1
|
Ertan E, Efe N, Sabaner MC, Dogan M. Results of the switch from intravitreal ranibizumab to intravitreal aflibercept therapy in patients with neovascular age-related macular degeneration: A 42-month retrospective real-world study. Niger J Clin Pract 2021; 24:1824-1827. [PMID: 34889791 DOI: 10.4103/njcp.njcp_696_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim The study aimed to evaluate the functional and anatomical results of patients treated with intravitreal ranibizumab (IVR) for neovascular age-related macular degeneration (n-AMD) but switched to intravitreal aflibercept (IVA) treatment due to insufficient response treatment. Material and Methods At least six doses of n-AMD were administered IVR to 33 patients who were switched to IVA treatment due to insufficient response and were included in the study. The patients were evaluated at the beginning of the IVR treatment during the transition to IVA treatment and at 6, 12, 18, 24, 30, 36, and 42 months of IVA treatment. Results After an average of 10.1 ± 5.04 IVR injections, the patients who were accepted as insufficient response were treated with IVA. The central macular thickness of the patients was evaluated at the beginning of the treatment, immediately before, and after the initiation of IVA treatment at 6, 12, 18, 24, 30, 36, 42 months. It was as follows: 325.21 ± 123.04, 351.42 ± 126.09, 284.81 ± 112.65, 296.68 ± 89.17, 282.61 ± 81.58, 292.27 ± 109, 92,269.75 ± 97.14, 267.50 ± 87.56, and 266.82 ± 88.35 μm. According to the best-corrected visual acuity (BCVA), it was initially 0.89 ± 0.65; 1.08 ± 0.53 during the transition to IVA; 0.91 ± 0.46 6 months after IVA; 12th 1.14 ± 0.59; 0.94 ± 0.55 at 18th; 1.07 ± 0.49 at 24th; 1.15 ± 0.57 at 30th; 1.06 ± 0.45 at 36th, and 1.13 ± 0.46 LogMAR ( Logarithm of the Minimum Angle of Resolution) at the 42nd month. Conclusion In conclusion, in n-AMD patients with inadequate response to intravitreal ranibizumab or with relapse, and therefore, switched to aflibercept treatment, the anatomical improvement and sustainment were observed, however, functional recovery could not be achieved.
Collapse
Affiliation(s)
- E Ertan
- Department of Ophthalmology, Gaziosmanpaşa Training Hospital, İstanbul, Turkey
| | - N Efe
- Department of Ophthalmology, Afyon University of Health Sciences, Afyonkarahisar, Turkey
| | - M C Sabaner
- Department of Ophthalmology, Bafra State Hospital, Samsun, Turkey
| | - M Dogan
- Department of Ophthalmology, Afyon University of Health Sciences, Afyonkarahisar, Turkey
| |
Collapse
|
2
|
Husum YS, Moe MC, Bragadóttir R, Jørstad ØK. Switching to aflibercept versus continuing bevacizumab for treatment-resistant neovascular age-related macular degeneration: a one-year comparative observational study. Acta Ophthalmol 2021; 99:e1354-e1359. [PMID: 33638291 DOI: 10.1111/aos.14825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE To compare outcomes of a treatment algorithm that allows for switching treatment-resistant neovascular age-related macular degeneration (nAMD) eyes to aflibercept with continuing bevacizumab. METHODS Retrospective study of nAMD patients who initiated treatment in 2012 (aflibercept unavailable) and 2018 (aflibercept available). Eyes were included in the case of residual macular fluid after a minimum of 4 monthly bevacizumab injections. Only eyes in the 2018 group could then switch to aflibercept. RESULTS The study included 40 eyes from 2012 and 88 eyes from 2018. Patient characteristics were similar across the groups at baseline and 4 months. In 2018, 59 eyes (67%) were switched to aflibercept after 4 months. Mean change in BCVA from 4 months to one year was +2.8 letters in 2018 versus -1.7 letters in 2012 (p = 0.043). Mean change in BCVA from baseline to one year was +9.4 letters in 2018 (p < 0.001) and +4.4 letters in 2012 (p = 0.073). Mean change in CRT from 4 months to one year was -36 µm in 2018 versus -23 µm in 2012 (p = 0.373). Mean change in CRT from baseline to one year was -100 µm in 2018 (p < 0.001) and -75 µm in 2012 (p < 0.001). Mean number of injections given in one year was 11.8 in 2018 versus 10.4 in 2012 (p < 0.001). After one year, a majority of eyes in both groups still received treatment at 4-week intervals. CONCLUSION The study suggests that the possibility of switching eyes with treatment-resistant nAMD to aflibercept leads to a modest visual benefit compared with continuing first-line bevacizumab therapy.
