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Roubelat FP, Barioulet L, Varenne F, Escudier C, Meyer P, Gomane C, Butterworth J, Pagot-Mathis V, Fournié P, Gualino V, Soler V. The Reinforced Treat-and-Extend Protocol for Exudative Age-Related Macular Degeneration: Retrospective Assessment of 24-Month Real-World Outcomes in France. Ophthalmol Ther 2024:10.1007/s40123-024-00938-7. [PMID: 38625500 DOI: 10.1007/s40123-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION The aim of this work is to evaluate the real-world outcomes of the reinforced treat-and-extend (RTE) protocol for the treatment of exudative age-related macular degeneration with intravitreal injections of aflibercept or ranibizumab (anti-vascular endothelial growth factor therapies). METHODS This was a retrospective review of patients from two tertiary ophthalmology centers in France initiating the RTE protocol between February 2018 and June 2021. The primary outcome was change in best-corrected visual acuity (BCVA) after 24 months. Secondary outcomes were change in central retinal thickness (CRT), recurrence, and management-related factors (injection interval, number of injections/consultations). Outcomes were additionally evaluated after protocol changes (strict versus modified RTE protocol groups). RESULTS Sixty-eight patients (72 eyes) were included (68% females; mean age 82.2 ± 7.8 years). After 24 months, mean BCVA significantly improved (65.22 ± 14 vs. 71.96 ± 13 Early Treatment Diabetic Retinopathy Study letters; p < 0.001) and CRT significantly decreased (388.6 ± 104 vs. 278.8 ± 51 μM; p < 0.001) with 21% of eyes showing signs of exudation. