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Tadayoni R, Paris LP, Danzig CJ, Abreu F, Khanani AM, Brittain C, Lai TYY, Haskova Z, Sakamoto T, Kotecha A, Schlottmann PG, Liu Y, Seres A, Retiere AC, Willis JR, Yoon YH. Efficacy and Safety of Faricimab for Macular Edema due to Retinal Vein Occlusion: 24-Week Results from the BALATON and COMINO Trials. Ophthalmology 2024; 131:950-960. [PMID: 38280653 DOI: 10.1016/j.ophtha.2024.01.029] [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: 09/26/2023] [Revised: 12/19/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024] Open
Abstract
PURPOSE To evaluate the 24-week efficacy and safety of the dual angiopoietin-2 (Ang-2) and vascular endothelial growth factor (VEGF)-A inhibitor faricimab versus aflibercept in patients with vein occlusion. DESIGN Phase 3, global, randomized, double-masked, active comparator-controlled trials: BALATON/COMINO (ClincalTrials.gov identifiers: NCT04740905/NCT04740931; sites: 149/192). PARTICIPANTS Patients with treatment-naïve foveal center-involved macular edema resulting from branch (BALATON) or central or hemiretinal (COMINO) RVO. METHODS Patients were randomized 1:1 to faricimab 6.0 mg or aflibercept 2.0 mg every 4 weeks for 24 weeks. MAIN OUTCOME MEASURES Primary end point: change in best-corrected visual acuity (BCVA) from baseline to week 24. Efficacy analyses included patients in the intention-to-treat population. Safety analyses included patients who received ≥ 1 doses of study drug. RESULTS Enrollment: BALATON, n = 553; COMINO, n = 729. The BCVA gains from the baseline to week 24 with faricimab were noninferior versus aflibercept in BALATON (adjusted mean change, +16.9 letters [95.03% confidence interval (CI), 15.7-18.1 letters] vs. +17.5 letters [95.03% CI, 16.3-18.6 letters]) and COMINO (+16.9 letters [95.03% CI, 15.4-18.3 letters] vs. +17.3 letters [95.03% CI, 15.9-18.8 letters]). Adjusted mean central subfield thickness reductions from the baseline were comparable for faricimab and aflibercept at week 24 in BALATON (-311.4 μm [95.03% CI, -316.4 to -306.4 μm] and -304.4 μm [95.03% CI, -309.3 to -299.4 μm]) and COMINO (-461.6 μm [95.03% CI, -471.4 to -451.9 μm] and -448.8 μm [95.03% CI, -458.6 to -439.0 μm]). A greater proportion of patients in the faricimab versus aflibercept arm achieved absence of fluorescein angiography-based macular leakage at week 24 in BALATON (33.6% vs. 21.0%; nominal P = 0.0023) and COMINO (44.4% vs. 30.0%; nominal P = 0.0002). Faricimab was well tolerated, with an acceptable safety profile comparable with aflibercept. The incidence of ocular adverse events was similar between patients receiving faricimab (16.3% [n = 45] and 23.0% [n = 84] in BALATON and COMINO, respectively) and aflibercept (20.4% [n = 56] and 27.7% [n = 100], respectively). CONCLUSIONS These findings demonstrate the efficacy and safety of faricimab, a dual Ang-2/VEGF-A inhibitor, in patients with macular edema secondary to retinal vein occlusion. 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)
- Ramin Tadayoni
- Lariboisière and Fondation Adolphe de Rothschild Hospitals, Université Paris Cité, Paris, France.
| | | | - Carl J Danzig
- Rand Eye Institute, Deerfield Beach, Florida; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Arshad M Khanani
- Sierra Eye Associates, Reno, Nevada; University of Nevada, Reno School of Medicine, Reno, Nevada
| | | | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong, New Territories, China
| | | | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | | | - Ying Liu
- Genentech, Inc., South San Francisco, California
| | | | | | | | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
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Basilious A, Duncan J, Smuck B, Malvankar-Mehta MS, Juncal VR, Hooper P, Sheidow TG. Treatment discontinuation patterns of anti VEGF in retinal vein occlusion. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00251-X. [PMID: 37669742 DOI: 10.1016/j.jcjo.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/12/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE The purpose of this research is to report on real-world anti-vascular endothelial growth factor (anti-VEGF) treatment patterns in retinal vein occlusions (RVO). DESIGN Retrospective cohort study. PARTICIPANTS Treatment-naive RVO patients initiating anti-VEGF injections between 2015 and 2021. METHODS Medical records available until June 2022 were reviewed. Demographics, diagnosis, number of injections, treatment length, reason for discontinuation, and baseline and final data (e.g., date, age, best-corrected visual acuity [BCVA], and central subfield thickness) were recorded. Statistical analyses performed with STATA 17.0 assessed differences between baseline and final values, branch (BRVO) and central retinal vein occlusion (CRVO), and treatment-discontinuation subgroups. RESULTS A total of 219 treatment-naive eyes were included (70.3 ± 13.2 years of age, 52.5% female), with 99 BRVOs and 120 CRVOs (2482 injections). The discontinuation rate was 76.7% (168 of 219), with 72.7% of patients (77 of 99) with BRVOs and 75.8% of patients (91 of 120) with CRVOs discontinuing injections. Reasons for discontinuation included stable off active therapy (98 eyes), severe comorbidity or death (17 eyes), switched to intraocular steroid (implant or injection) (12 eyes), lack of visual benefit (10 eyes), ocular comorbidity (5 eyes), patient decision (5 eyes), and patient transfer (5 eyes). Among the remaining 67 eyes, 16 (24%) were lost to follow-up. Reasons for discontinuation differed between BRVO and CRVO patients (p = 0.002). Eyes with CRVO presented with worse BCVA (p < 0.0001) and achieved worse final BCVA (p < 0.0001), but both groups experienced improvements (p < 0.0001). Younger age, better baseline BCVA, and a diagnosis of BRVO were independent predictors of better final visual acuity. CONCLUSION Over 7.5 years, treatment was discontinued for three-quarters of RVOs. Stable disease was the most common reason for discontinuation, with nearly half (45%) of all RVOs in the cohort stable off active therapy. Better visual outcomes were achieved in BRVO than in CRVO, although both groups benefited from treatment.