Collapse
Affiliation(s)
| | - Morten Carstens Moe
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute for Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute for Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute for Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| |
Collapse
|
3
|
Soliman MK, Tuli N, Lee TK, Britton WA, Tuli R. Visual and anatomical outcomes associated with treat-and-extend administration of intravitreal aflibercept for neovascular age-related macular degeneration. Int J Retina Vitreous 2021; 7:54. [PMID: 34579771 PMCID: PMC8474890 DOI: 10.1186/s40942-021-00326-4] [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: 01/09/2021] [Accepted: 09/11/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the visual and anatomical outcomes associated with treat-and-extend (TAE) regimen of intravitreal (IVT) aflibercept in eyes with treatment naïve neovascular age-related macular degeneration (nvAMD). Methods A retrospective chart review of eyes that underwent IVT aflibercept injections for nvAMD between May 2014 and March 2018 was performed. The primary outcome was the change in best corrected visual acuity (BCVA) at 12 months. Secondary outcomes included the change in central retinal thickness (CRT), subretinal fluid (SRF) and intraretinal fluid (IRF). Results Data from 213 eyes of 213 patients (138 female, 65%) met the inclusion criteria. The mean (SD) age of the patients was 80.4 (± 9.2) years. The mean baseline BCVA (0.92 ± 0.50 logMAR, improved by 0.20 (± 0.40) logMAR units at 12 months (p < 0.001). Seventy-two (34%) eyes gained ≥ 0.3 logMAR and 47 (22%) eyes achieved BCVA ≤ 0.3 logMAR at 12 months. Baseline BCVA, patient age, and the number of aflibercept injections received were predictors of the change in BCVA at 12 months. Mean CRT improved from 347 (± 117) µm at baseline to 246 (± 55) µm at 12 months (p < 0.001). The percentage of eyes with SRF and IRF on SD-OCT declined from 63 to 21% and from 60 to 26% at 12 months, respectively. Conclusion A TAE regimen of IVT aflibercept in treatment naïve nvAMD is associated with good visual and anatomical outcomes in routine clinical practice. Resolution of exudation occurred in about half of nvAMD cases at 12 months. Individualized administration of IVT aflibercept may reduce injection burden.
Collapse
Affiliation(s)
- Mohamed Kamel Soliman
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada.,Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nicolas Tuli
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Thomas K Lee
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada.,Retina Center of Ottawa, Ottawa, ON, Canada
| | - William A Britton
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada.,Retina Center of Ottawa, Ottawa, ON, Canada
| | - Raman Tuli
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada. .,Retina Center of Ottawa, Ottawa, ON, Canada. .,The Ottawa Hospital Riverside Campus, University of Ottawa, Ottawa, ON, K1H 7W9, Canada.
| |
Collapse
|
4
|
Wallsh JO, Gallemore RP. Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options. Cells 2021; 10:cells10051049. [PMID: 33946803 PMCID: PMC8145407 DOI: 10.3390/cells10051049] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023] Open
Abstract
Anti-vascular endothelial growth factor (anti-VEGF) therapy currently plays a central role in the treatment of numerous retinal diseases, most notably exudative age-related macular degeneration (eAMD), diabetic retinopathy and retinal vein occlusions. While offering significant functional and anatomic benefits in most patients, there exists a subset of 15–40% of eyes that fail to respond or only partially respond. For these cases, various treatment options have been explored with a range of outcomes. These options include steroid injections, laser treatment (both thermal therapy for retinal vascular diseases and photodynamic therapy for eAMD), abbreviated anti-VEGF treatment intervals, switching anti-VEGF agents and topical medications. In this article, we review the effectiveness of these treatment options along with a discussion of the current research into future directions for anti-VEGF-resistant eyes.
