certainty evidence). Overall, 1.4% of participants in the biosimilar group and 1.2% in the reference product group experienced serious ocular adverse events. The most frequently documented serious ocular AEs were retinal hemorrhage and endophthalmitis. Although the evidence is of low certainty due to imprecision, meta-analysis suggested that anti-VEGF biosimilars led to no difference compared with the reference products for cumulative incidence of ADAs (RR 0.84, 95% CI 0.58 to 1.22; 8 studies, 3066 participants; low-certainty evidence) or mean maximum serum concentrations (MD 0.42 ng/mL, 95% CI -0.22 to 1.05; subgroup of 3 studies, 100 participants; low-certainty evidence). We judged the overall risk of bias to be low for all studies. AUTHORS' CONCLUSIONS In our review, low to high certainty evidence suggests that there is little to no difference, to date, between the anti-VEGF biosimilars approved for treating neovascular AMD and their reference products in terms of benefits and harms. While anti-VEGF biosimilars may be a viable alternative to reference products, current evidence for their use is based on a limited number of studies - particularly for comparison with aflibercept - with sparse long-term safety data, and infrequent assessment of quality of life outcomes. Our effect estimates and conclusions may be modified once findings have been reported from studies that are currently ongoing, and studies of biosimilar agents that are currently in development. FUNDING Cochrane Eyes and Vision US Project is supported by grant UG1EY020522, National Eye Institute, National Institutes of Health. Takeshi Hasegawa and Hisashi Noma were supported by Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (Grant numbers: 22H03554, 19K03092, 24K06239). REGISTRATION Protocol available via doi.org/10.1002/14651858.CD015804.
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Affiliation(s)
- Tomiko Sunaga
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Sueko M Ng
- Department of Ophthalmology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Miki Takenaka Sato
- Department of Clinical Pharmacy, School of Pharmacy, Showa University , Tokyo, Japan
| | - Takeshi Hasegawa
- Institute of Clinical Epidemiology (iCE), Showa University, Tokyo, Japan
- Department of Hygiene, Public Health, and Preventive Medicine, Showa University School of Medicine, Tokyo, Japan
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan
| | - Andrew N Mason
- Department of General Education, School of Medicine, Juntendo University, Tokyo, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Erika Ota
- Global Health Nursing, St. Luke's International University, Tokyo, Japan
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Raimondi R, Falfeli T, Bogdanova-Bennet A, Varma D, Habib M, Kotagiri A, Steel DH, Grinton M. Outcomes of Treatment-Resistant Neovascular Age-Related Macular Degeneration Switched from Aflibercept to Faricimab. Ophthalmol Retina 2024; 8:537-544. [PMID: 38040055 DOI: 10.1016/j.oret.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE Although previous studies have demonstrated the efficacy of faricimab in treatment-naive patients with neovascular age-related macular degeneration (nAMD), its outcomes in patients switched from aflibercept are less understood. This study aimed to assess clinical anatomical and functional outcomes of switching to faricimab in patients undergoing aflibercept intravitreal injections (IVIs) for nAMD with suboptimal response. DESIGN Retrospective case series. SUBJECTS Patients with nAMD at a single tertiary care center who were switched from aflibercept to faricimab due to persistent suboptimal response. METHODS Patients had received a minimum of 6 consecutive IVIs of aflibercept and showed persistent presence of intraretinal (IRF) or subretinal fluid (SRF) on OCT despite receiving aflibercept at 4 or 6-weekly intervals at the time of the switch. Patients receiving 4-weekly aflibercept were switched with either 2 or 3 loading doses of 4-weekly faricimab injections. Regression models were used to identify predictors of clinical outcomes. MAIN OUTCOME MEASURES Visual acuity, central macular thickness (CMT), and OCT parameters were assessed preswitch and postswitch. RESULTS Eighty-one eyes of 68 patients were included. The mean age was 79.1 years (standard deviation: 8.9), and females constituted 53% of cases. A statistically significant reduction in CMT was observed postswitch (P < 0.0001). The proportion of cases with IRF (P = 0.0219) and SRF (P < 0.000) decreased significantly. Overall clinical improvement on OCT was noted in 80% of patients. No significant improvement in ETDRS vision was observed. There was no evidence that switching regimen (2 vs. 3 loading doses) had an independent effect on clinical outcomes. CONCLUSION Among patients with treatment-resistant nAMD, switching from aflibercept to faricimab may serve as a safe and effective option. Significant anatomical improvements were observed, with a trend toward visual stability. The loading regimen with 2 faricimab injections appeared to be sufficient for nonnaive patients. However, a longer follow-up and larger studies are warranted to confirm these findings. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Raffaele Raimondi
- Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom.
| | - Tina Falfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Anna Bogdanova-Bennet
- Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Deepali Varma
- Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Maged Habib
- Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom; Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ajay Kotagiri
- Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - David H Steel
- Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom; Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Grinton
- Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
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Guymer R, Bailey C, Chaikitmongkol V, Chakravarthy U, Chaudhary V, Finger RP, Gallego-Pinazo R, Chuan AKH, Ishida S, Lövestam-Adrian M, Parravano M, Luna Pinto JD, Schmitz-Valckenberg S, Sheth V, Souied EH, Chi GC, Gilberg F, Glittenberg C, Scheidl S, Bengus M. Rationale and Design of VOYAGER: Long-term Outcomes of Faricimab and Port Delivery System with Ranibizumab for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema in Clinical Practice. OPHTHALMOLOGY SCIENCE 2024; 4:100442. [PMID: 38304609 PMCID: PMC10831184 DOI: 10.1016/j.xops.2023.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Purpose To describe the rationale and design of the VOYAGER (NCT05476926) study, which aims to investigate the safety and effectiveness of faricimab and the Port Delivery System with ranibizumab (PDS) for neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME) in clinical practice. VOYAGER also aims to understand drivers of clinical practice treatment outcomes by gaining novel insight into the intersection of treatment regimens, decisions, anatomic outcomes, and vision. Design Primary data collection, noninterventional, prospective, multinational, multicenter clinical practice study. Participants At least 5000 patients initiating/continuing faricimab or PDS for nAMD/DME (500 sites, 31 countries). Methods Management will be per usual care, with no mandated scheduled visits/imaging protocol requirements. Using robust methodologies, relevant clinical and ophthalmic data, including visual acuity (VA), and data on treatment clinical setting/regimens/philosophies, presence of anatomic features, and safety events will be collected. Routinely collected fundus images will be uploaded to the proprietary Imaging Platform for analysis. An innovative investigator interface will graphically display the patient treatment journey with the aim of optimizing treatment decisions. Main Outcome Measures Primary end point: VA change from baseline at 12 months per study cohort (faricimab in nAMD and in DME, PDS in nAMD). Secondary end points: VA change over time and per treatment regimens (fixed, treat-and-extend, pro re nata, and other) and number. Exploratory end points: VA change in relation to presence/location of anatomic features that impact vision (fluid, central subfield thickness, fibrosis, atrophy, subretinal hyperreflective material, diabetic retinopathy severity, and disorganization of retinal inner layers) and per treatment regimen/philosophies. The impact of regional and practice differences on outcomes will be assessed as will safety. Results Recruitment commenced in November 2022 and will continue until late 2027, allowing for up to 5 years follow-up. Exploratory interim analyses are planned annually. Conclusions VOYAGER is an innovative study of retinal diseases that will assess the effectiveness and safety of faricimab and PDS in nAMD and DME and identify clinician- and disease-related factors driving treatment outcomes in clinical practices globally to help optimize vision outcomes. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Clare Bailey
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Voraporn Chaikitmongkol
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Usha Chakravarthy
- Queen’s University of Belfast, Royal Victoria Hospital, Belfast, United Kingdom
| | - Varun Chaudhary
- Department of Surgery, Hamilton Regional Eye Institute, McMaster University, Hamilton, Ontario, Canada
| | - Robert P. Finger
- Department of Ophthalmology, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | | | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Monica Lövestam-Adrian
- Department of Ophthalmology, Department of Clinical Sciences, Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | | | - Steffen Schmitz-Valckenberg
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus, Bonn, Germany
| | | | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Kikuchi Y, Kawczynski MG, Anegondi N, Neubert A, Dai J, Ferrara D, Quezada-Ruiz C. Machine Learning to Predict Faricimab Treatment Outcome in Neovascular Age-Related Macular Degeneration. OPHTHALMOLOGY SCIENCE 2024; 4:100385. [PMID: 37868796 PMCID: PMC10585644 DOI: 10.1016/j.xops.2023.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 10/24/2023]
Abstract
Purpose To develop machine learning (ML) models to predict, at baseline, treatment outcomes at month 9 in patients with neovascular age-related macular degeneration (nAMD) receiving faricimab. Design Retrospective proof of concept study. Participants Patients enrolled in the phase II AVENUE trial (NCT02484690) of faricimab in nAMD. Methods Baseline characteristics and spectral domain-OCT (SD-OCT) image data from 185 faricimab-treated eyes were split into 80% training and 20% test sets at the patient level. Input variables were baseline age, sex, best-corrected visual acuity (BCVA), central subfield thickness (CST), low luminance deficit, treatment arm, and SD-OCT images. A regression problem (BCVA) and a binary classification problem (reduction of CST by 35%) were considered. Overall, 10 models were developed and tested for each problem. Benchmark classical ML models (linear, random forest, extreme gradient boosting) were trained on baseline characteristics; benchmark deep neural networks (DNNs) were trained on baseline SD-OCT B-scans. Baseline characteristics and SD-OCT data were merged using 2 approaches: model stacking (using DNN prediction as an input feature for classical ML models) and model averaging (which averaged predictions from the DNN using SD-OCT volume and from classical ML models using baseline characteristics). Main Outcome Measures Treatment outcomes were defined by 2 target variables: functional (BCVA letter score) and anatomical (percent decrease in CST from baseline) outcomes at month 9. Results The best-performing BCVA regression model with respect to the test coefficient of determination (R2) was the linear model in the model-stacking approach with R2 of 0.31. The best-performing CST classification model with respect to test area under receiver operating characteristics (AUROC) was the benchmark linear model with AUROC of 0.87. A post hoc analysis showed the baseline BCVA and the baseline CST had the most effect in the all-model prediction for BCVA regression and CST classification, respectively. Conclusions Promising signals for predicting treatment outcomes from baseline characteristics were detected; however, the predictive benefit of baseline images was unclear in this proof-of-concept study. Further testing and validation with larger, independent datasets is required to fully explore the predictive capacity of ML models using baseline imaging data. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Yusuke Kikuchi
- Roche Personalized Healthcare Program, Genentech, Inc., South San Francisco, California
- Department of Industrial Engineering and Operations Research, University of California, Berkeley, Berkeley, California
| | - Michael G. Kawczynski
- Roche Personalized Healthcare Program, Genentech, Inc., South San Francisco, California
| | - Neha Anegondi
- Roche Personalized Healthcare Program, Genentech, Inc., South San Francisco, California
- Clinical Imaging Group, Genentech, Inc., South San Francisco, California
| | - Ales Neubert
- Data & Analytics, Roche Pharma Research and Early Development, Basel, Switzerland
| | - Jian Dai
- Roche Personalized Healthcare Program, Genentech, Inc., South San Francisco, California
| | - Daniela Ferrara
- Roche Personalized Healthcare Program, Genentech, Inc., South San Francisco, California
| | - Carlos Quezada-Ruiz
- Clinical Science, Genentech, Inc., South San Francisco, California
- Department of Ophthalmology, Clínica de Ojos Garza Viejo, San Pedro Garza, Garcia, Nuevo Leon, Mexico
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Korobelnik JF, Chaudhary V, Mitchell P, Kang SW, Tadayoni R, Allmeier H, Lee J, Zhang X, Machewitz T, Bailey C. XTEND: Two-Year Results from a Global Observational Study Investigating Proactive Dosing of Intravitreal Aflibercept in Neovascular Age-Related Macular Degeneration. Ophthalmol Ther 2024; 13:725-738. [PMID: 38198053 PMCID: PMC10853145 DOI: 10.1007/s40123-023-00867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/24/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION XTEND (NCT03939767) is a multicenter, observational, prospective study of patients with treatment-naïve neovascular age-related macular degeneration (nAMD) in routine clinical practice. The study aims to examine treatment outcomes of proactive intravitreal aflibercept (IVT-AFL) treatment regimens (fixed dosing or treat-and-extend) according to local marketing labels. METHODS Study eyes received IVT-AFL injections as per the local label. The mean changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) from baseline to month (M) 12 and M24 were measured and stratified by baseline factors. Treatment exposure and safety data were evaluated. Statistical analysis was descriptive. RESULTS Overall, 1466 patients from 17 countries were treated. For the overall population, the mean ± standard deviation (SD) age was 78.7 ± 8.5 (range 50-100) years, and 891 patients (60.8%) were female. The mean ± SD baseline BCVA was 54.3 ± 20.3 letters and CST was 374 ± 126 µm. At M12 and M24, mean (95% confidence interval [CI]) BCVA change was + 4.3 (3.4, 5.3) and + 2.3 (1.3, 3.3) letters, respectively. Mean (95% CI) CST was - 106 (- 114, - 99) μm and - 109 (- 117, - 102) μm at M12 and M24, respectively. At M24, 41.5% of patients had a BCVA ≥ 70 letters. Patients received a mean ± SD of 7.7 ± 2.7 injections by M12 and 10.8 ± 5.0 injections by M24 (3.1 injections between M12 and M24). Adverse events were consistent with the known safety profile of IVT-AFL. CONCLUSION The 24-month results indicate that, in routine clinical practice, a proactive IVT-AFL regimen achieves functional improvements in patients with treatment-naïve nAMD. The proportion of patients achieving ≥ 70 letters at M24 increased, and patients with baseline BCVA ≥ 70 letters maintained vision regardless of the followed IVT-AFL label. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03939767. A video abstract is available for this article. Supplementary file2 (MP4 364624 KB).