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Affiliation(s)
- Amy Basilious
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care, London, ON..
| | - Julie Duncan
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care, London, ON
| | - Bobbi Smuck
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care, London, ON
| | | | - Verena R Juncal
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care, London, ON
| | - Phil Hooper
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care, London, ON
| | - Tom G Sheidow
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care, London, ON
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Hattenbach LO, Abreu F, Arrisi P, Basu K, Danzig CJ, Guymer R, Haskova Z, Heier JS, Kotecha A, Liu Y, Loewenstein A, Seres A, Willis JR, Wykoff CC, Paris LP. BALATON and COMINO: Phase III Randomized Clinical Trials of Faricimab for Retinal Vein Occlusion: Study Design and Rationale. OPHTHALMOLOGY SCIENCE 2023; 3:100302. [PMID: 37810589 PMCID: PMC10556281 DOI: 10.1016/j.xops.2023.100302] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Purpose Dual inhibition of angiopoietin-2 and VEGF-A with faricimab (Vabysmo) offers excellent visual acuity gains with strong durability in patients with diabetic macular edema (ME) and neovascular age-related macular degeneration. The phase III BALATON/COMINO (NCT04740905/NCT04740931) trials will investigate the efficacy, safety, and durability of faricimab in patients with ME due to retinal vein occlusion (RVO). Design Two identically designed global, randomized, double-masked, active comparator-controlled studies. Participants Anti-VEGF treatment-naive patients with branch, central, or hemiretinal RVO. Methods Patients were randomized to 6 monthly injections of faricimab 6.0 mg or aflibercept 2.0 mg. From weeks 24 to 72, all patients received faricimab 6.0 mg administered in up to 16-week intervals using an automated treatment algorithm to generate a treat-and-extend-based personalized treatment interval dosing regimen. Personalized treatment interval adjustments were based on changes in central subfield thickness (CST) and best-corrected visual acuity (BCVA). Main Outcome Measures Primary end point was noninferiority of faricimab versus aflibercept in mean change from baseline in BCVA (week 24; noninferiority margin: 4 letters). Secondary end points (weeks 0-24) were mean change from baseline in BCVA, CST, and National Eye Institute Visual Function Questionnaire 25 composite score; proportion of patients gaining or avoiding loss of ≥ 15/≥ 10/≥ 5/> 0 letters. Secondary end points (weeks 24-72) were treatment durability (week 68); continuation of weeks 0 to 24 end points. Ocular/nonocular adverse events will be assessed. Results In total, 1282 patients across 22 countries were enrolled (BALATON, 553 patients, 149 centers; COMINO, 729 patients, 193 centers). Conclusions Using a novel automated interval algorithm, BALATON/COMINO will evaluate the efficacy and safety of faricimab for ME secondary to RVO and provide key insights into how to personalize treatment. 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)
| | | | | | - Karen Basu
- Roche Products (Ireland), Dublin, Ireland
| | - Carl J. Danzig
- Rand Eye Institute, Deerfield Beach, Florida
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Robyn Guymer
- The Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Australia
| | | | | | | | - Ying Liu
- Genentech, Inc., South San Francisco, California
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Cornish EE, Zagora SL, Spooner K, Fraser-Bell S. Management of macular oedema due to retinal vein occlusion: An evidence-based systematic review and meta-analysis. Clin Exp Ophthalmol 2023. [PMID: 37060158 DOI: 10.1111/ceo.14225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Central retinal vein occlusion and branch retinal vein occlusion are common causes of visual loss due to associated macular oedema. The aim of this review was to assess the effectiveness of interventions improving vision and treating macular oedema in central retinal vein occlusion and branch retinal vein occlusion. METHODS Medical search engines and clinical trial registries were systematically searched. Randomised clinical trials with ≥90 eyes and real-world outcome studies with ≥100 eyes each with ≥6 months follow-up were included. RESULTS There were 11 randomised controlled trials evaluating treatments for central retinal vein occlusion which met the inclusion criteria and 10 for branch retinal vein occlusion. There were 10 real world outcome studies of central retinal vein occlusion and 5 real world outcome studies of branch retinal vein occlusion. Meta-analysis was performed on studies that met the defined inclusion criteria. Main outcomes were change in visual acuity at 6-, 12-, 24- and 36 months by treatment. CONCLUSIONS Intravitreal anti-vascular endothelial derived growth factor is recommended as first line treatment over intravitreal corticosteroid due to its effectiveness and lower rate of ocular adverse events. Best outcomes are achieved when intravitreal treatment is started early. Macular laser may have an adjunctive role in branch retina vein occlusion but not central retinal vein occlusion.