Collapse
Affiliation(s)
- Josh O. Wallsh
- Department of Ophthalmology, Albany Medical College, Albany, NY 12208, USA;
| | | |
Collapse
|
5
|
Garweg JG, Gerhardt C. Disease stability and extended dosing under anti-VEGF treatment of exudative age-related macular degeneration (AMD) - a meta-analysis. Graefes Arch Clin Exp Ophthalmol 2021; 259:2181-2192. [PMID: 33528645 PMCID: PMC8352813 DOI: 10.1007/s00417-020-05048-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess disease stability (absence of intra- and/or subretinal fluid) and the portion of eyes being capable to extend their treatment interval to ≥ 12 weeks in exudative age-related macular degeneration (AMD). METHODS A systematic literature search was performed in NCBI, PubMed, CENTRAL, and ClinicalTrials.gov to identify clinical studies reporting treatment outcomes for ranibizumab, aflibercept, and brolucizumab in exudative AMD under a treat-and-extend protocol and a follow-up of ≥ 12 months. Weighted mean differences and subgroup comparisons were used to integrate the different studies. RESULTS This meta-analysis refers to 29 published series, including 27 independent samples and 5629 patients. In the pooled group, disease stability was reported in 62.9% and 56.0%, respectively, after 12 and 24 months of treatment, whereas treatment intervals were extended to ≥ 12 weeks in 37.7% and 42.6%, respectively. Ranibizumab, aflibercept, and brolucizumab differed regarding their potential to achieve disease stability (56.3%, 64.5%, and 71.5% after 12, and 50.0%, 52.7% and 75.7% after 24 months; p = < 0.001) and to allow an interval extension to ≥ 12 weeks (28.6%, 34.2%, and 53.3% after 12, and 34.2%, 47.7%, and 41.7% after 24 months; p = < 0.001). CONCLUSION The portion of eyes achieving disease stability regressed in the second year, whereas the portion of eyes under a ≥ 12-week interval increased. This discrepancy may reflect the challenges in balancing between under-treatment and a reduced treatment burden.
Collapse
Affiliation(s)
- Justus G Garweg
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland. .,Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland.
| | - Christin Gerhardt
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| |
Collapse
|
6
|
Jørstad ØK, Steffensen LA, Eriksen K, Bragadóttir R, Moe MC. Thirteen years of intravitreal anti-vascular endothelial growth factor therapy: the promises and burdens of a paradigm shift told from the perspective of the largest retina service in Norway. Acta Ophthalmol 2020; 98:774-779. [PMID: 31264363 DOI: 10.1111/aos.14177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/30/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To describe the first 13 years of anti-vascular endothelial growth factor (anti-VEGF) therapy from the perspective of a public ophthalmic department serving a local community of almost one million people. METHODS Retrospective registry study. Data from Oslo University Hospital, Norway were collected from 2006 through 2018. Hospital episode statistics were searched for episodes of care encompassing intravitreal anti-VEGF procedures. Patient-specific ID numbers, diagnoses, and drug codes were registered. In general, bevacizumab was used as first-line treatment, with aflibercept reserved for resistant cases from 2013. RESULTS The number of unique patients treated per year increased from 130 in 2006 to 3428 in 2018. In 2018, 2488 (73%) patients had also received treatment the previous year. The number of yearly injections increased from 228 in 2006 to 25 570 in 2018. In 2018 the diagnosis macular degeneration constituted 69% of injections, diabetic retinopathy constituted 15%, retinal vein occlusion constituted 13%, and other diagnoses constituted 3%. In the same year 49% of injections were with bevacizumab, 46% with aflibercept, 4% with ranibizumab, and 1% with dexamethasone implants. The bevacizumab to aflibercept ratio was almost 1:1 for macular degeneration and diabetic retinopathy; for retinal vein occlusion the ratio was 13:7. CONCLUSION In 13 years there was an approximately 100-fold increase in the number of yearly intravitreal injections. A majority of patients received long-term treatment. Macular degeneration was the most common diagnosis. Using bevacizumab as first-line treatment, with aflibercept reserved for resistant cases from 2013, eventually resulted in a nearly 1:1 ratio in drug usage.