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Affiliation(s)
- Jean-François Korobelnik
- Service d'Ophtalmologie, CHU Bordeaux, Bordeaux, France.
- University of Bordeaux, INSERM, BPH, UMR1219, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Varun Chaudhary
- Hamilton Regional Eye Institute, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paul Mitchell
- Westmead Institute for Medical Research-University of Sydney, Sydney, NSW, Australia
| | - Se Woong Kang
- Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ramin Tadayoni
- Ophthalmology Department, Université Paris Cité, AP-HP, Lariboisière and Saint Louis Hospitals, Paris, France
- Ophthalmology Department, Fondation Adolphe de Rothschild Hospital, 25-29 Rue Manin, Paris, France
| | | | | | - Xin Zhang
- Bayer Consumer Care AG, Basel, Switzerland
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10
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Dalai R, Bedant SS, Rout R, Panda BB. A Prospective Observational Study on Clinical Profile and Visual Outcomes in Neovascular Age-Related Macular Degeneration. Cureus 2024; 16:e52731. [PMID: 38384637 PMCID: PMC10880741 DOI: 10.7759/cureus.52731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Background and objectives Over the years, several treatment options have been developed for neovascular age-related macular degeneration (AMD), the most notable being intravitreal injections of anti-vascular endothelial growth factor drugs. The rationale for treating neovascular AMD is to preserve and improve central vision, enhance the quality of life for affected individuals, stabilize or improve vision, and prevent further structural damage to the macula. The objective of the present study was to evaluate the clinical course of different disease types of neovascular age-related macular degeneration and their treatment response to anti-vascular endothelial growth factor (anti-VEGF) injections. Methods This prospective observational study was conducted at a tertiary care referral hospital in Eastern India during October 2019 and September 2021. Patients diagnosed with neovascular AMD attending our Outpatient department and retina clinic were recruited for the study. An experienced ophthalmologist examined all patients, meeting the inclusion criteria. The clinical profile, including initial best corrected visual acuity (BCVA), ophthalmoscopic, fluorescein angiographic, and optical coherence tomography (OCT) findings of different patterns of neovascular AMD, were collected and analyzed. Patients were subjected to intravitreal Ranibizumab every month for three months and then on a when-required basis. Visual outcomes were recorded at each follow-up, and a comparison was done between initial and final visual acuity. Descriptive statistics were used for analysis, with p< 0.05 taken as statistically significant. Results A total of 72 patients were included in the study. Fundus fluorescein angiography revealed that 52.78% were classic, 15.28% were minimally classic, and 31.94% were of occult variety. 41.66% of lesions were subfoveal in location, 47.22% were juxtafoveal, and 11.11% lesions were extrafoveal in location. The mean BCVA was Log MAR (Logarithm of the Minimum Angle of Resolution) 1.061±0.25. The average number of intravitreal Ranibizumab injections given to each eye was five. BCVA of patients after the third injection was log MAR 0.818±0.296. There was a significant improvement in mean BCVA from baseline 1.061±0.254 to 0.787±0.317 after the study (p-valve: p<0.05). After the first injection, 49 patients (68.05%) experienced an initial improvement of at least one line, 20 patients (27.77%) did not exhibit any improvement, and 3 patients (4.16%) had a decline of one line in Snellen's visual acuity chart. Over the follow-up period,10 showed improvement in 1 line in the Snellen chart after subsequent injection. At the end of the study, six patients showed no change, and four patients showed deterioration after the completion of injections. No adverse events were noted during the study period. Conclusions Intravitreal Ranibizumab is effective in improving visual outcomes in treatment-naïve individuals with neovascular age-related macular degeneration. The decision for repeat intravitreal anti-VEGF injection should be based on OCT findings of subretinal fluid, pigment epithelial detachment, and cystoid macular edema as an indicator of disease activity. This can also lessen the number of intravitreal injections and morbidity in these patients.
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Affiliation(s)
- Ramamani Dalai
- Ophthalmology, Fakir Mohan Medical College and Hospital, Balasore, IND
| | - Snigdha S Bedant
- Ophthalmology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Rajashree Rout
- Ophthalmology, Saheed Laxman Nayak Medical College and Hospital, Koraput, IND
| | - Bijnya B Panda
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, IND
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Leroux P, Agard E, Billant J, Levron A, Bouvarel H, Badri Y, Douma I, Pradat P, Dot C. Long Intervals between Intravitreal Injections Using a Treat-and-Extend Protocol in a Real-Life Context in AMD: The LIRE Study. Ophthalmologica 2023; 247:44-57. [PMID: 38104545 PMCID: PMC10836925 DOI: 10.1159/000535806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The aim of the study was to assess the outcome of long treat-and-extend (TE) anti-VEGF intravitreal injection (IVI) intervals (≥every 12 weeks [Q12W]) in neovascular age-related macular degeneration (nAMD). The aims of this retrospective study were to determine the proportion of nAMD eyes treated ≥ Q12W, to analyze their longitudinal, functional, and anatomical outcomes, and to compare functional and anatomical outcomes between eyes that rapidly versus slowly reached a Q12W regimen and between eyes directly treated with versus initiating lately the TE regimen. METHODS All patients receiving IVIs for nAMD were screened. The longitudinal, functional, and anatomical characteristics of Q12W-treated eyes were reported at different timepoints. RESULTS Ninety-one eyes were included (38% of our total nAMD cohort). The mean TE regimen time to reach a Q12W interval was 20.1 ± 16.2 months. During this time, a mean number of 12.1 ± 9.3 IVIs were needed. The mean best-corrected visual acuity was 68 letters at the time of diagnosis and was maintained (p > 0.05). Eyes that rapidly reached a Q12W interval had a shorter follow-up before TE regimen initiation (p = 0.04) and received fewer IVIs (p = 0.02) than eyes that slowly reached a Q12W interval. Eyes directly treated with the TE regimen reached a Q12W interval more rapidly than eyes with late TE initiation. The neovascularization subtype was not a predictor of outcome in TE-treated eyes. CONCLUSION ≥Q12W eyes represent an important part of the nAMD population in our real-life study. No baseline anatomical characteristics were associated with the outcome under a TE regimen, although early TE regimen initiation allowed extending more rapidly the IVI interval.
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Affiliation(s)
- Pierre Leroux
- Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France,
- University Claude Bernard Lyon 1, Villeurbanne, France,
| | - Emilie Agard
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France
| | - Jérémy Billant
- Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France
| | - Antoine Levron
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France
| | - Hugo Bouvarel
- Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, Villeurbanne, France
| | - Yannis Badri
- Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, Villeurbanne, France
| | - Ikrame Douma
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France
| | - Pierre Pradat
- Centre for Clinical Research, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Corinne Dot
- Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France
- French Military Academy of Val-de-Grâce, Paris, France
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12
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Weng CY, Singh RP, Gillies MC, Regillo CD. Optimizing Visual Outcomes in Patients With Neovascular Age-Related Macular Degeneration: the Potential Value of Sustained Anti-VEGF Therapy. Ophthalmic Surg Lasers Imaging Retina 2023; 54:654-659. [PMID: 37956321 DOI: 10.3928/23258160-20231016-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Neovascular age-related macular degeneration (nAMD) leads to irreversible central vision loss if untreated. Frequent administration of anti-vascular endothelial growth factor (anti-VEGF) injections inhibits disease activity with excellent functional and morphological benefits. However, these injections pose a heavy therapeutic burden, and treatment discontinuation is common. Although current anti-VEGF treatment paradigms, such as treat-and-extend, mitigate treatment burden while still leading to acceptable vision outcomes, they fail to sustain initial vision gains for many. Novel longer-acting anti-VEGF therapies may reduce the overall burden on nAMD patients. Gene therapy might offer a paradigm shift by providing continuous expression of anti-VEGF, potentially decreasing treatment requirements and improving long-term vision outcomes. [Ophthalmic Surg Lasers Imaging Retina 2023;54:654-659.].
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13
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Creuzot Garcher CP, Srour M, Baudin F, Dot C, Nghiem-Buffet S, Girmens JF, Collin C, Ponthieux A, Delcourt C. Management of Neovascular Age-Related Macular Degeneration Treatment in France from 2008-2018: The Nationwide LANDSCAPE Study. Ophthalmol Ther 2023; 12:2687-2701. [PMID: 37531029 PMCID: PMC10441869 DOI: 10.1007/s40123-023-00772-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION The aim of this study was to describe the management of neovascular age-related macular degeneration (nAMD) in French patients between 2008 and 2018. METHODS This was a retrospective longitudinal cohort study using exhaustive nationwide health records from the French National Health Information database. Enrollment criteria were adults aged ≥ 50 years, nAMD diagnosis, or reimbursement for nAMD treatments (anti-vascular epithelial growth factor [VEGF] injection or dynamic phototherapy with verteporfin). Exclusion criteria were high myopia, diagnosis of other retinal diseases, and treatments for other macular diseases (dexamethasone implant, laser). Main outcome measures were consumption of medical care and nAMD treatments per calendar year and number of years of follow-up. RESULTS Between 2008 and 2018, we identified 342,961 patients who have been treated for nAMD. Median duration of ophthalmological follow-up exceeded 7 years (90 months). The median annual number of ophthalmology consultations decreased from nine visits in year 1 after treatment initiation to four visits from year 7 onwards. The median duration of nAMD treatment was 10.1 months for all patients, with 48.5% of patients undergoing treatment for < 1 year. Only 24.4% of patients had maintained treatment at year 11. Patients remaining under treatment had a median of four anti-VEGF treatments per year throughout the 10-year study period. Ranibizumab was the more common first-line treatment (67.5% of patients) compared to aflibercept (32.4%). About 20% of patients who initiated treatment switched treatment at least once. CONCLUSIONS LANDSCAPE provides exhaustive nationwide data on the real-world management of nAMD in France over a 10-year period. Further investigation into short treatment duration is required, especially in terms of understanding its relation to visual outcomes.
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Affiliation(s)
| | - Mayer Srour
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, Créteil, France
| | - Florian Baudin
- Department of Ophthalmology, University Hospital, Dijon, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France
| | | | - Jean-Francois Girmens
- Department of Ophthalmology, INSERM-DGOS CIC 1423 , Centre Hospitalier National d'Ophtalmologie (CHNO) des Quinze-Vingts, Paris, France
| | | | - Anne Ponthieux
- Novartis Pharma SAS, 8/10 rue Henri Sainte Claire Deville, CS 40150, 92563, Rueil-Malmaison CEDEX, France.
| | - Cécile Delcourt
- Team LEHA, Bordeaux Population Health Research Center, UMR INSERM 1219, Université de Bordeaux, Bordeaux, France
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Hanson RLW, Airody A, Sivaprasad S, Gale RP. Optical coherence tomography imaging biomarkers associated with neovascular age-related macular degeneration: a systematic review. Eye (Lond) 2023; 37:2438-2453. [PMID: 36526863 PMCID: PMC9871156 DOI: 10.1038/s41433-022-02360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/13/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this systematic literature review is twofold, (1) detail the impact of retinal biomarkers identifiable via optical coherence tomography (OCT) on disease progression and response to treatment in neovascular age-related macular degeneration (nAMD) and (2) establish which biomarkers are currently identifiable by artificial intelligence (AI) models and the utilisation of this technology. Following the PRISMA guidelines, PubMed was searched for peer-reviewed publications dated between January 2016 and January 2022. POPULATION Patients diagnosed with nAMD with OCT imaging. SETTINGS Comparable settings to NHS hospitals. STUDY DESIGNS Randomised controlled trials, prospective/retrospective cohort studies and review articles. From 228 articles, 130 were full-text reviewed, 50 were removed for falling outside the scope of this review with 10 added from the author's inventory, resulting in the inclusion of 90 articles. From 9 biomarkers identified; intraretinal fluid (IRF), subretinal fluid, pigment epithelial detachment, subretinal hyperreflective material (SHRM), retinal pigmental epithelial (RPE) atrophy, drusen, outer retinal tabulation (ORT), hyperreflective foci (HF) and retinal thickness, 5 are considered pertinent to nAMD disease progression; IRF, SHRM, drusen, ORT and HF. A number of these biomarkers can be classified using current AI models. Significant retinal biomarkers pertinent to disease activity and progression in nAMD are identifiable via OCT; IRF being the most important in terms of the significant impact on visual outcome. Incorporating AI into ophthalmology practice is a promising advancement towards automated and reproducible analyses of OCT data with the ability to diagnose disease and predict future disease conversion. SYSTEMATIC REVIEW REGISTRATION This review has been registered with PROSPERO (registration ID: CRD42021233200).