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Affiliation(s)
- Elisa E Cornish
- Sydney Medical School, Discipline of Ophthalmology and Eye Health, Save Sight Institute, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Department of Ophthalmology, Westmead Hospital, Westmead, Australia
| | - Sophia L Zagora
- Sydney Medical School, Discipline of Ophthalmology and Eye Health, Save Sight Institute, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Department of Ophthalmology, The Sydney Children's Hospital Network, Westmead, Australia
| | - Kimberley Spooner
- Sydney Retina Clinic, Sydney, Australia
- Roche Australia (Roche had no affiliation with this work), Millers Point, Australia
| | - Samantha Fraser-Bell
- Sydney Medical School, Discipline of Ophthalmology and Eye Health, Save Sight Institute, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, Australia
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Glacet-Bernard A, Girmens JF, Kodjikian L, Delcourt C, Fajnkuchen F, Creuzot-Garcher C, San Nicolas N, Massin P. Real-World Outcomes of Ranibizumab Treatment in French Patients with Visual Impairment due to Macular Edema Secondary to Retinal Vein Occlusion: 24-Month Results from the BOREAL-RVO Study. Ophthalmic Res 2023; 66:824-834. [PMID: 36972579 DOI: 10.1159/000530294] [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: 11/30/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Information about real-world ranibizumab use is needed to optimize treatment of macular edema secondary to retinal vein occlusion (RVO). The BOREAL-RVO study assessed treatment use, effectiveness, and safety of 24-month treatment with ranibizumab 0.5 mg in patients with visual impairment due to macular edema secondary to RVO in a real-world setting. METHODS This was a multicenter, post-authorization, observational study in France, including patients starting ranibizumab for RVO. Primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA) at month 6. Secondary endpoints were mean changes from baseline in BCVA at month 24 and central retinal thickness (CRT) at months 6 and 24, and treatment use in real-world setting. RESULTS 226 branch RVO (BRVO) and 196 central RVO (CRVO) patients were enrolled; 71.7% and 70.9% completed the 24-month follow-up, respectively. In BRVO, mean (SD) baseline BCVA was 55.2 (18.7) letters, with gains of 14.3 (13.7), 14.1 (16.5), 13.0 (17.5), and 11.4 (20.1) letters at months 3, 6, 12, and 24, respectively. In CRVO, mean (SD) baseline BCVA was 40.4 (25.6) letters, with gains of 16.0 (21.2), 9.5 (25.4), 9.2 (27.7), and 8.3 (23.8) letters at months 3, 6, 12, and 24, respectively. At month 24, 52% of BRVO and 41% of CRVO patients had gains of 15 or more letters. In BRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 550 (175), 315 (104), 343 (122), 335 (137), and 340 (105) μm. In CRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 643 (217), 327 (152), 400 (203), 379 (175), and 348 (161) μm. On average, BRVO patients had 3.8 injections for 6.9 visits by month 6, and 7.2 injections for 19.7 visits by month 24. CRVO patients had 2.7 injections for 4.2 visits by month 6 and 7.1 injections for 21.1 visits by month 24. Factors predictive of better BCVA gain at month 6 were age under 60 at baseline, lower baseline BCVA and BCVA gain at month 3. There were no new safety findings. CONCLUSION Major improvements in BCVA and CRT were observed at month 3 after the induction phase and then were sustained up to month 24, with a slight decrease, probably due to under-treatment. This study demonstrated ranibizumab to be a safe and effective treatment for BRVO and CRVO in the real-world setting, although more regular or proactive treatment could further improve outcomes.
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Affiliation(s)
- Agnès Glacet-Bernard
- Department of Ophthalmology/Paris-Est Créteil University (UPEC, Paris XII University)/Intercommunal Hospital Center and Henri Mondor Hospital, Créteil, France
| | - Jean-François Girmens
- Department of Ophthalmology, INSERM-DGOS CIC 1423, Centre Hospitalier National d'Ophtalmologie (CHNO) des Quinze-Vingts, Paris, France
| | - Laurent Kodjikian
- Ophthalmology, Hopital de la Croix Rousse, Lyon University, UMR CNRS MATEIS 5510, Lyon, France
| | - Cécile Delcourt
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, F-33000, Bordeaux, France
| | - Franck Fajnkuchen
- Ophthalmology, Hôpital Avicenne, Bobigny, France
- Centre d'Imagerie et Laser, Paris, France
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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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Douglas VP, Douglas KAA, Vavvas DG, Miller JW, Miller JB. Short- and Long-Term Visual Outcomes in Patients Receiving Intravitreal Injections: The Impact of the Coronavirus 2019 Disease (COVID-19)-Related Lockdown. J Clin Med 2022; 11:jcm11082097. [PMID: 35456189 PMCID: PMC9029849 DOI: 10.3390/jcm11082097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/10/2022] Open