Collapse
Affiliation(s)
- Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Norway
- Faculty of Medicine University of Oslo Norway
| | | | - Ketil Eriksen
- Department of Ophthalmology Oslo University Hospital Norway
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology Oslo University Hospital Norway
- Faculty of Medicine University of Oslo Norway
| | - Morten Carstens Moe
- Department of Ophthalmology Oslo University Hospital Norway
- Faculty of Medicine University of Oslo Norway
| |
Collapse
|
7
|
Karesvuo P, Hakkala L, Kaarniranta K, Uusitalo H, Ojamo M, Tuuminen R. Correlation between the rate of intravitreal injections, use of aflibercept as a second-line treatment and visual impairment for wet AMD in Finland. Acta Ophthalmol 2020; 98:472-476. [PMID: 32096347 DOI: 10.1111/aos.14376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/25/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To correlate the rate of intravitreal anti-VEGF injections and the use of aflibercept as a second-line treatment with visual impairment throughout Finland. METHODS Information related to anti-VEGF treatment, proportions of bevacizumab and aflibercept and new visual impairments due to wet age-related macular degeneration (AMD) was gathered from 5 university hospitals and 14 central hospital districts between 2015 and 2017 covering 232 568 injections and 1172 visual impairments. RESULTS Between 2015 and 2017, the number of annual total anti-VEGF injections increased from 60 412 to 93 589 (+24.5% annual change) and of aflibercept injections from 8299 to 20 833 (+58.7% annual change). The 3-year average for total anti-VEGF injections ranged from 9.6 to 21.1 (median 13.3) per 1000 citizens between hospital districts and for aflibercept injections from 0.8 to 4.0 (median 1.9). According to the primary protocol for wet AMD, during 2015-2017, the number of total anti-VEGF injections increased from 10.9 to 15.2 per 1000 citizens with the pro re nata (PRN) protocol and from 11.3 to 18.9 with the treat-and-extend regimen (TER). The 3-year average of aflibercept injections as a second-line treatment, but not the total number of anti-VEGF or bevacizumab injections, inversely correlated with new onset visual impairments (R = -0.505, P = 0.027) in the hospital districts. The number of visual impairments did not differ between the hospital districts according to the PRN and TER protocols (1.23 ± 0.41 and 1.14 ± 0.67, respectively, per 1000 citizens aged ≥64 years, P = 0.713). CONCLUSION These results emphasize that the use of aflibercept injections as a second-line treatment may decrease new onset visual impairments.
Collapse
Affiliation(s)
- Petteri Karesvuo
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Laura Hakkala
- Department of Ophthalmology, Turunmaa Regional Hospital, Turku, Finland
| | - Kai Kaarniranta
- Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Ophthalmology, University Hospital, Kuopio, Finland
| | - Hannu Uusitalo
- SILK, Department of Ophthalmology, Tampere University and Tays Eye Center, Tampere, Finland.,The Finnish Register of Visual Impairment, Helsinki, Finland.,The National Institute for Health and Welfare, Helsinki, Finland
| | - Matti Ojamo
- The Finnish Register of Visual Impairment, Helsinki, Finland.,The National Institute for Health and Welfare, Helsinki, Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Kymenlaakso Central Hospital, Eye Centre, Kotka, Finland
| |
Collapse
|
8
|
Bro T, Derebecka M, Jørstad ØK, Grzybowski A. Off-label use of bevacizumab for wet age-related macular degeneration in Europe. Graefes Arch Clin Exp Ophthalmol 2019; 258:503-511. [PMID: 31889214 DOI: 10.1007/s00417-019-04569-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/27/2019] [Accepted: 12/12/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To analyse current off-label use of bevacizumab for wet age-related macular degeneration (AMD) in Europe. METHODS The study was conducted as a combined survey and literature review. It included the 22 most populous countries in Europe. In each country, ophthalmologists with particular knowledge about off-label treatment responded to a questionnaire. RESULTS Answers were obtained from twenty European countries. The off-label use of bevacizumab for wet AMD greatly differed between nations; the bevacizumab proportion varied from non-existent (0%) to very high (97%). There were also large disparities within single countries (e.g. 0-80%), which were attributable to differences in regional decision-making. Both governmental institutions and national ophthalmological societies expressed highly diverging opinions on the use of off-label treatment. Intravitreal administration of bevacizumab had been a matter of legal dispute in several countries. The question about responsibility for off-label therapy mainly remained unanswered. CONCLUSIONS There was a highly varying utilization of bevacizumab between European countries. Despite an intention of a consistent approach to medical regulations, Europe has not yet reached a professional or political consensus on the ophthalmic off-label use of bevacizumab.