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Affiliation(s)
- Rachel L W Hanson
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Archana Airody
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Sobha Sivaprasad
- Moorfields National Institute of Health Research, Biomedical Research Centre, London, UK
| | - Richard P Gale
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
- Hull York Medical School, University of York, York, UK.
- York Biomedical Research Institute, University of York, York, UK.
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15
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Hujanen P, Ruha H, Lehtonen E, Pirinen I, Huhtala H, Vaajanen A, Syvänen U, Tuulonen A, Uusitalo-Järvinen H. Ten-year real-world outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration using pro re nata regimen. BMJ Open Ophthalmol 2023; 8:e001328. [PMID: 37586826 PMCID: PMC10432647 DOI: 10.1136/bmjophth-2023-001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND/AIMS To analyse long-term outcomes of antivascular endothelial growth factor (anti-VEGF) therapy for the treatment of neovascular age-related macular degeneration (nAMD) using pro re nata (PRN) regimen in a single-centre clinical practice. METHODS All patients receiving intravitreal injection (IVI) for nAMD between 1 January 2008 and 31 December 2020 were searched from electronic medical records. All 3844 treatment-naïve eyes of 3008 patients were included with a total of 50 146 IVIs (87% bevacizumab) administered. Main outcome measures were mean change in visual acuity (VA) from baseline, proportion of eyes within 15 letters of baseline, proportion of eyes with VA ≥20/40 Snellen and ≤20/200 Snellen, number of annual visits and number of annual IVIs. RESULTS The mean baseline VA was 55 Early Treatment Diabetic Retinopathy Study (ETDRS) letters and the mean change in VA from baseline was +2, +2, ±0, -2, -2 and -4 ETDRS letters at year 1, 2, 3, 5, 7 and 10, respectively. Proportions of eyes within 15 letters of baseline were 88%, 87%, 82%, 80%, 76% and 72% at the end of years 1, 2, 3, 5, 7 and 10, respectively. The median number of annual IVI was 6 at years 1-7 and 5 at year 10. The median number of annual total visits was 10 at year 1, 9 at years 2-7 and 8 at year 10, respectively. CONCLUSIONS VA was maintained short-term and long-term with anti-VEGF therapy using PRN treatment regimen.
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Affiliation(s)
- Pekko Hujanen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heikki Ruha
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eemil Lehtonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Inka Pirinen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anu Vaajanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Syvänen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Hannele Uusitalo-Järvinen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Chakraborty D, Mondal S, Sengupta S, Abbas Z, Chandra K, Boral S, Maiti A, Roy S, Mukherjee A, Das A, Chakraborty S, Nag P. Incidence, clinical features, risk factors, and outcomes of Intraocular inflammation following Brolucizumab in Indian eyes - A multicentric study. Indian J Ophthalmol 2023; 71:1979-1985. [PMID: 37203069 PMCID: PMC10391460 DOI: 10.4103/ijo.ijo_2688_22] [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: 05/20/2023] Open
Abstract
Purpose To report the incidence, clinical features, potential risk factors, and outcomes of intraocular inflammation (IOI) following brolucizumab in Indian eyes. Methods All consecutive patients diagnosed with brolucizumab-induced IOI from 10 centers in eastern India between October 2020 and April 2022 were included. Results Of 758 injections given during the study period across centers, 13 IOI events (1.7%) were recorded attributable to brolucizumab. The IOI occurred after the first dose in two eyes (15%) (median 45 days after brolucizumab), second dose in six eyes (46%) (median = 8.5 days), and third dose (39%) in the remaining five eyes (median 7 days). Reinjections of brolucizumab were administered at a median interval of 6 weeks (interquartile range = 4-10 weeks) in the 11 eyes, where IOI occurred after the second or third dose. Eyes that experienced IOI after the third dose had received a significantly greater number of previous antivascular endothelial growth factor injections (median = 8) compared to those who developed it after the first or second dose (median = 4) (P = 0.001). Anterior chamber cells were seen in almost all eyes (n = 11, 85%), while peripheral retinal hemorrhages were seen in two eyes, and one eye showed branch artery occlusion. Two-thirds of patients (n = 8, 62%) recovered with a combination of topical and oral steroids, while remaining recovered with topical steroids alone. Irreversible visual loss was not seen in any eye, and median vision recovered to pre-IOI levels by 3 months' time point. Conclusion Brolucizumab-induced IOI was relatively rare, occurring in 1.7% of eyes, was more common after the second or third injection, especially in those who required frequent reinjections every 6 weeks, and occurred earlier with increasing number of previous brolucizumab injections. Continued surveillance is necessary even after repeated doses of brolucizumab.
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Affiliation(s)
- Debdulal Chakraborty
- Department of Vitreo Retina Services, Disha Eye Hospitals, Barrackpore, Kolkata, West Bengal, India
| | - Soumen Mondal
- Department of Vitreo Retina Services, Disha Eye Hospitals, Barrackpore, Kolkata, West Bengal, India
| | - Sabyasachi Sengupta
- Department of Vitreo-Retina Services, Consultant Vitreoretinal Surgeon, Future Vision Eye Care and Research Centre, Mumbai, Maharashtra, India
| | - Zahir Abbas
- Department of Retina Services, Consultant Vitreoretinal Surgeon, Apollo Gleneagles Medical Centre, Fortis Medical Centre, Kolkata, West Bengal, India
| | - Khushboo Chandra
- Department of Vitreo Retina Services, Disha Eye Hospitals, Barrackpore, Kolkata, West Bengal, India
| | - Subhendu Boral
- Department of Vitreo Retina Services, Disha Eye Hospitals, Barrackpore, Kolkata, West Bengal, India
| | - Aniruddha Maiti
- Department of Vitreo Retina Services, Global Eye Hospitals, Kolkata, West Bengal, India
| | - Sangeeta Roy
- Department of Vitreo Retina Services, Global Eye Hospitals, Kolkata, West Bengal, India
| | - Angshuman Mukherjee
- Department of Vitreo Retina Services, Disha Eye Hospitals, Barrackpore, Kolkata, West Bengal, India
| | - Arnab Das
- Department of Vitreo Retina Services, Disha Eye Hospitals, Barrackpore, Kolkata, West Bengal, India
| | - Somnath Chakraborty
- Deptt of Vitreo-Retina Services, Retina Institute of Bengal, Siliguri, West Bengal, India
| | - Pinaki Nag
- Deptt of Ophthalmology, Diptakshi Eye Surgery and Medical Centre, Hooghly, West Bengal, India
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Bressler NM, Veith M, Hamouz J, Ernest J, Zalewski D, Studnička J, Vajas A, Papp A, Vogt G, Luu J, Matuskova V, Yoon YH, Pregun T, Kim T, Shin D, Oh I, Jeong H, Kim MY, Woo SJ. Biosimilar SB11 versus reference ranibizumab in neovascular age-related macular degeneration: 1-year phase III randomised clinical trial outcomes. Br J Ophthalmol 2023; 107:384-391. [PMID: 34656987 PMCID: PMC9985746 DOI: 10.1136/bjophthalmol-2021-319637] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS To provide longer-term data on efficacy, safety, immunogenicity and pharmacokinetics (PK) of ranibizumab biosimilar SB11 compared with the reference ranibizumab (RBZ) in patients with neovascular age-related macular degeneration (nAMD). METHODS Setting: Multicentre. Design: Randomised, double-masked, parallel-group, phase III equivalence study. Patient population: ≥50 years old participants with nAMD (n=705), one 'study eye'. INTERVENTION 1:1 randomisation to monthly intravitreal injection of 0.5 mg SB11 or RBZ. Main outcome measures: Visual efficacy endpoints, safety, immunogenicity and PK up to 52 weeks. RESULTS Baseline and disease characteristics were comparable between treatment groups. Of 705 randomised participants (SB11: n=351; RBZ: n=354), 634 participants (89.9%; SB11: n=307; RBZ: n=327) completed the study until week 52. Previously reported equivalence in primary efficacy remained stable up to week 52 and were comparable between SB11 and RBZ. The adjusted treatment difference between SB11 and RBZ in full analysis set at week 52 of change from baseline in best-corrected visual acuity was -0.6 letters (90% CI -2.1 to 0.9) and of change from baseline in central subfield thickness was -14.9 µm (95% CI -25.3 to -4.5). The incidence of ocular treatment-emergent adverse events (TEAEs) (SB11: 32.0% vs RBZ: 29.7%) and serious ocular TEAE (SB11: 2.9% vs RBZ: 2.3%) appeared comparable between treatment groups, and no new safety concerns were observed. The PK and immunogenicity profiles were comparable, with a 4.2% and 5.5% cumulative incidence of antidrug antibodies up to week 52 for SB11 and RBZ, respectively. CONCLUSIONS Longer-term results of this study further support the biosimilarity established between SB11 and RBZ.
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Affiliation(s)
- Neil M Bressler
- Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Miroslav Veith
- Department of Ophthalmology, University Hospital Kralovske Vinohrady, Prague, Czech Republic.,Department of Ophthalmology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Hamouz
- Department of Ophthalmology, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,University Hospital Kralovske Vinohrady, Praha, Czech Republic
| | - Jan Ernest
- Department of Ophthalmology, Central Military Hospital, Praha, Czech Republic
| | - Dominik Zalewski
- Diagnostic and Microsurgery Center of the Eye LENS, Olsztyn, Poland
| | - Jan Studnička
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.,University Hospital Hradec Kralove, Hradec Kralove, Královéhradecký, Czech Republic
| | - Attila Vajas
- Department of Ophthalmology, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
| | - András Papp
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Gabor Vogt
- Department of Ophthalmology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - James Luu
- Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado, USA
| | - Veronika Matuskova
- Department of Ophthalmology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,University Hospital Brno, Brno, Czech Republic
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, Songpa-gu, Seoul, South Korea.,University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea
| | - Tamás Pregun
- Department of Ophthalmology, Bajcsy-Zsilinszky Hospital and Clinic, Budapest, Hungary
| | | | | | - Inkyung Oh
- Samsung Bioepis Co Ltd, Incheon, South Korea
| | | | | | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea .,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
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18
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Baumal CR, Sørensen TL, Karcher H, Freitas RL, Becher A, Balez S, Clemens A, Singer M, Kodjikian L. Efficacy and safety of brolucizumab in age-related macular degeneration: A systematic review of real-world studies. Acta Ophthalmol 2023; 101:123-139. [PMID: 36117281 DOI: 10.1111/aos.15242] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/30/2022] [Accepted: 08/19/2022] [Indexed: 12/01/2022]
Abstract
Intravitreally injected anti-vascular endothelial growth factor (anti-VEGF) agents are first-line treatment for neovascular age-related macular degeneration (nAMD). Phase 3 trials demonstrated non-inferiority of anti-VEGF therapy with brolucizumab compared with aflibercept in best corrected visual acuity (BCVA) gains, with superior anatomical outcomes after brolucizumab. The purpose of the review was to summarize real-world efficacy and safety data on brolucizumab in patients with nAMD. The review protocol was registered with PROSPERO (ID: CRD42021290530). We conducted systematic searches in Embase, Medline and key ophthalmology congress websites (19 October 2021). Original reports of efficacy and/or safety in patients receiving brolucizumab to treat nAMD in clinical practice were eligible. The descriptive summary includes reports describing at least 10 brolucizumab-treated eyes. In total, 2907 brolucizumab-treated eyes from 26 studies were included. Outcomes were available for treatment-naive eyes (six studies), eyes switched to brolucizumab from other anti-VEGFs (16 studies), and/or treatment-naive and switch eyes combined (eight studies). Follow-up time points ranged from 4 weeks to 1 year post-brolucizumab initiation. For BCVA, significant improvements compared with brolucizumab initiation were reported in four of six studies in treatment-naive eyes (mean BCVA improvement, range: +3.7 to +11.9 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and in three of 12 studies in switch eyes (range: +9.0 to +15 ETDRS letters) (all p < 0.05); remaining studies reported no significant post-brolucizumab BCVA changes. For central subfield thickness (CST), improvements post-brolucizumab initiation were reported in all six studies in treatment-naive eyes (mean CST improvement, range: -113.4 to -150.1 μm) and in eight of 11 studies in switch eyes (range: -26 to -185.7 μm) (all p < 0.05). The 14 studies reporting on intraretinal, subretinal and/or total fluid observed improvements post-brolucizumab initiation. The four studies comparing treatment intervals observed extension of the interval between injections after switching to brolucizumab from other anti-VEGFs. Incidence of intraocular inflammation ranged from 0% to 19%. In conclusion, real-world efficacy and safety data concur with brolucizumab pivotal trials. Additionally, reduction of disease activity in anti-VEGF switch eyes was demonstrated by fluid reduction and/or visual acuity gain, along with prolongation of the interval between injections.