Abstract
Purpose: To investigate the short- and long-term impact of COVID-19—related lockdown on the vision of patients requiring intravitreal injections (IVI) for neovascular Age-related Macular degeneration (nvAMD), diabetic retinopathy (DR), central retinal vein occlusion (CRVO), or branch retinal vein occlusion (BRVO). Methods: This is a retrospective study from the Retina department of three Mass Eye and Ear centers. Charts of patients age of ≥ 18 years with any of the abovementioned diagnoses who had a scheduled appointment anytime between 17 March 2020 until 18 May 2020 (lockdown period in Boston, Massachusetts) were reviewed at baseline (up to 12 weeks before the lockdown), at first available follow-up (=actual f/u) during or after the lockdown period, at 3 months, 6 months, and at last available completed appointment of 2020. Results: A total of 1001 patients met the inclusion criteria. Of those patients, 479 (47.9%) completed their intended f/u appointment, while 522 missed it (canceled and “no show”). The delay in care of those who missed it was 59.15 days [standard deviation (SD) ± 49.6]. In these patients, significant loss of vision was noted at actual f/u [Best corrected visual acuity (BCVA) in LogMAR (Logarithm of the Minimum Angle of Resolution)—mean (±SD)—completed: 0.45 (±0.46), missed: 0.53 (±0.55); p = 0.01], which was more prominent in the DR group [Visual acuity (VA) change in LogMAR—mean (±SD); completed: 0.04 (±0.28), missed: 0.18 (±0.44); p = 0.02] and CRVO [completed: −0.06 (±0.27), missed: 0.11 (±0.35); p = <0.001] groups followed by nvAMD [completed: 0.006 (±0.16), missed: 0.06 (±0.27); p = 0.004] and BRVO [completed: −0.02 (±0.1), missed: 0.03 (±0.14); p = 0.02] ones. Overall, a higher percent of people who missed their intended f/u experienced vision loss of more than 15 letters at last f/u compared to those who completed it [missed vs. completed; 13.4% vs. 7.4% in nvAMD (p = 0.72), 7.8% vs. 6.3% in DR (0.84), 15.5% vs. 9.9% in CRVO (p < 0.001) and 9.6% vs. 2% in BRVO (p = 0.48)]. Conclusions: Delay in care of about 8.45 weeks can lead to loss of vision in patients who receive IVI with DR and CRVO patients being more vulnerable in the short-term, whereas in the long-term, CRVO patients followed by the nvAMD patients demonstrating the least vision recovery. BRVO patients were less likely to be affected by the delay in care. Adherence to treatment is key for maintaining and improving visual outcomes in patients who require IVI.
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Affiliation(s)
| | | | | | | | - John B. Miller
- Correspondence: ; Tel.: +1-(617)-573-3750; Fax: +1-(617)-573-3698
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Modi YS, Goduni L, Moini H, Gibson A, Boucher N, Lucas G, Dhoot DS. Antivascular Endothelial Growth Factor Dosing Frequency and Visual Outcomes in Macular Edema Following Central Retinal Vein Occlusion. JOURNAL OF VITREORETINAL DISEASES 2021; 5:505-512. [PMID: 37007170 PMCID: PMC9976151 DOI: 10.1177/2474126421989225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: We evaluated the relationship between dosing frequency of intravitreal antivascular endothelial growth factor (anti-VEGF) agents and visual acuity (VA) outcomes over 2 years in eyes with macular edema (ME) secondary to central retinal vein occlusion (CRVO) in the US routine clinical practice setting. Methods: This retrospective analysis assessed electronic medical records of eyes with ME secondary to CRVO that received their first anti-VEGF injection January 1, 2012, to May 31, 2016, and were followed for 1 year or more in the US-based Vestrum Health Treatment and Outcomes database. Eyes were divided into 2 injection frequency subcohorts (≤6 or ≥7 injections/year). Results: Overall, 851 (34.6%) of 2458 eyes with ME secondary to CRVO received 6 or fewer injections, and 1607 (65.4%) received 7 or more injections through 1 year. The mean number of injections in patients receiving 6 or fewer injections and 7 or more injections was 4.7 and 8.8, respectively, and baseline mean VA was 35 and 37 letters, respectively. At year 1, mean letter gain from baseline was less in eyes receiving 6 or fewer injections vs in those receiving 7 or more injections (7.0 vs 12.2, P < .001). Mean VA at year 2 was 50 letters in eyes receiving 6 or fewer injections (n = 50) and 55 letters in eyes receiving 7 or more injections (n = 157). Conclusions: In routine clinical practice, more frequent dosing with anti-VEGF agents was associated with greater visual benefits in eyes with ME secondary to CRVO.
