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Cui Z, Zhou W, Chang Q, Zhang T, Wang H, Meng X, Liu Y, Yan H. Cost-Effectiveness of Conbercept vs. Ranibizumab for Age-Related Macular Degeneration, Diabetic Macular Edema, and Pathological Myopia: Population-Based Cohort Study and Markov Model. Front Med (Lausanne) 2021; 8:750132. [PMID: 34926500 PMCID: PMC8676057 DOI: 10.3389/fmed.2021.750132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background: With the advent of aging society of China, fundus diseases related to pathological neovascularization, including age-related macular degeneration (AMD), diabetic macular edema (DME), and pathological myopia (PM), have become an increasingly serious medical and health problems. As effective drugs of the treatment, conbercept and ranibizumab have been commonly used and covered by the national basic medical insurance in China. However, the pharmacoeconomic evaluation of conbercept vs. ranibizumab for DME and PM remains lacking. This study would assess the cost-effectiveness of conbercept and ranibizumab for the treatment of AMD, DME, and PM from the perspective of Chinese payers. Methods: A Markov chain model was constructed based on the visual conditions of the patient indicated by the number of letters in best corrected visual acuity (BCVA). We conducted models based on real-world scenario to calculate the cost per the quality-adjusted life-year (QALY) gained. A 1-year cycle length and a 10-year simulation treatment were applied and the number of injections of conbercept and ranibizumab was assumed to the average number within 10 years. Transition probabilities, costs, utility data, and other parameters were obtained from literature searches. A 3.5% discounting rate was applied for both the costs and utilities. Results: The incremental cost-effectiveness ratios (ICERs) were more favorable for conbercept than ranibizumab in treatment of AMD, DME, and PM, with associated ICER of 66,669 renminbi (RMB), −258,813 RMB, and −373,185 RMB per QALY gained. Compared with ranibizumab, the incremental effectiveness of conbercept in treatment of AMD, DME, and PM was −0.665 QALYs, 0.215 QALYs, and 0.029 QALYs, respectively. The sensitivity analysis showed the same findings, although the ICER is sensitive to the costs of this program. Conclusion: Under the current Chinese healthcare setting, conbercept is suitable and cost-effective in treatment of AMD, DME, and PM compared with ranibizumab.
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Affiliation(s)
- Zhuang Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wei Zhou
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qinxue Chang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Tiantian Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hui Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiangda Meng
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuanyuan Liu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
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Lu Y, Huang W, Zhang Y, Huang X, Zhang X, Ma H, Ren G, Shi F, Kuang L, Yan S, Luo S, Zhang J, He J, Yang W, Gao Z, Leng Y. Factors for Visual Acuity Improvement After Anti-VEGF Treatment of Wet Age-Related Macular Degeneration in China: 12 Months Follow up. Front Med (Lausanne) 2021; 8:735318. [PMID: 34859005 PMCID: PMC8632047 DOI: 10.3389/fmed.2021.735318] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate the treatment solutions and effectiveness of intravitreal ranibizumab (RBZ) or conbercept in patients with wet age-related macular degeneration (wAMD) in a real-life setting in China. Methods: The medical records of 368 patients with wAMD who started RBZ or conbercept treatment between 1 May 2014 and 30 April 2018 were evaluated. All patients were defined on fundus angiography at baseline to determine the subtype of AMD (PCV or CNV). We report visual acuity (VA) and central retinal thickness (CRT) measurements at baseline and 12 months. Results: The average number of anti-VEGF injections was 2.1 ± 1.2. The BCVA improvement of these two groups was similar with a difference of 1.00 letter (95% CI: −1.4~3.4, p = 0.8505). At the end of the study, a BCVA increase of at least 5 letters was determined to be a satisfactory efficacy endpoint. Several factors were related to the possible improvement in the satisfactory efficacy endpoint, including female sex (OR 2.07, 95% CI 1.22~3.51), number of injections (OR 1.40, 95% CI 1.12~1.75) and VA change at the first month (OR 13.75, 95% CI 7.41~25.51). Additionally, some factors were related to the possible reduction in the satisfactory efficacy endpoint, including diabetes (OR 0.27, 95% CI 0.10~0.73) and disease history (OR 0.75, 95% CI 0.57~0.98). Conclusion: Our study demonstrates that anti-VEGF drugs can effectively improve BCVA and reduce CRT in AMD patients. Sex, number of injections, VA change at the first month, diabetes and disease history are the most important factors affecting visual acuity.