Collapse
Affiliation(s)
- Tomas Bro
- Futurum, the Academy for Health and Care in Region Jönköping, Jönköping, Sweden. .,Ögonmottagningen, Höglandssjukhuset, 575 81, Eksjö, Sweden.
| | | | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Andrzej Grzybowski
- University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
| |
Collapse
|
9
|
Yu S, Rückert R, Munk MR. Treat-and-extend regimens with anti-vascular endothelial growth factor agents in age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1698948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Siqing Yu
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Marion R. Munk
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
10
|
A new method for pharmaceutical compounding and storage of anti-VEGF biologics for intravitreal use in silicone oil-free prefilled plastic syringes. Sci Rep 2019; 9:18021. [PMID: 31792234 PMCID: PMC6888834 DOI: 10.1038/s41598-019-54226-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/06/2019] [Indexed: 12/27/2022] Open
Abstract
Intravitreal injections of antibody-based biologics targeting vascular endothelial growth factor (VEGF) are highly effective and have markedly decreased the risk of visual impairment associated with prevalent retinal diseases, such as neovascular age-related macular degeneration and diabetes macular oedema. The diseases are chronic in their nature, and most patients need long-term therapy to suppress disease activity. We previously reported a compounding method for repackaging and storage of aflibercept (Eylea), a commonly used anti-VEGF biologic, in silicone oil-coated plastic syringes without compromising drug stability or activity. In addition to improving safety and time spent per patient, compounding of anti-VEGF biologics enables single-dose vials to be split into multiple syringes, thereby considerably reducing waste and drug expenses. However, symptomatic silicone oil droplets may deposit in the eye’s vitreous body after repetitive injections. To fully avoid this complication, we here report on a novel pharmaceutical compounding method using silicone oil-free syringes and a 33 G × 9 mm Low Dead Space Needle hub injection needle. We evaluate the method for three anti-VEGF biologics commonly used in ophthalmology: aflibercept, ranibizumab (Lucentis) and bevacizumab (Avastin). Our results show that compounding and storage for one week does not compromise the functional activity of the biologics and allows for safe and cost-effective compounding of anti-VEGF biologics for intravitreal injections in prefilled silicone oil-free syringes.
Collapse
|
11
|
Jelin E, Wisløff T, Moe MC, Heiberg T. Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) in a Norwegian population of patients with neovascular age-related macular degeneration compared to a control population. Health Qual Life Outcomes 2019; 17:140. [PMID: 31412873 PMCID: PMC6692950 DOI: 10.1186/s12955-019-1203-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although visual acuity and optical coherence tomography (OCT) are most widely used as outcomes in treatment of neovascular age-related Macular Degeneration (nAMD), patient reported outcome measures are increasingly recognized. National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) was developed to capture the perceived visual function. Yet, evidence of psychometric performance in the target population is required. The aim of this study was to examine the psychometric properties of NEI-VFQ 25 in a Norwegian cohort of newly diagnosed nAMD patients followed with a Treat and Extend (T/E) protocol. Methods Patients receiving intravitreal anti–vascular endothelial growth factor (anti-VEGF) injection treatment according to a T/E protocol completed a Norwegian translation of NEI-VFQ 25, EuroQoL Health Questionnaire (EQ-5D), and Patient acceptable symptom state (PASS 5) at baseline, 3, 6 and 12 months. In addition, a control population completed the same questionnaires. Visual acuity was assessed with LogMar for best/treated eye. Validity testing comprised face validity by a 0–10 numeric rating scale about relevance of NEI-VFQ 25 as well as regression analyses and correlations between NEI-VFQ 25 and other relevant variables. Reliability was examined with Intraclass Correlation Coefficient (ICC) and Cronbach’s alpha for internal consistency were performed. Responsiveness, discriminatory power and predictive value were also explored. Results Number of respondents at baseline, after 3, 6 and 12 months was 197, 186, 176 and 168, respectively. The control population comprised 26 individuals. Face validity of NEI-VFQ 25 had a mean (SD) of 7.8 (1.7) (n = 84). NEI-VFQ was significantly correlated to visual acuity and PASS 5 as well as EQ-5D at baseline. Reliability (ICC) of the overall and sub scores for the patients/controls ranged from 0.49–0.97/0.59–0.97. Cronbach’s alpha was 0.61–0.85. Discriminatory power was confirmed by significant differences of the overall score between controls and patients (P < 0.001). NEI-VFQ 25 indicates responsiveness showing overall score improved significantly (P ≤ 0.001) from baseline to 3 months. NEI-VFQ 25, general health and visual acuity at baseline were the strongest predictors for how patients reported vision after 6 months follow-up. Conclusion NEI-VFQ 25 showed acceptable psychometric performance, which supports that the Norwegian version can be used to monitor patients treated for nAMD.