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Affiliation(s)
- Yasha S. Modi
- New York University Langone Health, New York, NY, USA
| | | | - Hadi Moini
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | | | | | - Dilsher S. Dhoot
- California Retina Consultants/Retina Consultants of America, Santa Barbara, CA, USA
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Kim MS, Choi J, Lee HD, Woo SJ. Dexamethasone Intravitreal Implant for the Treatment of Macular Edema Following Retinal Vein Occlusion: Post Hoc Analysis of Post-Marketing Surveillance Data in the Real-World Setting in Korea. Clin Ophthalmol 2021; 15:3623-3636. [PMID: 34475750 PMCID: PMC8407780 DOI: 10.2147/opth.s302014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/21/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose To supplement established efficacy and safety data, this analysis evaluated the real-world use of dexamethasone (DEX) intravitreal implant 700 µg for retinal vein occlusion (RVO)-related macular edema in an Asian population and baseline factors potentially associated with DEX implant efficacy. Patients and Methods A prospective, observational, post-marketing surveillance study was conducted at 38 sites in South Korea in patients consecutively presenting with macular edema following branch or central RVO (BRVO, CRVO), and administered a first DEX implant. Follow-up visits and subsequent DEX or other therapies conformed with local practice. Outcome measures included best-corrected visual acuity (BCVA), change in BCVA from baseline, responder rates, and adverse events. Associations between baseline characteristics and BCVA gains were evaluated. Month-1, -2, -4, and -6 visit analysis windows were established. Results In all, 700 patients (79.1% BRVO, 20.9% CRVO) received 1.12 DEX implants (mean) and were followed for 101.5 days (standard deviation, 51.7); 90% received a single implant. Among patients with analyzable data, mean BCVA improved from baseline with peak changes in Month 2 of −0.193 and −0.212 LogMAR, (P < 0.0001) and remained significant in the BRVO subgroup at the Month 4 and 6 windows (P < 0.0001 and P = 0.0039, respectively). Treatment-naïve patients experienced greater BCVA increases. The proportion of patients with stable/improved BCVA tended to decrease after Month 2 through Month 6 and the decline was greater in the CRVO subgroup. At the Month-2 window, ≥1-, 2- and 3-line increases were positively associated with younger age, worse baseline BCVA, and treatment naivety. The most common adverse event was increased intraocular pressure. Conclusion In the real-world clinical setting in South Korea, DEX implant improved visual acuity and had a favorable safety profile similar to that reported in randomized controlled trials and observational European and North American studies. These data further support the value of DEX implant as a treatment option for RVO. ClinicalTrials.gov Identifier NCT01976650. Date of registration: November 6, 2013.
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Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | | | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Lee T, Robbins CB, Thomas AS, Fekrat S. Treatment Patterns and Clinical Outcomes for Branch Retinal Vein Occlusion: An 8-Year Experience at a Tertiary Eye Center. JOURNAL OF VITREORETINAL DISEASES 2021; 5:412-419. [PMID: 37008715 PMCID: PMC9976115 DOI: 10.1177/2474126420978874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work aims to investigate real-world treatment patterns and outcomes in eyes with branch retinal vein occlusion in the antivascular endothelial growth factor (anti-VEGF) era. Methods: A retrospective, nonrandomized, comparative study was conducted on eyes diagnosed with branch retinal vein occlusion at a single tertiary center between 2009 and 2017. Medical history, treatment patterns, and visual acuity outcomes were examined. Subanalysis was performed for eyes that met the eligibility criteria for the BRAVO (Ranibizumab for the Treatment of Macular Edema Following Branch Retinal Vein Occlusion) trial. Results: A total of 315 eyes were included, of which 244 were treatment naive. In all eyes, the most common first treatment was the following: intravitreal bevacizumab (38.4%), aflibercept (15.1%), ranibizumab (8.1%), sectoral scatter laser (6.2%), and triamcinolone (3.1%). At 1 year, treatment-naive eyes had received an average of 2.43 anti-VEGF injections. During follow-up, treatment-naive eyes gained an average of 0.21 Early Treatment Diabetic Retinopathy Study lines. Forty eyes that met BRAVO trial criteria received an average of 5.05 anti-VEGF injections in the first year and gained an average of 1.83 Early Treatment Diabetic Retinopathy Study lines. Conclusions: This real-world cohort received fewer anti-VEGF injections at year 1 and experienced less improvement in visual acuity during the course of treatment than clinical trial participants. Trial-eligible patients received more injections and had greater visual gains than those who would not have been eligible for the trial.
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Affiliation(s)
- Terry Lee
- Duke University School of Medicine, Durham, NC, USA
| | | | | | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
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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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RANIBIZUMAB TREATMENT IN TREATMENT-NAIVE NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Results From LUMINOUS, a Global Real-World Study. Retina 2021; 40:1673-1685. [PMID: 31764612 PMCID: PMC7447127 DOI: 10.1097/iae.0000000000002670] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effectiveness, safety, and treatment patterns of ranibizumab 0.5 mg in treatment-naive patients with neovascular age-related macular degeneration enrolled in LUMINOUS study. METHODS This 5-year, prospective, multicenter, observational study recruited 30,138 adult patients (treatment-naive or previously treated with ranibizumab or other ocular treatments) who were treated according to the local ranibizumab label. RESULTS Six thousand two hundred and forty-one treatment-naive neovascular age-related macular degeneration patients were recruited. Baseline (BL) demographics were, mean (SD) age 75.0 (10.2) years, 54.9% females, and 66.5% Caucasian. The mean (SD) visual acuity (VA; letters) gain at 1 year was 3.1 (16.51) (n = 3,379; BLVA, 51.9 letters [Snellen: 20/92]) with a mean (SD) of 5.0 (2.7) injections and 8.8 (3.3) monitoring visits. Presented by injection frequencies <3 (n = 537), 3 to 6 (n = 1,924), and >6 (n = 918), visual acuity gains were 1.6 (14.93), 3.3 (16.57), and 3.7 (17.21) letters, respectively. Stratified by BLVA <23 (n = 382), 23 to <39 (n = 559), 39 to <60 (n = 929), 60 to <74 (n = 994), and ≥74 (n = 515), visual acuity change was 12.6 (20.63), 6.7 (17.88), 3.6 (16.41), 0.3 (13.83), and -3.0 (11.82) letters, respectively. The incidence of ocular/nonocular adverse events was 8.2%/12.8% and serious adverse events were 0.9%/7.4%, respectively. CONCLUSION These results demonstrate the effectiveness and safety of ranibizumab in treatment-naive neovascular age-related macular degeneration patients.