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Affiliation(s)
- Yan Lu
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Wenzhi Huang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yuehong Zhang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Xiongfei Huang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Xu Zhang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Haizhi Ma
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Guoliang Ren
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Feng Shi
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Lihui Kuang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Shigang Yan
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Shuke Luo
- Department of Ophthalmology, Foshan Second People's Hospital, Foshan, China
| | - Junyan Zhang
- Bothwin Clinical Study Consultant, Redmond, WA, United States
| | - Jingfang He
- Bothwin Clinical Study Consultant, Shanghai, China
| | - Weizhong Yang
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zongyin Gao
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yunxia Leng
- Department of Ophthalmology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
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Burhan AM, Klahan B, Cummins W, Andrés-Guerrero V, Byrne ME, O’Reilly NJ, Chauhan A, Fitzhenry L, Hughes H. Posterior Segment Ophthalmic Drug Delivery: Role of Muco-Adhesion with a Special Focus on Chitosan. Pharmaceutics 2021; 13:1685. [PMID: 34683978 PMCID: PMC8539343 DOI: 10.3390/pharmaceutics13101685] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/04/2023] Open
Abstract
Posterior segment eye diseases (PSEDs) including age macular degeneration (AMD) and diabetic retinopathy (DR) are amongst the major causes of irreversible blindness worldwide. Due to the numerous barriers encountered, highly invasive intravitreal (IVT) injections represent the primary route to deliver drugs to the posterior eye tissues. Thus, the potential of a more patient friendly topical route has been widely investigated. Mucoadhesive formulations can decrease precorneal clearance while prolonging precorneal residence. Thus, they are expected to enhance the chances of adherence to corneal and conjunctival surfaces and as such, enable increased delivery to the posterior eye segment. Among the mucoadhesive polymers available, chitosan is the most widely explored due to its outstanding mucoadhesive characteristics. In this review, the major PSEDs, their treatments, barriers to topical delivery, and routes of topical drug absorption to the posterior eye are presented. To enable the successful design of mucoadhesive ophthalmic drug delivery systems (DDSs), an overview of mucoadhesion, its theory, characterization, and considerations for ocular mucoadhesion is given. Furthermore, chitosan-based DDs that have been explored to promote topical drug delivery to the posterior eye segment are reviewed. Finally, challenges of successful preclinical to clinical translation of these DDSs for posterior eye drug delivery are discussed.
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Affiliation(s)
- Ayah Mohammad Burhan
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (W.C.); (N.J.O.); (L.F.); (H.H.)
| | - Butsabarat Klahan
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (W.C.); (N.J.O.); (L.F.); (H.H.)
| | - Wayne Cummins
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (W.C.); (N.J.O.); (L.F.); (H.H.)
| | - Vanessa Andrés-Guerrero
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain;
| | - Mark E. Byrne
- Biomimetic & Biohybrid Materials, Biomedical Devices & Drug Delivery Laboratories, Department of Biomedical Engineering, Rowan University, Glassboro, NJ 08028, USA;
| | - Niall J. O’Reilly
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (W.C.); (N.J.O.); (L.F.); (H.H.)
| | - Anuj Chauhan
- Chemical and Biological Engineering Department, Colorado School of Mines, Golden, CO 80401, USA;
| | - Laurence Fitzhenry
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (W.C.); (N.J.O.); (L.F.); (H.H.)
| | - Helen Hughes
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (W.C.); (N.J.O.); (L.F.); (H.H.)
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Short-Term Results of Switch from Conbercept to Bevacizumab or Ranibizumab in Eyes with Persistent Neovascular Age-Related Macular Degeneration. J Ophthalmol 2020; 2020:9340356. [PMID: 33005448 PMCID: PMC7508218 DOI: 10.1155/2020/9340356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To study the short-term anatomical and functional outcomes in patients with neovascular age-related macular degeneration (nAMD) who were previously treated with conbercept and switched to ranibizumab or bevacizumab due to persistent activity. Methods This retrospective single-arm study included nAMD patients who were followed up for at least three months after switching from at least 3 monthly intravitreal conbercept injections to bevacizumab or ranibizumab for persistent choroidal neovascularization (CNV) activity. The demographic data, treatments, best-corrected visual acuity (BCVA), central macular thickness (CMT), and the height of pigmented epithelial detachment (PED) before and after switching were recorded and analyzed. Results A total of 64 eyes of 64 patients were included with a mean follow-up of 9.6 ± 3.0 months. The average number of injections of conbercept was 3.6 ± 0.8 (range, 3–5) before switching. 18 eyes were switched to bevacizumab, and the other 46 eyes were switched to ranibizumab. After switching, mean BCVA slowly improved from 0.73 ± 0.48 to 0.64 ± 0.41 (p=0.0132) at one month after the last intravitreal injection of ranibizumab or bevacizumab during the mean follow-up of 4.4 ± 2.0 months. One month after switching, the mean CMT decreased significantly from 294.9 ± 121.8 μm to 230.9 ± 107.0 μm (p < 0.0001) and kept stable during the follow-up. There was a significant reduction of maximum PED height (mPEDH) at the first month after switching (from 384.3 ± 340.3 μm to 287.2 ± 245.2 μm, p=0.0018) and kept stable during the follow-up. The mean PED height at foveal center (cPEDH) showed a regression over time after switching (from 169.3 ± 230.6 μm to 130.5 ± 180.2 μm, p=0.0227) and also kept stable during the follow-up. The proportion of patients with IRF was slightly increased but not statistically significant before switching. After switching, this proportion decreased significantly from 96.9% to 81.3% at one month after the first intravitreal injection of ranibizumab or bevacizumab (p=0.0086). The proportion of patients with SRF did not change significantly before and after switching. The mean decrease of mPEDH and cPEDH at the last follow-up after switching was significantly larger in the IVR subgroup than in the IVB subgroup (p=0.023 and 0.010). Conclusion Our results indicate that switching from intravitreal conbercept injections to bevacizumab or ranibizumab can lead to significant improvement of CMT, PED, and IRF and slight improvement of BCVA in a short period of time for persistent nAMD patients.
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COVID-19 and macular edema: a necessarily blindness? Graefes Arch Clin Exp Ophthalmol 2020; 258:2569-2570. [PMID: 32666248 PMCID: PMC7358321 DOI: 10.1007/s00417-020-04838-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/07/2020] [Accepted: 07/08/2020] [Indexed: 12/28/2022] Open
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