Collapse
Affiliation(s)
- Elma Jelin
- Department of Ophthalmology, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318, Oslo, Norway.
| | - Torbjørn Wisløff
- Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten C Moe
- Department of Ophthalmology, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318, Oslo, Norway
| | - Turid Heiberg
- Department of Regional Research Support, Oslo University Hospital, Sogn Arena, POBox 4950, Nydalen, N-0424, Oslo, Norway.,Faculty of Health and Welfare, Østfold University College, POBox 700, N-1757, Halden, Norway
| |
Collapse
|
12
|
Empeslidis T, Storey M, Giannopoulos T, Konidaris V, Tranos PG, Panagiotou ES, Voudouragkaki IC, Konstas AG. How Successful is Switching from Bevacizumab or Ranibizumab to Aflibercept in Age-Related Macular Degeneration? A Systematic Overview. Adv Ther 2019; 36:1532-1548. [PMID: 31102206 PMCID: PMC6824395 DOI: 10.1007/s12325-019-00971-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Indexed: 01/28/2023]
Abstract
Emerging anti-vascular endothelial growth factor (anti-VEGF) therapies for neovascular age-related macular degeneration (nAMD) have revolutionised medical retina practice and the management and eventual outcome of nAMD. Recent research has focused on evaluating and comparing the efficacy of the two most widely employed anti-VEGF agents, bevacizumab and ranibizumab; however, a subgroup of patients with nAMD demonstrates a suboptimal response to standard therapy. We have therefore conducted a review of pertinent studies published until August 2018 which have documented the clinical efficacy when switching to a different anti-VEGF. Evidence on baseline disease characteristics, injection frequency and disease outcome has been obtained for patients treated with ranibizumab 0.5 mg and/or bevacizumab 1.25 mg and were switched to aflibercept 2 mg. Our review identified 45 studies investigating switching to aflibercept. Our review showed a clear anatomical benefit after the switch in terms of central retinal thickness and pigment epithelium detachment characteristics, whereas the functional outcomes were variable. Remarkable heterogeneity was documented among the relevant studies with regard to several factors including the baseline characteristics of the cohorts, the non-response definition and previous treatment protocols. Larger prospective trials with appropriate control arms are therefore required to elucidate the potential benefit when switching between anti-VEGF agents in refractory nAMD.
Collapse
|
13
|
Amarakoon S, Martinez-Ciriano JP, van den Born LI, Baarsma S, Missotten T. Bevacizumab in age-related macular degeneration: a randomized controlled trial on the effect of on-demand therapy every 4 or 8 weeks. Acta Ophthalmol 2019; 97:107-112. [PMID: 30369062 DOI: 10.1111/aos.13774] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 03/04/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Intravitreal anti-vascular endothelial growth factor (VEGF) injections are an effective treatment for neovascular age-related macular degeneration (nARMD). Bevacizumab appears to be a cost-effective off-label anti-VEGF alternative to ranibizumab, but an optimal injection schedule has not yet been determined. In this study, we investigate whether on-demand bevacizumab treatment every 8 weeks is non-inferior to on-demand bevacizumab every 4 weeks in treating nARMD. METHODS A total of 120 nARMD patients were randomly assigned to an on-demand regimen of intravitreal bevacizumab (IVB) every 4 (n = 60) or 8 weeks (n = 60). The primary outcome was visual acuity (VA) change after 1 year of treatment. RESULTS Visual acuity (VA) improved between baseline and 1 year in both treatment groups. The mean change in the VA score at 1 year was not significantly different between bevacizumab administration on-demand every 4 weeks [5.6 ± 10.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letter] or 8 weeks (4.6 ± 12.0 ETDRS letters). A reduction in the central retinal thickness was observed in both groups. At 1 year, the mean decrease in central foveal thickness ranged from 61 ± 90 μm in the 4-week group to 91 ± 83 μm in the 8-week group (p = 0.07). The mean number of IVB treatments during the study period was 8.7 ± 2.3 in the 4-week group and 5.9 ± 1.0 in the 8-week group. CONCLUSION At 1 year, bevacizumab administration on-demand every 8 weeks was non-inferior to administration every 4 weeks. The results strongly suggest that bevacizumab acts longer than 4 weeks in ARMD, reducing the burden of injections for patients.