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Affiliation(s)
- Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Torben Lykke Sørensen
- University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | - Rita L Freitas
- Novartis Farma - Produtos Farmacêuticos, S.A., Porto Salvo, Portugal
| | | | | | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Singer
- University of Texas Health Science Center and Medical Center Ophthalmology, San Antonio, Texas, USA
| | - Laurent Kodjikian
- University of Lyon and Croix-Rousse University Hospital UCBL, INSA Lyon, CNRS, MATEIS, UMR5510, Hospices Civils de Lyon, Lyon, France
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19
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Gale RP, Finger RP, Eldem B, Aslam T, Barratt J, Daien V, Kodjikian L, Loewenstein A, Okada M, Wong TY, Sylvanowicz M, Rodríguez FJ. The management of neovascular age-related macular degeneration: A systematic literature review of patient-reported outcomes, patient mental health and caregiver burden. Acta Ophthalmol 2023; 101:e26-e42. [PMID: 35790079 PMCID: PMC10084380 DOI: 10.1111/aos.15201] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this systematic literature review was to describe patient-reported outcomes, mental health and caregiver burden in patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents in routine clinical practice. METHODS Electronic searches were conducted in Embase and MEDLINE according to pre-defined criteria. RESULTS Of 856 records identified, 63 met inclusion criteria. Depression or depressive symptoms were reported in up to 42% of patients with nAMD. Of 25/63 (40%) studies evaluating quality of life (QoL) and using various tools, eight studies reported composite National Eye Institute Visual Functioning Questionnaire scores following anti-VEGF treatment. Of these, seven reported a statistically significant improvement at the earliest time point measured (Month 3-12) and approximately 50% reported sustained QoL benefits at 12 months. In studies comparing the attributed or different regimens, the most important factor from the patient's perspective was the likelihood that a particular regimen would maintain vision. There was a preference towards treat and extend, which was associated with a perceived reduction in patient and caregiver burden, compared to fixed dosing. CONCLUSIONS A coordinated holistic approach to patient care is key to optimizing patient well-being as well as visual outcomes. Further research regarding the patient-reported impact of nAMD management outside the trial setting (particularly international longitudinal studies) is warranted. Standardization of QoL studies would assist in establishing whether sustained QoL improvement, rather than prevention of QoL decline, should be a realistic expectation of treatment of nAMD in the longer term.
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Affiliation(s)
- Richard P Gale
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Tariq Aslam
- Manchester Royal Eye Hospital, Manchester, UK.,University of Manchester, Manchester, UK
| | - Jane Barratt
- International Federation on Ageing, Toronto, ON, Canada
| | - Vincent Daien
- Department of Ophthalmology, University Hospital of Montpellier, Montpellier, France
| | - Laurent Kodjikian
- University of Lyon, Lyon, France.,Croix-Rousse University Hospital, Lyon, France
| | - Anat Loewenstein
- Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mali Okada
- Royal Victorian Eye and Ear Hospital, Melbourne, Vic., Australia
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | | | - Francisco J Rodríguez
- Department of Ophthalmology, Fundación Oftalmológica Nacional and Universidad del Rosario School of Medicine, Bogotá, Colombia
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20
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Choi M, Kim SW, Yun C, Oh JH, Oh J. Predictive role of optical coherence tomography angiography for exudation recurrence in patients with type 1 neovascular age-related macular degeneration treated with pro-re-nata protocol. Eye (Lond) 2023; 37:34-41. [PMID: 34992249 PMCID: PMC9829809 DOI: 10.1038/s41433-021-01879-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/10/2021] [Accepted: 11/25/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES We sought to identify the consecutive changes and predictive features for exudation recurrence in macular neovascularization (MNV) using optical coherence tomography angiography (OCTA) in type 1 neovascular age-related macular degeneration (NVAMD). METHODS A total of 291 OCTA images in consecutive visit of 45 patients newly diagnosed with type 1 NMV and treated with three loading intravitreal anti-vascular endothelial growth factor injections (IVIs) and a pro-re-nata (PRN) therapy regimen were analysed. Quantitative features of OCTA included the MNV area, MNV length, total number of endpoints (open-ended vessels) and junctions (internal branching) using AngioTool. Two subgroups were divided according to exudation recurrence time from the third IVI (group 1: ≤3 months vs. group 2: >3 months). RESULTS The area, length, number of total junctions, and endpoints decreased during three loading IVIs and increased at exudation recurrence (all p < 0.05). In a subgroup analysis of consecutive OCTA images, the number of total endpoints increased at two months prior to exudate recurrence in group 2 (the late recurrence group, p = 0.020). A higher total number of endpoints of MNV at baseline were found to be related with group 1 (early recurrence, p = 0.020 and 0.012 in univariate and multivariate regression analyses). CONCLUSIONS The MNV with higher open-ended vessels at the lesion periphery at baseline might be expected to show earlier recurrence of exudation after loading IVIs. By observing the number of open-ended vessels in consecutive OCTA images, exudation recurrence could be predicted.
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Affiliation(s)
- Mihyun Choi
- Department of Ophthalmology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Seong-Woo Kim
- Department of Ophthalmology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Cheolmin Yun
- Department of Ophthalmology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Jong-Hyun Oh
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University Anam Hospital, 145, Anam-ro, Seongbuk-gu, Seoul, Republic of Korea
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21
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Holz FG, Abreu-Gonzalez R, Bandello F, Duval R, O'Toole L, Pauleikhoff D, Staurenghi G, Wolf A, Lorand D, Clemens A, Gmeiner B. Does real-time artificial intelligence-based visual pathology enhancement of three-dimensional optical coherence tomography scans optimise treatment decision in patients with nAMD? Rationale and design of the RAZORBILL study. Br J Ophthalmol 2023; 107:96-101. [PMID: 34362776 PMCID: PMC9763175 DOI: 10.1136/bjophthalmol-2021-319211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/RATIONALE Artificial intelligence (AI)-based clinical decision support tools, being developed across multiple fields in medicine, need to be evaluated for their impact on the treatment and outcomes of patients as well as optimisation of the clinical workflow. The RAZORBILL study will investigate the impact of advanced AI segmentation algorithms on the disease activity assessment in patients with neovascular age-related macular degeneration (nAMD) by enriching three-dimensional (3D) retinal optical coherence tomography (OCT) scans with automated fluid and layer quantification measurements. METHODS RAZORBILL is an observational, multicentre, multinational, open-label study, comprising two phases: (a) clinical data collection (phase I): an observational study design, which enforces neither strict visit schedule nor mandated treatment regimen was chosen as an appropriate design to collect data in a real-world clinical setting to enable evaluation in phase II and (b) OCT enrichment analysis (phase II): de-identified 3D OCT scans will be evaluated for disease activity. Within this evaluation, investigators will review the scans once enriched with segmentation results (i.e., highlighted and quantified pathological fluid volumes) and once in its original (i.e., non-enriched) state. This review will be performed using an integrated crossover design, where investigators are used as their own controls allowing the analysis to account for differences in expertise and individual disease activity definitions. CONCLUSIONS In order to apply novel AI tools to routine clinical care, their benefit as well as operational feasibility need to be carefully investigated. RAZORBILL will inform on the value of AI-based clinical decision support tools. It will clarify if these can be implemented in clinical treatment of patients with nAMD and whether it allows for optimisation of individualised treatment in routine clinical care.
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Affiliation(s)
- Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Rodrigo Abreu-Gonzalez
- Department of Ophthalmology, University Hospital of La Candelaria, Santa Cruz de Tenerife, Spain
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, University Vita Salute Hospital San Raffaele, Milano, Italy
| | - Renaud Duval
- Department of Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Louise O'Toole
- Department of Ophthalmology, Bon Secours Hospital Dublin, Dublin, Ireland
| | | | - Giovanni Staurenghi
- Dipartimento di Scienze Cliniche Luigi Sacco, Eye Clinic, University of Milan, Milan, Italy
| | - Armin Wolf
- Department of Ophthalmology, University of Ulm, Ulm, Germany
| | | | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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22
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Talks SJ, Daien V, Mitchell P, Aslam T, Barratt J, Biberger A, Lamoureux EL, Hirst C, Sylvanowicz M, Finger RP. The Patient Voice in Neovascular Age-Related Macular Degeneration: Findings from a Qualitative Study. Ophthalmol Ther 2022; 12:561-575. [PMID: 36525220 PMCID: PMC9756919 DOI: 10.1007/s40123-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Visual impairment resulting from diseases such as neovascular age-related macular degeneration (nAMD) may cause behavioural, environmental, psychological, and logistical challenges that could act as barriers to effective uptake and sustainability of treatment with anti-vascular endothelial growth factor agents (anti-VEGFs). Understanding emotions and experiences of patients with nAMD may help inform the determinants of adherence, and could contribute to improvements in ophthalmic outcomes and quality of life. METHODS Seventeen patients with nAMD receiving anti-VEGF injections were enrolled from three clinics: one each in France (n = 5), Germany (n = 6), and the UK (n = 6). Patients' health information and treatment characteristics were collected. Individual phone interviews were conducted by experienced health care interviewers. Transcripts were analysed thematically. RESULTS Patients (53% female) had a mean age of 77 years. Bilateral anti-VEGF injections were received by 24% (n = 4); and most (76%, n = 13) were adherent to their treatment. Patient emotions at diagnosis ranged from happiness at learning about the treatment for nAMD to being terrified of receiving an injection in the eye. Most patients mentioned feeling anxious and fearful before their first injection despite receiving reassurance. After the first injection, these feelings and apprehension abated for many, but not all. With the goal of maintaining the best possible vision, few (24%, n = 4) patients reported more than one missed appointment, and most had never considered stopping treatment. No patient reported additional assistance beyond family support; however, many had difficulties with recreational and domestic activities and had developed coping strategies. CONCLUSION This study provides insights on patients' emotions related to their experience of nAMD and its management, highlighting the varying experiences between individuals. It shows the importance of the patient's voice when considering patient care and management, and how the nature and timing of interventions can improve the experience of living with and managing nAMD.