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Gurung RL, FitzGerald LM, McComish BJ, Hewitt AW, Verma N, Burdon KP. Comparing vision and macular thickness in neovascular age-related macular degeneration, diabetic macular oedema and retinal vein occlusion patients treated with intravitreal antivascular endothelial growth factor injections in clinical practice. BMJ Open Ophthalmol 2021; 6:e000749. [PMID: 34013049 PMCID: PMC8098929 DOI: 10.1136/bmjophth-2021-000749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/17/2021] [Accepted: 04/24/2021] [Indexed: 02/06/2023] Open
Abstract
Objective To compare the visual outcomes of intravitreal antivascular endothelial growth factor (anti-VEGF) injections in neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO) in a real-world setting. Methods and analysis Retrospective analysis of data from the Tasmanian Ophthalmic Biobank database. The median change in best-corrected visual acuity (BCVA) between baseline and 12 months post initiating intravitreal anti-VEGF treatment were compared between the three diseases. Final BCVA, central macular thickness (CMT), cumulative number of injections and overall predictors of change in BCVA and CMT were also determined. Results At 12 months, change in BCVA was significantly different between nAMD, DMO and RVO cohorts (p=0.032), with lower median change for DMO (2 letters, range −5 to 20) than for RVO (11 letters, range −20 to 35). Likewise, CMT change was significantly different between the three cohorts (p=0.022), with a smaller reduction in CMT in DMO (−54 µm, range −482 to 50) than RVO patients (−137 µm, range −478 to 43; p=0.033). Total number of injections received (p=0.028) and final BCVA score (p=0.024) were also significantly different between the groups. Baseline BCVA was a negative predictor (p=0.042) and baseline CMT a positive predictor (p<0.001) of outcome. After adjusting for baseline BCVA and CMT, diagnosis of nAMD or RVO was a predictor of visual improvement compared with the DMO. Conclusions At the end of 12 months, nAMD and RVO cohorts had the greatest improvement in BCVA, however the final BCVA for DMO was significantly better than for nAMD.
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Affiliation(s)
- Rajya L Gurung
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Liesel M FitzGerald
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bennet J McComish
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Alex W Hewitt
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Nitin Verma
- Department of Ophthalmology, University of Tasmania, Hobart, Tasmania, Australia
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Treatment outcomes of retinal vein occlusion in clinical practice in Nepal. BMC Ophthalmol 2021; 21:92. [PMID: 33602158 PMCID: PMC7890616 DOI: 10.1186/s12886-021-01857-y] [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: 07/24/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluated the treatment outcomes of retinal vein occlusion (RVO) in a routine clinical practice in Nepal. METHODS This was a retrospective analysis of observational data of patients with RVO who attended the retina clinic of the Tilganga Institute of Ophthalmology from 1 November 2017 to 31 October 2018. The main outcome was the mean change in visual acuity (VA) at 12 months from the start of treatment. Other outcomes of interest were the mean change in central subfield thickness (CST) and the number of treatments over 12 months. RESULTS A total of 99 eyes (of 99 patients) with RVO (60 - branch RVO [BRVO] and 39 - central RVO [CRVO] were available for the analysis. Eyes with CRVO had worse VA and CST at baseline. Eyes in both groups were similar for age, associated factors for RVO, duration of vision loss and the presence of ischemia at baseline. The mean (95% Confidence Interval [CI]) VA change at 12 months for BRVO was - 0.35 (- 0.46, - 0.23) logMAR (p < 0.001) from a mean (SD) of 0.75 (0.42) logMAR at baseline with 63% achieving VA < 0.3 logMAR while for CRVO it was - 0.35 (- 0.46, - 0.23) logMAR (p = 0.19) from 1.13 (0.61) logMAR at baseline and VA < 0.3 logMAR in 36%. The mean (95% CI) change in CST over 12 months was - 114 (- 189, - 40) μm (p = 0.003) from a mean (SD) of 423 (151) μm at baseline for BRVO and - 184(- 276, - 91) μm (p < 0.001) from 519 (213) μm for CRVO. Patients in both groups received a median of 2 bevacizumab injections over 12 months. Around 37% eyes were lost before 12 months' observation. The mean VA and CST trajectory in these eyes at their last visit was similar to those that completed 12 months. CONCLUSION The outcomes of RVO over the 12 months were inferior and the number of treatments fewer than those of the clinical trials and other reports from routine clinical practice. Future studies to identify the treatment barriers are warranted to improve the treatment outcomes in our patients.