Collapse
Affiliation(s)
- Sankha Amarakoon
- Rotterdam Eye Hospital; Rotterdam the Netherlands
- Rotterdam Ophthalmic Institute; Rotterdam the Netherlands
| | | | | | | | | |
Collapse
|
14
|
Taipale C, Laine I, Tuuminen R. Anatomical and functional response after conversion to aflibercept using the treat-and-extend regimen protocol in bevacizumab treatment-resistant wet age-related macular degeneration. Clin Ophthalmol 2018; 13:17-23. [PMID: 30587915 PMCID: PMC6302797 DOI: 10.2147/opth.s188624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective To evaluate the functional and anatomical response after the switch from bevacizumab to aflibercept in treatment-resistant wet age-related macular degeneration (wAMD) using the treat-and-extend regimen protocol. Design A retrospective single-center study. Participants The registry consisted of 576 patients with wAMD. Of these, a total of 41 eyes of 37 patients met the study inclusion criteria with a minimum of three prior bevacizumab injections and at least 1-year follow-up after the switch to aflibercept injections for the treatment of wAMD. Methods Central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were recorded before and after bevacizumab loading phase, before the switch to aflibercept, after aflibercept loading phase, and after the last injection or at the study end point at a minimum of 1 year from the switch. Results At the switch to aflibercept injections, the mean CRT was 361.1±117.7 µm (mean±SD) and BCVA was 0.29±0.19 decimals. The switch to aflibercept resulted in mean CRT resolution by 59.9±80.2 µm after the loading phase and by 61.3±102.9 µm at the study end point. Anatomical response to aflibercept switch was found in 34 of 41 eyes (83%) after the loading phase, and in 32 of 41 eyes (78%) at the study end point. BCVA improvement was 0.08±0.13 decimals in 26 of 41 eyes (63%) after the loading phase, and 0.04±0.17 decimals in 17 of 41 eyes (41%) at the study end point. The mean treatment interval of aflibercept was 8.0±2.2 weeks at the study end point. Conclusion Regardless of impressive anatomical outcomes of aflibercept switch, functional response was modest for most of the study eyes at long term.
Collapse
Affiliation(s)
- Claudia Taipale
- Helsinki Retina Research Group, Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland, .,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Laine
- Helsinki Retina Research Group, Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland, .,Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland,
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland, .,Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland,
| |
Collapse
|
15
|
Jelin E, Wisløff T, Moe MC, Heiberg T. Development and testing of a patient-derived questionnaire for treatment of neovascular age-related macular degeneration: dimensions of importance in treatment of neovascular age-related macular degeneration. Acta Ophthalmol 2018; 96:804-811. [PMID: 30198182 DOI: 10.1111/aos.13847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Studies reporting on patient perspectives during treatment of neovascular age-related macular degeneration (nAMD) are limited. Thus, the aim of this study was to develop and test psychometric performance of a patient-derived questionnaire to capture important experiences during intravitreal treatment. METHODS Patients (n = 44) with at least 3-month experience of intravitreal injection treatment for nAMD identified the dimensions of priority and also performed a weighting procedure to develop a score for comparison. The questionnaire comprised two versions: one focusing on the relative importance' of the dimensions and one on the experience of the 'management' during treatment. The questionnaire was then tested for psychometric performance in a longitudinal design in newly diagnosed patients at baseline (n = 197), after three (n = 184) and six (n = 150) months of treatment. RESULTS Of the 15 included dimensions, the following were most frequently reported: 'receive treatment to preserve vision', 'information', 'waiting time', 'trust' and 'accommodating staff. The psychometric testing showed moderate reliability (intraclass correlation coefficient: 0.65-0.67) for the two versions and high level of face validity (8.3). The dimensions, 'preserving vision', 'early access to treatment', 'pain relief', 'information about the treatment/diagnosis' and 'visual aids' were consistently reported higher in 'importance' than in 'management', at both 3 and 6 months, indicating a potential for improvement in clinical practice for these dimensions. CONCLUSION This study provides a brief patient-derived questionnaire, expressed with a score with good psychometric performance that can be used for monitoring during intravitreal injection treatment of nAMD patients.