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Affiliation(s)
- S. James Talks
- grid.420004.20000 0004 0444 2244Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vincent Daien
- grid.157868.50000 0000 9961 060XDepartment of Ophthalmology, University Hospital of Montpellier, Montpellier, France
| | - Paul Mitchell
- grid.1013.30000 0004 1936 834XUniversity of Sydney (Westmead Institute for Medical Research), Sydney, NSW Australia
| | - Tariq Aslam
- grid.416375.20000 0004 0641 2866Manchester Royal Eye Hospital, Manchester, UK ,grid.5379.80000000121662407University of Manchester, Manchester, UK
| | - Jane Barratt
- grid.511577.00000 0001 0942 4326International Federation on Ageing, Toronto, ON Canada
| | | | - Ecosse L. Lamoureux
- grid.272555.20000 0001 0706 4670Singapore Eye Research Institute, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - Ceri Hirst
- grid.483721.b0000 0004 0519 4932Bayer Consumer Care AG, Basel, Switzerland
| | | | - Robert P. Finger
- grid.10388.320000 0001 2240 3300Department of Ophthalmology, University of Bonn, Bonn, Germany
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23
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Cicinelli MV, Torrioli E, La Franca L, Agrawal H, Barthelmes D, Chhablani J, Chowers I, Foa N, Goldstein M, Mansour A, Muhammed RP, Sivaprasad S, Vilela MAP, Zweifel S, Bandello F, Battaglia Parodi M. Incidence and Risk Factors of Visual Impairment in Patients with Angioid Streaks and Macular Neovascularization. Ophthalmol Retina 2022; 7:431-440. [PMID: 36503161 DOI: 10.1016/j.oret.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To estimate the incidence and risk factors of visual impairment and complications in eyes with macular neovascularization (MNV) because of angioid streaks (ASs). DESIGN Longitudinal multicenter retrospective cohort study. SUBJECTS Patients with AS-associated MNV treated with anti-VEGF agents and a follow-up of > 3 months. METHODS Clinical and MNV characteristics were collected at baseline. Visual acuity (VA) values and the presence of atrophy or fibrosis were collected at each visit. MAIN OUTCOME MEASURES Rate of VA change over time and associated factors; the incidence rate of moderate-to-severe visual impairment (MSVI) and blindness and hazard ratio (HR) of candidate risk factors for MSVI; the incidence rate of fibrosis and macular atrophy. RESULTS Overall, 84 eyes of 66 patients (39 men, 58%) with a mean (standard deviation) age of 55.7 (13.8) years were followed for a mean (standard deviation) of 67.7 (48.5) months. The median number of anti-VEGF doses per eye was 13. The average rate (95% confidence interval [CI]) of visual loss was +0.04 (0.02-0.06) logarithm of the minimum angle of resolution/year (P < 0.001); the visual loss was faster in nonnaive eyes (P = 0.007) and those with better baseline VA (P < 0.001); it was slower in eyes with pattern dystrophy-like features (P = 0.04). The incidence rates (95% CI) of MSVI and blindness were 10.4 (6.88-15)/100-eye-years and 2.33 (1.12-4.29)/100-eye-years. A higher number of injections (HR [95% CI] = 0.45 [0.19-0.94] for receiving ≥ 13 injections vs. < 13; P = 0.03) was protective against MSVI. The incidence rates (95% CI) of fibrosis and macular atrophy were 24.1 (17.5-32.3)/100-eye-years and 14.3 (10.1-19.6)/100-eye-years. CONCLUSIONS Eyes with MNV-related AS had a high rate of visual impairment and propensity to macular fibrosis and atrophy. A higher number of injections yielded better chances of maintaining good VA, suggesting the need for intensive treatment. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Edoardo Torrioli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Lamberto La Franca
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Hitesh Agrawal
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Itay Chowers
- Hadassah Medical Center, and the Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nastasia Foa
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Michaella Goldstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | | | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Manuel A P Vilela
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Battaglia Parodi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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24
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Pastor-Pascual F, Pastor-Pascual R, Gálvez-Perez P, Dolz-Marco R, Gallego-Pinazo R. Use of Artificial Tears in Patients Undergoing Treatment with Anti-VEGF Intravitreal Injections. Clin Ophthalmol 2022; 16:3959-3972. [PMCID: PMC9719699 DOI: 10.2147/opth.s391082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose To analyze the use of artificial tears in patients undergoing treatment with anti-vascular endothelial growth (anti-VEGF) intravitreal injections. Methods Thirty-four eyes undergoing anti-VEGF treatment were analyzed. Each patient underwent a subjective and objective evaluation of the ocular surface, using the Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ)-5, tear meniscus height (TMH), first and average non-invasive Keratograph Break-Up Time (NIKBUT), bulbar conjunctival redness, meibography and the Vision Break-Up Time (VBUT). Patients attended 5 visits (days 0, 7, 30, 37, and 60). All patients continued with their intravitreal injection treatment during the study (days 0, 30, and 60). Patients did not receive any artificial tear treatment during the first month of the study, and at the baseline visit they were randomly assigned to one of two study groups to receive either the Systane Hydration or the Viscofresh 10mg/mL formulation. Patients were instructed to instill one drop of the assigned study treatment 3 times a day for 30 days during the second month of the study. Results According to the Mixed Models for Repeated Measures analysis, there is not enough statistical evidence for any of the parameters examined to determine significant differences between being treated with artificial tears and not being treated (p > 0.05). There is, however, a tendency toward improved outcomes in some parameters when artificial tears were used. OSDI, DEQ-5, TMH, and meibography were not affected by either the type of artificial tear used or by the time (from day 30 to day 60; p > 0.05), but the NIKBUT and VBUT values increased over time during this period regardless of which treatment the patient was receiving. Conclusion The use of artificial tears may help to keep the tear film stable Future studies with larger samples should be conducted to elucidate whether the tendency reported in our study becomes significant.
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Affiliation(s)
- Francisco Pastor-Pascual
- Anterior Segment Department, Valencia, Spain,Correspondence: Francisco Pastor-Pascual, Clínica Oftalvist, Valencia, Spain, Tel +34 963 51 33 04, Email
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Intravitreal aflibercept for the treatment of patients with neovascular age-related macular degeneration in routine clinical practice in Latin America: the AQUILA study. Int J Retina Vitreous 2022; 8:76. [PMID: 36258240 PMCID: PMC9579549 DOI: 10.1186/s40942-022-00425-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AQUILA (NCT03470103) was a prospective, observational, 12-month cohort study evaluating treatment patterns, clinical effectiveness, and safety of intravitreal aflibercept (IVT-AFL) in patients from Latin America with neovascular age-related macular degeneration (nAMD). METHODS Treatment-naïve and previously treated (switching to IVT-AFL) patients (aged ≥ 55 years) were enrolled from March 2018, with a primary completion date of September 2020, from Argentina, Colombia, Costa Rica, and Mexico. Patients received IVT-AFL in a routine clinical practice setting. RESULTS Of 274 patients in the full analysis set, 201 were treatment-naïve and 73 had received previous treatment. The mean ± standard deviation number of IVT-AFL injections received by month 12 was 4.2 ± 1.9 (treatment-naïve) and 5.2 ± 2.7 (previously treated). The median duration from diagnosis to IVT-AFL treatment was 1.2 months (treatment-naïve) and 19.5 months (previously treated). Mean best-corrected visual acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS] letters) improved from baseline to month 12 by + 5.2 ± 18.3 (treatment-naïve; baseline: 48.2 ± 23.5) and + 3.1 ± 15.3 letters (previously treated; baseline: 47.7 ± 21.4). CONCLUSION AQUILA is the first study to assess the use of IVT-AFL in routine clinical practice in Latin America. Mean BCVA and other visual acuity outcomes improved in both treatment groups, despite many patients not receiving the IVT-AFL label-recommended regimen of three initial monthly doses, or seven or more injections in 12 months. Patients who did receive the label-recommended number of injections had numerically greater improvements in visual acuity outcomes. Patients with nAMD treated regularly and more frequently with IVT-AFL, therefore, have the potential to achieve outcomes consistent with those observed in interventional studies. TRIAL REGISTRATION Clinicaltrials.gov, NCT03470103. Registered February 5, 2018, https://clinicaltrials.gov/ct2/show/NCT03470103.
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Kim JH, Sagong M, Woo SJ, Kim YC, Cho H, Lee YH, Byon I, Jo YJ, Chin HS, Lee Y, Chae JE, Kang SW. A real-world study assessing the impact of retinal fluid on visual acuity outcomes in patients with neovascular age-related macular degeneration in Korea. Sci Rep 2022; 12:14166. [PMID: 35986074 PMCID: PMC9391430 DOI: 10.1038/s41598-022-18158-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/05/2022] [Indexed: 11/22/2022] Open
Abstract
To evaluate the real-world treatment outcomes in patients with neovascular age-related macular degeneration (nAMD) in Korea, focusing on retinal fluid resolution. This multi-institutional retrospective chart review study, analyzed medical records of patients with nAMD (age ≥ 50 years) who received their first anti-vascular endothelial growth factor (VEGF) treatment in ophthalmology clinics across South Korea between January 2017 and March 2019. The primary endpoint was the proportion of patients with retinal fluid after 12 months of anti-VEGF treatment. The association between fluid-free period and VA gains was also evaluated. A total of 600 patients were enrolled. At baseline, 97.16% of patients had retinal fluid; after 12 months of anti-VEGF treatment, 58.10% of patients had persistent retinal fluid. VA improvements were relatively better in patients with absence of retinal fluid compared with presence of retinal fluid (+ 12.29 letters vs. + 6.45 letters at month 12; P < .0001). Longer duration of absence of retinal fluid over first 12 months correlated with better VA gains at month 12 (P < .01). More than half of the study patients with nAMD had retinal fluid even after 12 months of treatment with their current anti-VEGF. Presence of retinal fluid was associated with relatively worse VA outcomes.
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Validation of an automated fluid algorithm on real-world data of neovascular AMD over five years. Retina 2022; 42:1673-1682. [DOI: 10.1097/iae.0000000000003557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bakri SJ, Karcher H, Andersen S, Souied EH. Anti-VEGF treatment discontinuation and interval in neovascular age-related macular degeneration in the US. Am J Ophthalmol 2022; 242:189-196. [PMID: 35738393 DOI: 10.1016/j.ajo.2022.06.005] [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: 02/10/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the association between treatment interval and likelihood of anti-vascular endothelial growth factor (anti-VEGF) discontinuation among patients with neovascular age-related macular degeneration (nAMD) in a real-world setting US. DESIGN Retrospective clinical cohort study. METHODS Health insurance claims data from the IBM MarketScan® Commercial and Medicare Supplemental databases were retrospectively reviewed to identify adults with nAMD who received anti-VEGF for the first time between 1 January 2011 and 30 June 2020. The proportion of discontinued patients was analyzed using Kaplan-Meier curves. Cox proportional hazards models were used to examine the association between treatment intervals at 24 months and anti-VEGF discontinuation. RESULTS The analysis included 8,167 patients on continuous, unilateral anti-VEGF treatment for at least 24 months. Baseline demographics and clinical characteristics were well balanced between treatment interval groups. The overall rate of discontinuation from 24 months until 60 months after treatment initiation was 30.4%. At 60 months, patients on shorter treatment intervals were more likely to remain on treatment than those on longer intervals, ranging from 76.8% (4-week interval group) to 60.6% (>12-week interval group) and corresponding to a 28% lower likelihood (HR [SE] 0.72 [0.12], p<0.01) and 55% higher likelihood of discontinuing treatment (HR [SE] 1.55 [0.07], p<0.01), respectively, compared with the 8-week group. CONCLUSIONS nAMD patients on longer anti-VEGF treatment intervals at 24 months had consistently higher discontinuation rates than patients on shorter intervals in the following years. This highlights the need to support and educate patients on long treatment intervals to continue with their treatment.
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Affiliation(s)
- Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
| | | | | | - Eric H Souied
- Department of Ophthalmology, Université Paris-Est Créteil, Paris, France
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Comparative Efficacy of Brolucizumab in the Treatment of Neovascular Age-Related Macular Degeneration: A Systematic Literature Review and Network Meta-Analysis. Adv Ther 2022; 39:3425-3448. [PMID: 35678996 PMCID: PMC9309118 DOI: 10.1007/s12325-022-02193-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
Introduction A systematic literature review (SLR) and network meta-analysis (NMA) were conducted to evaluate the comparative efficacy of brolucizumab relative to other anti-vascular endothelial growth factor (VEGF) treatments for neovascular age-related macular degeneration (nAMD) at 1 and 2 years, and overall safety and injection frequency of each treatment. Methods An SLR identifying randomized controlled trials (RCTs) published before June 2021 according to a pre-specified protocol was followed by a Bayesian NMA to compare brolucizumab (6 mg q12w/q8w) against sham and all relevant anti-VEGF regimens. Pooled mean injection frequency, serious adverse ocular events, and discontinuation rates were estimated for each treatment regimen. Results Nineteen RCTs were included in NMA base-case analysis. Brolucizumab (6 mg q12w/q8w) with loading-phase (LP) demonstrated superior best-corrected visual acuity (BCVA) gains to sham both at year 1 (mean difference 16.8 [95%CrI 13.3, 20.4]) and year 2 (mean difference 21.2 [95%CrI 17.4, 25.0]) and was comparable to other anti-VEGFs. Brolucizumab (6 mg q12w/q8w) also showed superior retinal thickness reduction to most comparators including ranibizumab (0.5 mg q4w; year 1 mean difference − 50.1 [95%CrI − 70.3, − 29.8]; year 2 mean difference − 49.5 [95%CrI − 70.8, − 28.6]), aflibercept (2 mg q8w; year 1 mean difference − 39.7 [95%CrI − 52.9, − 26.4]; year 2 mean difference − 35.0 [95%CrI − 49.1, − 21.4]), and faricimab (6 mg q16w/q8w; year 1 mean difference − 27.6 [95%CrI − 42.3, − 12.8]). Brolucizumab (6 mg q12w/q8w) showed similar rates of treatment discontinuation and serious and overall adverse events (both years). At year 2, pooled annualized injection frequency was lowest for brolucizumab (6 mg q12w/q8w) and highest for ranibizumab (0.5 mg q4w) at 5.7 and 11.5 injections annually, respectively. Conclusion Among all licensed anti-VEGF treatments, brolucizumab showed superior reduction in retinal thickness and comparable BCVA gains and discontinuation rates, despite having the lowest injection frequency. The current study provides the most up-to-date, robust comparison of treatments for nAMD. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02193-3.