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Pearce I, Clemens A, Brent MH, Lu L, Gallego-Pinazo R, Minnella AM, Creuzot-Garcher C, Spital G, Sakamoto T, Dunger-Baldauf C, McAllister IL. Real-world outcomes with ranibizumab in branch retinal vein occlusion: The prospective, global, LUMINOUS study. PLoS One 2020; 15:e0234739. [PMID: 32555630 PMCID: PMC7302470 DOI: 10.1371/journal.pone.0234739] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/01/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the effectiveness, safety, and treatment patterns of ranibizumab 0.5 mg in treatment-naïve patients with branch retinal vein occlusion (BRVO) enrolled in the LUMINOUS™ study. Study design A 5-year, global, prospective, multicenter, observational, open-label study conducted in a clinical practice (real-world) setting at outpatient ophthalmology clinics that recruited 30,138 consenting adult patients from all approved indications for ranibizumab across 42 countries. Patients with BRVO were treated according to the local ranibizumab label of the participating countries. Mean change in visual acuity (VA) in Early Treatment Diabetic Retinopathy Study letters from baseline to Year 1, treatment exposure during Year 1, and adverse events (AEs) over 5 years were assessed. Results Of the 1366 recruited BRVO patients, 405 were treatment-naïve at baseline with a mean (standard deviation [SD]) age of 67.9 (12.5) years, 57.5% were female, and 71.8% were White. At Year 1 (n = 189), the mean (SD) VA gain was 11.9 (17.66) letters from a baseline of 49.2 (±20.32) letters with a mean (SD) of 5.0 (2.34) injections. VA gains were higher in patients (n = 83) who received 6–9 injections (13.6 [20.16] letters) than in those who received 2–5 injections (n = 92, 11.7 [15.43] letters), or 1 injection (n = 14, 3.6 [13.72] letters). Patients with baseline VA <23 letters had numerically highest VA gains (n = 20, 31.1 [24.48] letters). Over 5 years, the rate of ocular/non-ocular AEs was 7.4%/9.1% and serious AEs was 0.3%/4.4% in treatment-naïve BRVO patients (n = 405). Conclusions One year results from the LUMINOUS real-world study showed a clinically meaningful VA improvement with ranibizumab in treatment-naïve patients with BRVO; numerically higher VA gains were achieved in patients who received more injections and those with poor baseline VA. No new safety signals were observed.
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Affiliation(s)
- Ian Pearce
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, England, United Kingdom
- Department of Eye and Vision Science, University of Liverpool, Liverpool, England, United Kingdom
| | - 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
- * E-mail:
| | - Michael H. Brent
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | - Angelo Maria Minnella
- Department of Ophthalmology, Catholic University of Sacred Heart - Foundation "Policlinico Universitario A. Gemelli"- IRCCS, Rome, Italy
| | | | - Georg Spital
- Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | | | - Ian L. McAllister
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, Australia
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Vilela MA. Use of Anti-VEGF Drugs in Retinal Vein Occlusions. Curr Drug Targets 2020; 21:1181-1193. [PMID: 32342813 DOI: 10.2174/1389450121666200428101343] [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: 12/02/2019] [Revised: 02/12/2020] [Accepted: 03/05/2020] [Indexed: 11/22/2022]
Abstract
Retinal vein occlusion (RVO) is one of the most prevalent causes of visual loss in the Western World. Its pathogenesis is still not completely known. Chronic macular edema and ischemia compromise the functional and anatomical status of the retina. Antivascular endothelial growth factor (anti-VEGF) injections have demonstrated better results than other previous options, including observation or laser therapy. This narrative review aims to analyze the current aspects related to these drugs.
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Affiliation(s)
- Manuel Ap Vilela
- Medical School, Federal University of Health Sciences of Porto Alegre, Brazil and Ophthalmological Service, Cardiology Institute, University Foundation of Cardiology, Porto Alegre, Brazil
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Stallworth JY, Thomas AS, Constantine R, Stinnett SS, Fekrat S. Treatment Patterns and Clinical Outcomes for Central Retinal Vein Occlusion in the Antivascular Endothelial Growth Factor Era. JOURNAL OF VITREORETINAL DISEASES 2019; 4:13-21. [PMID: 37009559 PMCID: PMC9976087 DOI: 10.1177/2474126419878922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This article describes treatment patterns and visual outcomes for central retinal vein occlusion (CRVO) in the antivascular endothelial growth factor (anti-VEGF) era. Methods: A retrospective cohort study of eyes diagnosed with CRVO between 2009 and 2016 was conducted. Treatment history and visual acuity (VA) measurements were abstracted from medical records and analyzed. Results: A total of 476 eyes of 476 patients (median age 67 years, median follow-up 25.4 months) were included. Optical coherence tomography was obtained in 93.9% and fluorescein angiography in 80% of cases on presentation. Mean VA at presentation and final visit was 20/60 and 20/94, respectively, for eyes with nonischemic CRVO, whereas that of ischemic cases remained worse than 20/800 at final follow-up. Intravitreal bevacizumab was the most common first treatment (42.2%). Intravitreal steroid was the first treatment in 3.6% and ultimately administered in 11.3% of eyes. In the first year, an average of 5.2 ± 3.6 and 2.2 ± 3.4 anti-VEGF injections were given in treatment-naive and nontreatment-naive eyes, respectively. Conclusions: In our real-world cohort, anti-VEGF injection burden and frequency are lower than in published clinical trials. Visual outcomes in both ischemic and nonischemic eyes with CRVO are poorer than expected and worse than those recorded in controlled trial settings.