Collapse
Affiliation(s)
- Elma Jelin
- Department of Ophthalmology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Torbjørn Wisløff
- Norwegian Institute of Public Health; Oslo Norway
- Institute of Health and Society; University of Oslo; Oslo Norway
| | - Morten C. Moe
- Department of Ophthalmology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Turid Heiberg
- Regional Research Support; Oslo University Hospital; Oslo Norway
- Østfold University College; Halden Norway
| |
Collapse
|
16
|
Azuma K, Asaoka R, Matsuda A, Lee J, Shimizu K, Inui H, Murata H, Ogawa A, Yamamoto M, Inoue T, Obata R. Two-year outcome of treat-and-extend aflibercept after ranibizumab in age-related macular degeneration and polypoidal choroidal vasculopathy patients. Clin Ophthalmol 2018; 12:1589-1597. [PMID: 30214143 PMCID: PMC6120579 DOI: 10.2147/opth.s172115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of the study was to evaluate the 2-year outcome and predictive factors of treat-and-extend aflibercept in patients with eyes affected by typical neovascular age-related macula degenelation (t-AMD) or polypoidal choroidal vasculopathy (PCV), who were switched from ranibizumab. Patients and methods The patients underwent three monthly aflibercept injections and subsequent administration following the treat-and-extend protocol. Sixty-two eyes of 62 patients were reviewed retrospectively. R statistical software was used for statistical analysis. Results Twenty-two eyes were t-AMD and the remaining 40 eyes were PCV. There was no significant difference in the logarithm of the minimal angle of resolution visual acuity (VA) between baseline and 2 years after switching to aflibercept (0.40 vs 0.40; P=0.99). Multivariate analyses suggested that the following factors were significantly correlated with better VA at 2 years after switching to aflibercept: patients with PCV, the absence of intraretinal fluid at baseline, and better VA at baseline. Conclusion In conclusion, VA was maintained and there was an anatomical improvement at 2 years in patients with t-AMD and PCV who were switched from ranibizumab to treat-and-extend aflibercept. PCV patients showed more favorable visual outcomes and less injections at 2 years compared to t-AMD patients. Intraretinal fluid and VA at baseline were predictors of VA at 2 years.
Collapse
Affiliation(s)
- Keiko Azuma
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Ryo Asaoka
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Aya Matsuda
- Department of Ophthalmology, Toranomon Byoin, Tokyo, Japan
| | - Jihee Lee
- Department of Ophthalmology, Miyata Eye Hospital, Miyakonojo, Japan
| | - Kimiko Shimizu
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Hiroko Inui
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Hiroshi Murata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Asako Ogawa
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Motoshi Yamamoto
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Tatsuya Inoue
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| |
Collapse
|
17
|
Mansour AM, Charbaji A, Farah ME, Mansour HA, Chhablani J. Long-term outcome of treat and extend intravitreal ziv-aflibercept therapy. Br J Ophthalmol 2018; 103:938-941. [DOI: 10.1136/bjophthalmol-2018-312593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/25/2018] [Accepted: 07/19/2018] [Indexed: 11/04/2022]
Abstract
AimTo assess the 30-month outcome of treat and extend (TAE) intravitreal ziv-aflibercept therapy in eyes with macular diseases.MethodsIn this prospective study, consecutive subjects received intravitreal 0.05 mL ziv-aflibercept (1.25 mg) injections for various macular diseases. Outcome measures were best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution) and central macular thickness (CMT) on spectral domain optical coherence tomography. Paired comparison was done using Wilcoxon signed-rank test calculator.ResultsFifty-three eyes of 48 subjects (33 naïve eyes) received intravitreal ziv-aflibercept and were followed between 12 and 30 months following TAE included neovascular age-related macular degeneration (nAMD) (35 eyes) and diabetic macular oedema (DMO) (18 eyes). In eyes with nAMD, CMT decreased by 107.8 µm at the 30-month follow-up (p=0.012) with BCVA gain of 0.52 (p=0.001). In eyes with DMO, CMT decreased by 224.3 µm at the 30-month follow-up (p=0.027) with BCVA gain of 0.46 (p=0.042). Combining all disease categories, the mean number of injections was 9.2 at month 12, 2.5 between 12 and 18 months, 1.6 between 18 and 24 months and 1.0 between 24 and 30 months.ConclusionsUsing TAE regimen, intravitreal ziv-aflibercept appeared efficacious at managing retinal disease through month 30 using the TAE regimen.
Collapse
|
18
|
Cundy O, Shah M, Downes SM. Intravitreal aflibercept: its role in treatment of neovascular age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1468250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Olivia Cundy
- London North West University Healthcare Trust, Harrow, UK
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mital Shah
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Susan M. Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|