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Lupidi M, Schiavon S, Cerquaglia A, Fruttini D, Gujar R, Muzi A, Fiore T, Reibaldi M, Chhablani J, Cagini C. Real-world outcomes of anti-VEGF therapy in treatment-naïve neovascular age-related macular degeneration diagnosed on OCT angiography: the REVEAL study. Acta Ophthalmol 2022; 100:e936-e942. [PMID: 34407298 DOI: 10.1111/aos.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/28/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the 12 months visual and anatomical outcomes of treatment-naïve neovascular age-related macular degeneration (nAMD) patients diagnosed by optical coherence tomography angiography (OCT-A) compared with fluorescein angiography (FA)/indocyanine green angiography (ICGA), after anti-VEGF treatment in a real-world setting. METHODS Monocentric, observational, parallel-group study of nAMD patients diagnosed with either FA/ICGA or non-invasive OCT-A methods. Patients were treated with a fixed dosing regimen of intravitreal ranibizumab or aflibercept and followed up for 12 months. Primary outcomes were the 12 months functional (BCVA) and anatomical (CST reduction) gains between the two groups. The stratification of BCVA and CST gains by type of neovascular lesion and by anti-VEGF treatment was also assessed. RESULTS Seventy-two patients received FA/ICGA for the initial diagnosis of nAMD, while 73 received OCT-A. Overall, the mean BCVA gain at 12 months was 11.5 ± 9.6 letters. There were no statistically significant differences between the invasive and non-invasive imaging groups in BCVA gain (p = 0.87) or CST reduction (p = 0.76). No statistically significant outcome differences between different lesion types and the two drugs were observed. CONCLUSION In a real-world setting, nAMD patients diagnosed with OCT-A showed meaningful improvements in visual and anatomical parameters during 12 months of treatment, without significant differences with those diagnosed by invasive modalities.
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Affiliation(s)
- Marco Lupidi
- Department of Medicine and Surgery Section of Ophthalmology S. Maria della Misericordia Hospital University of Perugia Perugia Italy
- Fondazione per la Macula Onlus Di.N.O.G.Mi. University Eye Clinic Genova Italy
- Centre de l’Odéon Paris France
| | - Stefano Schiavon
- Department of Medicine and Surgery Section of Ophthalmology S. Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Alessio Cerquaglia
- Department of Medicine and Surgery Section of Ophthalmology S. Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Daniela Fruttini
- Department of Medicine and Surgery Section of Internal Medicine S. Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Ramkailash Gujar
- Department of Medicine and Surgery Section of Ophthalmology S. Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Alessio Muzi
- Department of Medicine and Surgery Section of Ophthalmology S. Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Tito Fiore
- Department of Medicine and Surgery Section of Ophthalmology S. Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Michele Reibaldi
- Department of Surgical Sciences Eye Clinic Section University of Turin Turin Italy
| | - Jay Chhablani
- UPMC Eye Center University of Pittsburgh Pittsburgh PA USA
| | - Carlo Cagini
- Department of Medicine and Surgery Section of Ophthalmology S. Maria della Misericordia Hospital University of Perugia Perugia Italy
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Zhao X, Seah I, Xue K, Wong W, Tan QSW, Ma X, Lin Q, Lim JYC, Liu Z, Parikh BH, Mehta KN, Lai JW, Yang B, Tran KC, Barathi VA, Cheong KH, Hunziker W, Su X, Loh XJ. Antiangiogenic Nanomicelles for the Topical Delivery of Aflibercept to Treat Retinal Neovascular Disease. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2108360. [PMID: 34726299 DOI: 10.1002/adma.202108360] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 06/13/2023]
Abstract
The traditional intravitreal injection delivery of antivascular endothelial growth factor (anti-VEGF) to the posterior segment of the eye for treatment of retinal diseases is invasive and associated with sight-threatening complications. To avoid such complications, there has been significant interest in developing polymers for topical drug delivery to the retina. This study reports a nanomicelle drug delivery system made of a copolymer EPC (nEPCs), which is capable of delivering aflibercept to the posterior segment topically through corneal-scleral routes. EPC is composed of poly(ethylene glycol) (PEG), poly(propylene glycol) (PPG), and polycaprolactone (PCL) segments. In this study, aflibercept-loaded nEPCs (nEPCs + A) are capable of penetrating the cornea in ex vivo porcine eye models and deliver a clinically significant amount of aflibercept to the retina in laser-induced choroidal neovascularization (CNV) murine models, causing CNV regression. nEPCs + A also demonstrate biocompatibility in vitro and in vivo. Interestingly, this study also suggests that nEPCs have intrinsic antiangiogenic properties. The ability to deliver anti-VEGF drugs and the intrinsic antiangiogenic properties of nEPCs may result in synergistic effects, which can be harnessed for effective therapeutics. nEPCs may be a promising topical anti-VEGF delivery platform for the treatment of retinal diseases.
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Affiliation(s)
- Xinxin Zhao
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Singapore, 138 673, Singapore
| | - Ivan Seah
- Department of Ophthalmology, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119 228, Singapore
| | - Kun Xue
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Singapore, 138 634, Singapore
| | - Wendy Wong
- Department of Ophthalmology, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119 228, Singapore
| | - Queenie Shu Woon Tan
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Singapore, 138 673, Singapore
| | - Xiaoxiao Ma
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Singapore, 138 673, Singapore
| | - Qianyu Lin
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Singapore, 138 634, Singapore
| | - Jason Y C Lim
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Singapore, 138 634, Singapore
| | - Zengping Liu
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Singapore, 138 673, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119 228, Singapore
| | - Bhav Harshad Parikh
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Singapore, 138 673, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119 228, Singapore
| | - Karishma N Mehta
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Singapore, 138 673, Singapore
- Singapore Institute of Technology (SIT), SIT@Dover, 10 Dover Drive, Singapore, 138 683, Singapore
| | - Joel Weijia Lai
- Science, Mathematics and Technology Cluster, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487 372, Singapore
| | - Binxia Yang
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Singapore, 138 673, Singapore
| | - Kim Chi Tran
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119 228, Singapore
| | - Veluchamy Amutha Barathi
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6 Discovery Tower, Singapore, 169856, Singapore
- Academic Clinical Program in Ophthalmology, Duke-NUS Medical School, 8 College Road, Singapore, 169 857, Singapore
| | - Kang Hao Cheong
- Science, Mathematics and Technology Cluster, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487 372, Singapore
- SUTD-Massachusetts Institute of Technology International Design Centre, 8 Somapah Road, Singapore, 487 372, Singapore
| | - Walter Hunziker
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Singapore, 138 673, Singapore
| | - Xinyi Su
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Singapore, 138 673, Singapore
- Department of Ophthalmology, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119 228, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119 228, Singapore
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6 Discovery Tower, Singapore, 169856, Singapore
| | - Xian Jun Loh
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Singapore, 138 634, Singapore
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Yin S, Cui Y, Jiao W, Zhao B. Potential Prognostic Indicators for Patients With Retinal Vein Occlusion. Front Med (Lausanne) 2022; 9:839082. [PMID: 35692537 PMCID: PMC9174432 DOI: 10.3389/fmed.2022.839082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
The second most prevalent cause of retinal vascular disease is retinal vein occlusion (RVO). RVO raises intravascular pressure in the capillary and veins, triggering vessel barrier collapse and subsequent leaking of blood or plasma components into the tissue (edema). Macular edema (ME) is a major complication of RVO that results in significant visual impairment. Laser therapy, intravitreal steroid injections, and vascular endothelial growth factor (VEGF) inhibitors are the major therapeutic techniques. Different therapies reduce ME of RVO and improve visual activity. However, some people have no impact on the resolution of ME, while others have a poor visual prognosis despite full ME cure. There are many investigators who studied the relationship between indicators of various instruments with visual activity. However, a summary of those findings is currently lacking. Therefore, we will focus on the predictive factors of different studies associated with positive visual activity outcomes, which would be very useful and important to help address both treatment expectations and methods for patients with RVO.
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Affiliation(s)
- Shan Yin
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanyan Cui
- Department of Ophthalmology, Liaocheng People’s Hospital, Liaocheng, China
| | - Wanzhen Jiao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Bojun Zhao,
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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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Zarranz-Ventura J, Nguyen V, Creuzot-Garcher C, Verbraak F, O Toole L, Invernizzi A, Viola F, Squirrel D, Barthelmes D, Gillies MC. INTERNATIONAL IMPACT OF THE COVID-19 PANDEMIC LOCKDOWN ON INTRAVITREAL THERAPY OUTCOMES: Fight Retinal Blindness Registry. Retina 2022; 42:616-627. [PMID: 34907129 DOI: 10.1097/iae.0000000000003368] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the impact of the COVID-19 pandemic lockdowns on the outcomes of eyes treated for neovascular age-related macular degeneration, diabetic macular edema, and retinal vein occlusion in eight countries. METHODS A multicenter international database study of 5,782 eyes (4,708 patients) receiving intravitreal antivascular endothelial growth factor injections before, during, and after national lockdowns. The baseline visit was defined as the last visit within 3 months before lockdown, and prelockdown and postlockdown periods were defined as 6 months before and after the lockdown date. RESULTS Eyes with neovascular age-related macular degeneration (n = 4,649) lost vision in all countries in proportion to the reduced number of injections. The mean visual acuity change postlockdown ranged from -0.4 to -3.8 logarithm of the minimum angle of resolution letters, and the median number of injections/visits decreased from 4-5/4-7 to 2-4/2-4 postlockdown. The diabetic macular edema (n = 654) and retinal vein occlusion (n = 479) eyes' mean visual acuity change ranged from -2.8 to +1.7 letters and -1.6 to +0.1 letters, and the median number of injections/visits decreased from 2.5-5/4-6 to 1-3/2-4 and from 3-5.5/4-5 to 1-3.5/2-3.5, respectively. The 6-month dropout rates postlockdown were 20% for neovascular age-related macular degeneration, 27% for diabetic macular edema, and 28% for retinal vein occlusion. CONCLUSION This international study provides estimates of the impact of COVID-19 pandemic lockdown on intravitreal therapy and suggests that prioritizing neovascular age-related macular degeneration eyes seems appropriate.
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Affiliation(s)
- Javier Zarranz-Ventura
- Institut Clínic of Ophthalmology (ICOF), Hospital Clínic, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Vuong Nguyen
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Frank Verbraak
- Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | | | - Alessandro Invernizzi
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia
- Eye Clínic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesco Viola
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - David Squirrel
- Department of Ophthalmology, Greenlane Clinical Centre and District Health Board, Auckland, New Zealand; and
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Mark C Gillies
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia
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Hariprasad SM, Gale RP, Weng CY, Ebbers HC, Rezk MF, Tadayoni R. An Introduction to Biosimilars for the Treatment of Retinal Diseases: A Narrative Review. Ophthalmol Ther 2022; 11:959-982. [PMID: 35278204 PMCID: PMC9114261 DOI: 10.1007/s40123-022-00488-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/16/2022] [Indexed: 12/03/2022] Open
Abstract
Biological therapies have revolutionized the treatment of disease across a number of therapeutic areas including retinal diseases. However, on occasion, such treatments may be relatively more expensive compared to small molecule therapies. This can restrict patient access and treatment length leading to suboptimal clinical outcomes. Several biosimilar candidates of ranibizumab and aflibercept are currently in development and the first biosimilar of ranibizumab received EMA approval in August and FDA approval in September 2021. Biosimilars are biological medicines that are highly similar to an already-approved biological medicine (reference product). The physicochemical and clinical similarity of a biosimilar is determined by a rigorous analytical and clinical program, including extensive pharmacokinetic and pharmacodynamic analysis with phase III equivalence studies where appropriate. These phase III studies are carried out in a patient population that is representative of all of the potential approved therapeutic indications of the originator product and the most sensitive for detecting potential differences between the biosimilar and the reference product. Biosimilars have been used successfully across a wide range of therapeutic areas for the past 15 years where they have achieved substantial cost savings that can be reinvested into healthcare systems without affecting the quality of patient care. The current review provides an introduction to biosimilars with the aim of preparing retinal specialists for discussing these products with their patients.
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Affiliation(s)
- Seenu M Hariprasad
- Department of Ophthalmology and Visual Science, University of Chicago Medicine, Chicago, IL, USA.
| | - Richard P Gale
- Department of Ophthalmology, York Teaching Hospital, University of York, York, UK
| | - Christina Y Weng
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Ramin Tadayoni
- Université de Paris, AP-HP, Lariboisière, Saint Louis and Fondation Adolphe de Rothschild Hospitals, Paris, France
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36
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A model to quantify the influence of treatment patterns and optimize outcomes in nAMD. Sci Rep 2022; 12:2789. [PMID: 35181697 PMCID: PMC8857272 DOI: 10.1038/s41598-022-06362-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/28/2022] [Indexed: 12/14/2022] Open
Abstract
Neovascular age-related macular degeneration (nAMD) is a progressive retinal disease that often leads to severe and permanent vision loss. Early initiation of anti-vascular endothelial growth factor (anti-VEGF) therapy has been shown to preserve vision in nAMD patients. Concurrently, treatment outcomes in real-world are inferior to those reported in clinical trials. The most likely reasons observed are fewer treatment-intensity in routine clinical practice than in clinical trials. The other possibility could be the delay in starting treatment and the re-treatment interval. Although a negative impact of aforementioned parameters seems obvious, quantitative impact measures remain elusive in a real-world setting due to a lack of an ‘optimal treatment’ control group. To overcome this shortcoming, we developed, validated, and applied a model to assess and quantify the impact of anti-VEGF administration variables on visual acuity development in a prospective nAMD patient cohort. The model was further applied to probe the impact of the COVID-19 pandemic on visual progressions in nAMD patients. The presented model paves the way to systematically explore and evaluate realistic interventions in the current treatment paradigm, that can be adopted in routine clinical care.