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Affiliation(s)
| | | | | | | | - Sharon Fekrat
- Department of Ophthalmology, Duke University, Durham, NC, USA
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Sharma S, Khan MA, Chaturvedi A. Real-Life Clinical Effectiveness of Razumab® (the World's First Biosimilar of Ranibizumab) in Retinal Vein Occlusion: A Subgroup Analysis of the Pooled Retrospective RE-ENACT Study. Ophthalmologica 2018; 241:24-31. [PMID: 29945143 PMCID: PMC6390449 DOI: 10.1159/000488602] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND This subgroup analysis of the RE-ENACT study evaluates the effectiveness of Razumab® (the world's first biosimilar of ranibizumab by Intas Pharmaceuticals Ltd.) in Indian patients with retinal vein occlusion (RVO). METHODS The data on patients with RVO who had received ≥3 injections of Razumab® between January and August 2016 were analyzed. Endpoints were: improvement in best corrected visual acuity (BCVA), and a decrease in central macular thickness (CMT), intraretinal fluid (IRF), and subretinal fluid (SRF) from baseline at weeks 4, 8, and 12. RESULTS Of 160 patients, the majority (61.87%) were men. The mean (±SE) BCVA improved from baseline (0.76 ± 0.04) to week 4 (0.73 ± 0.03; p = 0.0656), which attained significance at week 8 (0.55 ± 0.02; p < 0.0001) and week 12 (0.47 ± 0.02; p < 0.0001). The mean (±SE) CMT significantly decreased from baseline (447.60 ± 10.91 μm) to week 4 (431.84 ± 10.92 μm; p = 0.0028), week 8 (339.28 ± 8.12 μm; p < 0.0001), and week 12 (298.23 ± 6.68 μm; p < 0.0001). The proportion of patients with IRF and SRF significantly (p < 0.0001) decreased from baseline to weeks 4, 8, and 12 (IRF: from 70.63 to 45.63, 39.38, and 30.00%, respectively; SRF: from 65.63 to 37.50, 28.13, and 24.38%, respectively). A subgroup analysis of branch RVO and central RVO showed similar results. No new safety concerns were observed. CONCLUSION Razumab® (biosimilar of ranibizumab) effectively improved visual acuity and disease outcomes in patients with RVO in a real-world setting with no new safety concerns.
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Albrecht M, Nica M, Colombo D, Ferri C, Tadini P, Introini U, Bandello F. Il trattamento con farmaci intravitreali anti-VEGF in pazienti naïve in Italia. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2018. [DOI: 10.1177/2284240318793905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M Albrecht
- Scientific Institute San Raffaele, Milan, Italy
| | - M Nica
- Novartis Farma, Origgio, Italy
| | | | - C Ferri
- Scientific Institute San Raffaele, Milan, Italy
| | - P Tadini
- Scientific Institute San Raffaele, Milan, Italy
| | - U Introini
- Scientific Institute San Raffaele, Milan, Italy
| | - F Bandello
- Scientific Institute San Raffaele, Milan, Italy
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Comments to: Real-World Outcomes of Anti-VEGF Treatment for Retinal Vein Occlusion in Portugal. Eur J Ophthalmol 2017; 27:e190-e191. [PMID: 28777389 DOI: 10.5301/ejo.5001016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Author's Reply to Comments to: Real-World Outcomes of Anti-VEGF Treatment for Retinal Vein Occlusion in Portugal. Eur J Ophthalmol 2017; 27:e192. [PMID: 28862735 DOI: 10.5301/ejo.5001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Short-term results of endovascular surgery with tissue plasminogen activator injection for central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2017; 255:2135-2140. [PMID: 28803326 DOI: 10.1007/s00417-017-3763-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/01/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To examine the effects of retinal endovascular surgery (REVS) with tissue plasminogen activator injection into the retinal vein in central retinal vein occlusion (CRVO) eyes. METHODS Sixteen consecutive CRVO patients with macular edema and decreased visual acuity who were referred to Toyama University Hospital between March 2014 and February 2016 were included in this study. Changes in visual acuity (VA) and central retinal thickness (CRT) were evaluated up to 6 months after REVS. Staining and leakage of the retinal veins in fluorescein angiography (FA) was graded in nine patients. RESULTS Ten of 16 eyes were determined to be non-ischemic while the remaining six were ischemic. The mean logarithm of the minimum angle of resolution (logMAR) of VA was significantly improved from 0.98 ± 0.58 (mean ± standard deviation) at baseline to 0.78 ± 0.61 at 3 months (p = 0.002), and 0.64 ± 0.60 at 6 months (p = 0.003) after REVS. At 6 months, VA was improved in eight eyes (50%), while the other eight (50%) showed no change; none showed worsening. In the 10 eyes with non-ischemic CRVO, the mean VA was significantly improved at 6 months (p = 0.002), whereas no improvement was found in the six eyes with ischemic CRVO, . In all eyes, the mean CRT was significantly improved from 804 ± 343 μm at baseline to 506 ± 304 μm at 2 months (p = 0.014), 332 ± 229 μm at 3 months (p = 0.0001), and 305 ± 235 μm at 6 months (p = 0.00001). The postoperative complications observed were prolonged vitreous hemorrhage in one eye and neovascular glaucoma in two eyes. For postoperative recurrence of macular edema, sub-tenon injection of triamcinolone acetonide was given to five eyes, and intravitreal injection of an anti-VEGF agent was given to five eyes. Pan-retinal photocoagulation was performed on six eyes with ischemic type CRVO. The FA score was significantly improved after REVS (p = 0.018). CONCLUSIONS REVS using a specially made micro-needle may be a surgical treatment option for non-ischemic CRVO, but it did not seem effective for ischemic CRVO.
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