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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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38
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Tamura H, Akune Y, Hiratsuka Y, Kawasaki R, Kido A, Miyake M, Goto R, Yamada M. Real-world effectiveness of screening programs for age-related macular degeneration: amended Japanese specific health checkups and augmented screening programs with OCT or AI. Jpn J Ophthalmol 2022; 66:19-32. [PMID: 34993676 DOI: 10.1007/s10384-021-00890-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the effectiveness of screening and subsequent intervention for age-related macular degeneration (AMD) in Japan. STUDY DESIGN Best-case-scenario analysis using a Markov model. METHODS The clinical effectiveness and cost-effectiveness of screening for AMD were assessed by calculating the reduction proportion of blindness and the incremental cost-effectiveness ratio (ICER). The Markov model simulation began at screening at the age of 40 years and ended at screening at the age of 90 years. The first-eye and second-eye combined model assumed annual state-transition probabilities in the development and treatment of AMD. Data on prevalence, morbidity, transition probability, utility value, and treatment costs were obtained from previously published reports. Sensitivity analysis was performed to assess the influence of the parameters. RESULTS In the base-case analysis, screening for AMD every 5 years, beginning at age 40 years and ending at age 74 years (reflecting the screening ages of the current Japanese legal "Specific Health Checkups") showed a decrease of 40.7% in the total number of blind patients. The screening program reduced the number of blind people more than did the additional AREDS/AREDS2 formula supplement intake. However, the ICER of screening versus no screening was ¥9,846,411/QALY, which was beyond what people were willing to pay (WTP) in Japan. Sensitivity analysis revealed that neither OCT nor AI improved the ICER, but the scenario in which the prevalence of smoking decreased by 30% improved the ICER (¥4,655,601/QALY) to the level under the WTP. CONCLUSIONS Ophthalmologic screening for AMD is highly effective in reducing blindness but is not cost-effective, as demonstrated by a Markov model based on real-world evidence from Japan.
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Affiliation(s)
- Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
- Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University, Kyoto, Japan.
| | - Yoko Akune
- Graduate School of Health Management, Keio University, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Kawasaki
- Artificial Intelligence Center for Medical Research and Application, Osaka University Hospital, Suita, Japan
| | - Ai Kido
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Tokyo, Japan
| | - Masakazu Yamada
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Japan
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Lu Y, Huang W, Zhang Y, Huang X, Zhang X, Ma H, Ren G, Shi F, Kuang L, Yan S, Luo S, Zhang J, He J, Yang W, Gao Z, Leng Y. Factors for Visual Acuity Improvement After Anti-VEGF Treatment of Wet Age-Related Macular Degeneration in China: 12 Months Follow up. Front Med (Lausanne) 2021; 8:735318. [PMID: 34859005 PMCID: PMC8632047 DOI: 10.3389/fmed.2021.735318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate the treatment solutions and effectiveness of intravitreal ranibizumab (RBZ) or conbercept in patients with wet age-related macular degeneration (wAMD) in a real-life setting in China. Methods: The medical records of 368 patients with wAMD who started RBZ or conbercept treatment between 1 May 2014 and 30 April 2018 were evaluated. All patients were defined on fundus angiography at baseline to determine the subtype of AMD (PCV or CNV). We report visual acuity (VA) and central retinal thickness (CRT) measurements at baseline and 12 months. Results: The average number of anti-VEGF injections was 2.1 ± 1.2. The BCVA improvement of these two groups was similar with a difference of 1.00 letter (95% CI: −1.4~3.4, p = 0.8505). At the end of the study, a BCVA increase of at least 5 letters was determined to be a satisfactory efficacy endpoint. Several factors were related to the possible improvement in the satisfactory efficacy endpoint, including female sex (OR 2.07, 95% CI 1.22~3.51), number of injections (OR 1.40, 95% CI 1.12~1.75) and VA change at the first month (OR 13.75, 95% CI 7.41~25.51). Additionally, some factors were related to the possible reduction in the satisfactory efficacy endpoint, including diabetes (OR 0.27, 95% CI 0.10~0.73) and disease history (OR 0.75, 95% CI 0.57~0.98). Conclusion: Our study demonstrates that anti-VEGF drugs can effectively improve BCVA and reduce CRT in AMD patients. Sex, number of injections, VA change at the first month, diabetes and disease history are the most important factors affecting visual acuity.
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Affiliation(s)
- Yan Lu
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Wenzhi Huang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yuehong Zhang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Xiongfei Huang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Xu Zhang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Haizhi Ma
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Guoliang Ren
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Feng Shi
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Lihui Kuang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Shigang Yan
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Shuke Luo
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Junyan Zhang
- Bothwin Clinical Study Consultant, Redmond, WA, United States
| | - Jingfang He
- Bothwin Clinical Study Consultant, Shanghai, China
| | - Weizhong Yang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zongyin Gao
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yunxia Leng
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
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Kaiser SM, Arepalli S, Ehlers JP. Current and Future Anti-VEGF Agents for Neovascular Age-Related Macular Degeneration. J Exp Pharmacol 2021; 13:905-912. [PMID: 34616189 PMCID: PMC8488047 DOI: 10.2147/jep.s259298] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/06/2021] [Indexed: 12/27/2022] Open
Abstract
Age-related macular degeneration (AMD) is the most common cause of legal blindness in developed countries. Neovascular (ie, wet) AMD is currently managed with intravitreal therapy. Traditional treatments (ie, bevacizumab, ranibizumab, aflibercept) provide high-efficacy therapy but can also require frequent dosing. Newer and future anti-VEGF therapies aim to decrease injection frequency through eitherlonger half life or port-delivery systems (brolucizumab, conbercept, KSI-301, ranibizumab). This review outlines current anti-VEGF treatments and ways by which their duration might be extended.
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Ryu G, Noh D, Moon G, Sagong M. Real-World Outcomes of Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration: A Large-Scale Postmarketing Surveillance in Korea. Clin Ophthalmol 2021; 15:3601-3611. [PMID: 34471345 PMCID: PMC8405230 DOI: 10.2147/opth.s324600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate the efficacy and safety of intravitreal aflibercept (IVT-AFL) in Asian patients with neovascular age-related macular degeneration (nAMD) in a real-world clinical setting. Patients and Methods In this analysis of a prospective, regulatory, postmarketing surveillance study for IVT-AFL, 3115 patients with nAMD were included and followed for 8 months. The mean changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were analyzed using last observation carried forward method. A post hoc subgroup analysis and a multivariate logistic regression analysis were also performed to assess factors related to treatment outcomes. Results Mean BCVA improved from 0.62 to 0.51 logarithm of minimum angle resolution and mean CRT decreased from 383.3 to 289.7 μm, with a mean of 3.4 injections during the 8-month follow-up. In the subgroup analysis, patients who had received 3 initial monthly doses had significantly better anatomical improvements than those treated as needed. Patients with confirmed polypoidal choroidal vasculopathy (PCV) had significantly better anatomical improvements and better visual recovery than those with other types of nAMD. The multivariate regression analysis demonstrated that age, injection number, PCV, and baseline BCVA were significantly associated with higher odds of gaining 3 lines at 8 months, and sex, injection number, PCV, and baseline CRT were associated with CRT ≤250 µm at 8 months. No new safety findings were identified. Conclusion IVT-AFL was effective and well tolerated in a real-world setting with a large number of Asian patients with nAMD. Number of injections and PCV were important determinants for improved treatment outcomes.
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Affiliation(s)
- Gahyung Ryu
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea.,Yeungnam Eye Center, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Donghyoun Noh
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea.,Yeungnam Eye Center, Yeungnam University Hospital, Daegu, Republic of Korea
| | | | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea.,Yeungnam Eye Center, Yeungnam University Hospital, Daegu, Republic of Korea
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42
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Staurenghi G, Bandello F, Viola F, Varano M, Barbati G, Peruzzi E, Bassanini S, Biancotto C, Fenicia V, Furino C, Vadalà M, Reibaldi M, Vujosevic S, Ricci F. Effectiveness of anti-vascular endothelial growth factors in neovascular age-related macular degeneration and variables associated with visual acuity outcomes: Results from the EAGLE study. PLoS One 2021; 16:e0256461. [PMID: 34469431 PMCID: PMC8409622 DOI: 10.1371/journal.pone.0256461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the overall effectiveness of anti-vascular endothelial growth factor (VEGF) therapy in treatment-naïve patients with neovascular age-related macular degeneration (nAMD) in a clinical practice setting. Study design EAGLE was a retrospective, 2-year, cohort observational, multicenter study conducted in Italy that analyzed secondary data of treatment-naïve patients with nAMD. The primary endpoint evaluated the mean annualized number of anti-VEGF injections at Years 1 and 2. The main secondary endpoints analyzed the mean change in visual acuity (VA) from baseline and variables associated with visual outcomes at Years 1 and 2. Results Of the 752 patients enrolled, 745 (99.07%) received the first dose of anti-VEGF in 2016. Overall, 429 (57.05%) and 335 (44.5%) patients completed the 1- and 2-year follow-ups, respectively. At baseline, mean (standard deviation, SD) age was 75.6 (8.8) years and the mean (SD) VA was 53.43 (22.8) letters. The mean (SD) number of injections performed over the 2 years was 8.2 (4.1) resulting in a mean (SD) change in VA of 2.45 (19.36) (P = 0.0005) letters at Year 1 and −1.34 (20.85) (P = 0.3984) letters at Year 2. Linear regression models showed that age, baseline VA, number of injections, and early fluid resolution were the variables independently associated with visual outcomes at Years 1 and 2. Conclusions The EAGLE study analyzed the routine clinical practice management of patients with nAMD in Italy. The study suggested that visual outcomes in clinical practice may be improved with earlier diagnosis, higher number of injections, and accurate fluid resolution targeting during treatment induction.
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Affiliation(s)
- Giovanni Staurenghi
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
- * E-mail:
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Francesco Viola
- Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | | | | | | | - Vito Fenicia
- Faculty of Medicine and Psychology, NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Claudio Furino
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico Consorziale Bari, Bari, Italy
| | - Maria Vadalà
- Biomedicine, Neuroscience and Advanced Diagnostic Department, Unit of Ophthalmology, University of Palermo, Palermo, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | | | - Federico Ricci
- Department Experimental Medicine, Tor Vergata University, Viale Oxford, Roma, Italy
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Ferrara D, Newton EM, Lee AY. Artificial intelligence-based predictions in neovascular age-related macular degeneration. Curr Opin Ophthalmol 2021; 32:389-396. [PMID: 34265783 PMCID: PMC8373444 DOI: 10.1097/icu.0000000000000782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW Predicting treatment response and optimizing treatment regimen in patients with neovascular age-related macular degeneration (nAMD) remains challenging. Artificial intelligence-based tools have the potential to increase confidence in clinical development of new therapeutics, facilitate individual prognostic predictions, and ultimately inform treatment decisions in clinical practice. RECENT FINDINGS To date, most advances in applying artificial intelligence to nAMD have focused on facilitating image analysis, particularly for automated segmentation, extraction, and quantification of imaging-based features from optical coherence tomography (OCT) images. No studies in our literature search evaluated whether artificial intelligence could predict the treatment regimen required for an optimal visual response for an individual patient. Challenges identified for developing artificial intelligence-based models for nAMD include the limited number of large datasets with high-quality OCT data, limiting the patient populations included in model development; lack of counterfactual data to inform how individual patients may have fared with an alternative treatment strategy; and absence of OCT data standards, impairing the development of models usable across devices. SUMMARY Artificial intelligence has the potential to enable powerful prognostic tools for a complex nAMD treatment landscape; however, additional work remains before these tools are applicable to informing treatment decisions for nAMD in clinical practice.
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Affiliation(s)
| | | | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, School of Medicine, Seattle, Washington, USA
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44
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Phan LT, Broadhead GK, Hong TH, Chang AA. Predictors of Visual Acuity After Treatment of Neovascular Age-Related Macular Degeneration - Current Perspectives. Clin Ophthalmol 2021; 15:3351-3367. [PMID: 34408393 PMCID: PMC8364912 DOI: 10.2147/opth.s205147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/28/2021] [Indexed: 12/30/2022] Open
Abstract
Visual acuity is a key outcome measure in the treatment of neovascular age-related macular degeneration (nAMD) using anti-vascular endothelial growth factor agents. Large variations in visual responses between individuals within clinical trials and real-world studies may relate to underlying differences in patient and treatment factors. Most notably, a better baseline visual acuity, younger age and smaller choroidal neovascularization lesion size have been strongly associated with achieving better visual outcomes. In addition, there is emerging evidence for other roles including genetic factors and anatomical variables such as fluid status. Apart from patient-related factors, treatments that favor a higher number of injections tend to provide better visual outcomes. Overall, the identification of predictive factors does not currently play an essential role in the clinical management of patients with nAMD. However, they have allowed for the understanding that early detection, timely management and close monitoring of the disease are required to achieve optimal visual outcomes. Further investigation into predictive factors alongside the development of novel therapeutic agents may one day provide a means to accurately predict patient outcomes. Treatment regimens that offer flexible dosing patterns such as the treat-and-extend strategy currently provide a degree of personalization during treatment.
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Affiliation(s)
- Long T Phan
- Sydney Retina, Sydney, New South Wales, Australia.,Discipline of Orthoptics, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Geoffrey K Broadhead
- Sydney Retina, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Andrew A Chang
- Sydney Retina, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
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Lotery A, Clemens A, Tuli R, Xu X, Shimura M, Nardi M, Ziemssen F, Dunger-Baldauf C, Tadayoni R. Effectiveness and safety of ranibizumab in patients with central retinal vein occlusion: results from the real-world, global, LUMINOUS study. Eye (Lond) 2021; 36:1656-1661. [PMID: 34326500 PMCID: PMC9307792 DOI: 10.1038/s41433-021-01702-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the effectiveness, treatment patterns and long-term safety of ranibizumab 0.5 mg in treatment-naïve patients with central retinal vein occlusion (CRVO) in a real-world setting. Methods LUMINOUS, a 5-year, global, prospective, multicentre, multi-indication, observational, open-label study, recruited treatment naïve or prior treated patients who were treated as per the local ranibizumab label. Here, we report the mean change in visual acuity (VA; Early Treatment Diabetic Retinopathy Study [ETDRS] letters), treatment exposure over year (Y) 1 and 5-year safety in treatment-naïve CRVO patients. Results At baseline, the mean age of treatment-naïve CRVO patients (n = 327) was 68.9 years, with a mean (Standard deviation [SD]) VA of 40.6 (23.9) letters. At Y1, patients (n = 144) had a mean (SD) VA gain from baseline of 10.8 (19.66) letters, with a mean (SD) of 5.4 (2.65) ranibizumab injections. Patients demonstrated mean (SD) VA gains of 2.7 (19.35), 11.6 (20.56), 13.9 (18.08), 11.1 (18.46) and 8.2 (24.86) letters with 1, 2–3, 4–5, 6–8 and >8 ranibizumab injections, respectively. Mean (SD) VA gains at Y1 in patients receiving loading (67.4%) and no loading dose (32.6%) was 11.9 (20.42) and 8.4 (17.99) letters, respectively. Over five years, the incidence of ocular/non-ocular adverse events (AEs) and serious AEs was 11.3%/8.6% and 1.2%/6.7%, respectively. Conclusions These results demonstrate the effectiveness of ranibizumab in treatment-naïve CRVO patients at Y1 with clinically meaningful VA gains and no new safety findings over five years. These findings may help inform routine practice and enable better clinical management to achieve optimal visual outcomes.
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Affiliation(s)
- Andrew Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland. .,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Raman Tuli
- Department of Ophthalmology, University of Ottawa, Ottawa, Canada
| | - Xun Xu
- Department of Ophthalmology, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Masahiko Shimura
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji-shi, Tokyo-To, Japan
| | - Marco Nardi
- Ophthalmology Unit, University of Pisa, Pisa, Italy
| | - Focke Ziemssen
- Department for Ophthalmology, Eberhard Karl University Tübingen, Tübingen, Germany
| | | | - Ramin Tadayoni
- Université de Paris, Ophthalmology Department, AP-HP, Lariboisière, Saint Louis and Fondation Rothschild Hospitals, Paris, France
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Arruabarrena C, Toro MD, Onen M, Malyugin BE, Rejdak R, Tognetto D, Zweifel S, Giglio R, Teus MA. Impact on Visual Acuity in Neovascular Age Related Macular Degeneration (nAMD) in Europe Due to COVID-19 Pandemic Lockdown. J Clin Med 2021; 10:jcm10153281. [PMID: 34362066 PMCID: PMC8348378 DOI: 10.3390/jcm10153281] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
This is a retrospective, multicenter study of consecutive patients with nAMD scheduled for a visit and/or a treatment with an intravitreal injection (IVI) during the 3 months before lockdown in the Ophthalmology Departments of six centers of Europe.The study was conducted on 546 patients, of which 55.13% were females, almost 100% of the patients were White/Caucasian race, and 71.53% of the patients presented a type 1 macular neovascularization (NVM). A total of 62.82% of patients (343 patients) that were on scheduled clinic visits and/or intravitreal injection treatment during the 3 months before the quarantine did not attend either to visit or for treatment during the lockdown. The mean number of injections during the lockdown was significantly reduced. This was followed by a significant reduction in the mean best-corrected visual acuity (BCVA) between the 3 months before the lockdown (mean BCVA of 60.68 ± 19.77 letters) and 6 months after lockdown (mean BCVA of 56.98 ± 22.59 letters). Patients with better BCVA before the lockdown and the ones showing neovascular activity were more likely to attend their scheduled visits and/or IVI treatments. The COVID-19 pandemic and the lockdown have led to a decrease in the number of IVI treatments in patients with nAMD, evidencing a significant vision loss at 6 months.
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Affiliation(s)
- Carolina Arruabarrena
- Department of Ophthalmology, University Hospital of Alcalá de Henares, Universidad de Alcalá, 28802 Alcalá de Henares, Spain;
- Correspondence: ; Tel.: +34-(91)-8878100
| | - Mario Damiano Toro
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.D.T.); (S.Z.)
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, 01815 Warsaw, Poland
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland;
| | - Mehmet Onen
- Department of Ophthalmology, Ankara City Hospital, Ankara 06800, Turkey;
| | - Boris E Malyugin
- S. Fyodorov Eye Microsurgery Federal State Institution, Russian Federation, 127486 Moscow, Russia;
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland;
| | - Danielle Tognetto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (D.T.); (R.G.)
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.D.T.); (S.Z.)
| | - Rosa Giglio
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (D.T.); (R.G.)
| | - Miguel A Teus
- Department of Ophthalmology, University Hospital of Alcalá de Henares, Universidad de Alcalá, 28802 Alcalá de Henares, Spain;
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Kozak I, Gurbaxani A, Safar A, Rao P, Masalmeh A, Assaf H, Farghaly M, Pathak P, Natarajan A, Saffar I. Treatment patterns in patients with age-related macular degeneration and diabetic macular edema: A real-world claims analysis in Dubai. PLoS One 2021; 16:e0254569. [PMID: 34255798 PMCID: PMC8277020 DOI: 10.1371/journal.pone.0254569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To characterize the pattern of approved anti-vascular endothelial growth factor (VEGF) treatments among patients with neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) in the United Arab Emirates (UAE). METHOD This was a retrospective, nonrandomized, observational cohort analysis of the Dubai Real-world Claims Database with a 360-day follow-up period. Adult patients diagnosed with nAMD or DME treated with ranibizumab or aflibercept for the first time were included. The primary objective was to evaluate anti-VEGF treatment patterns with respect to the proportion of patients receiving ranibizumab and aflibercept for nAMD and DME separately. RESULTS Of the 451 patients included in the final study cohort, 83.6% and 16.4% had a diagnosis of DME (ranibizumab: 48.5%; aflibercept: 51.5%) and nAMD (ranibizumab: 40.5%; aflibercept: 59.5%), respectively, at baseline. Treatment frequency of ranibizumab/aflibercept was similar for nAMD (mean: 2.4/2.9 injections; p = 0.2389) with fewer injections in the ranibizumab cohort for DME (mean: 1.9/2.5 injections; p = 0.0002). Most patients received ≤3 anti-VEGF injections during the 360-day follow-up period. The time between consecutive treatments was large (nAMD: 73.6 days/10.5 weeks; DME: 80.5 days/11.5 weeks). Approximately 10%-13.5% of patients switched their anti-VEGF therapy. Most patients (83.8%) had a diabetes diagnosis during the follow-up period. CONCLUSIONS This real-world study provides an initial understanding of anti-VEGF treatment patterns in patients with nAMD and DME in the UAE. Treatment frequency of the 2 anti-VEGF agents assessed was similar in both patient populations. Both treatments were infrequently administered with large dosing intervals.
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Affiliation(s)
- Igor Kozak
- Moorfields Eye Hospitals, Abu Dhabi, United Arab Emirates
| | | | - Ammar Safar
- Moorfields Eye Hospitals, Abu Dhabi, United Arab Emirates
| | - Prasan Rao
- Medcare Eye Centre, Dubai, United Arab Emirates
| | - Amal Masalmeh
- Department of Ophthalmology, Novartis Middle East FZE, Dubai, United Arab Emirates
| | - Hazar Assaf
- Department of Ophthalmology, Novartis Middle East FZE, Dubai, United Arab Emirates
| | - Mohamed Farghaly
- Dubai Health Insurance Corporation, Dubai Health Authority, Dubai, United Arab Emirates
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48
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Schmidt-Erfurth U, Reiter GS, Riedl S, Seeböck P, Vogl WD, Blodi BA, Domalpally A, Fawzi A, Jia Y, Sarraf D, Bogunović H. AI-based monitoring of retinal fluid in disease activity and under therapy. Prog Retin Eye Res 2021; 86:100972. [PMID: 34166808 DOI: 10.1016/j.preteyeres.2021.100972] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022]
Abstract
Retinal fluid as the major biomarker in exudative macular disease is accurately visualized by high-resolution three-dimensional optical coherence tomography (OCT), which is used world-wide as a diagnostic gold standard largely replacing clinical examination. Artificial intelligence (AI) with its capability to objectively identify, localize and quantify fluid introduces fully automated tools into OCT imaging for personalized disease management. Deep learning performance has already proven superior to human experts, including physicians and certified readers, in terms of accuracy and speed. Reproducible measurement of retinal fluid relies on precise AI-based segmentation methods that assign a label to each OCT voxel denoting its fluid type such as intraretinal fluid (IRF) and subretinal fluid (SRF) or pigment epithelial detachment (PED) and its location within the central 1-, 3- and 6-mm macular area. Such reliable analysis is most relevant to reflect differences in pathophysiological mechanisms and impacts on retinal function, and the dynamics of fluid resolution during therapy with different regimens and substances. Yet, an in-depth understanding of the mode of action of supervised and unsupervised learning, the functionality of a convolutional neural net (CNN) and various network architectures is needed. Greater insight regarding adequate methods for performance, validation assessment, and device- and scanning-pattern-dependent variations is necessary to empower ophthalmologists to become qualified AI users. Fluid/function correlation can lead to a better definition of valid fluid variables relevant for optimal outcomes on an individual and a population level. AI-based fluid analysis opens the way for precision medicine in real-world practice of the leading retinal diseases of modern times.
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Affiliation(s)
- Ursula Schmidt-Erfurth
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Gregor S Reiter
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Sophie Riedl
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Philipp Seeböck
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Wolf-Dieter Vogl
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Barbara A Blodi
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA.
| | - Amitha Domalpally
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA.
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Yali Jia
- Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.
| | - David Sarraf
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA.
| | - Hrvoje Bogunović
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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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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50
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Mun Y, Park KH, Park SJ, Woo SJ. Efficacy of anti-vascular endothelial growth factor agents for treating neovascular age-related macular degeneration in vitrectomized eyes. PLoS One 2021; 16:e0252006. [PMID: 34111133 PMCID: PMC8191940 DOI: 10.1371/journal.pone.0252006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/09/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for treatment of neovascular age-related macular degeneration (nAMD) in vitrectomized eyes. METHODS The medical records were reviewed of nAMD patients treated with anti-VEGF agents who previously underwent pars plana vitrectomy (PPV). PPV was performed with complete posterior vitreous detachment induction. RESULTS A total of 44 eyes from 44 patients were included. The mean central foveal thickness (CFT) was 478.50 ± 156.93 μm at baseline, 414.25 ± 143.55 μm (86.6% of baseline) at 1 month after first injection (P < 0.001), and 386.75 ± 141.45 μm (80.8% of baseline) after monthly multiple injections (2.30 ± 1.07; range, 1-5) (P < 0.001). The mean logarithm of the minimum angle of resolution best-corrected visual acuity visual acuity (BCVA) was 0.85 ± 0.57 at baseline, 0.86 ± 0.63 after the first injection, and 0.84 ± 0.64 after monthly multiple injections. BCVA improved in 39.5% at 1 month after first injection and 45.2% at 1 month after monthly multiple injections. In the subgroup analysis, CFT of eyes with the posterior capsule decreased significantly to 85.8% and 79.8% of baseline values at 1 month after the first injection and after monthly multiple injections, respectively. CFT of eyes without the posterior capsule decreased to 91.6% and 87.4% of baseline values at 1 month after the first injection and after monthly multiple injections, respectively, without statistical significance. CONCLUSION Monthly injections of Intravitreal anti-VEGF agents induced favorable anatomical improvement and vision maintenance in vitrectomized eyes with nAMD.
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Affiliation(s)
- Yongseok Mun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Seoul National University Bundang Hospital, Seongnam, South Korea
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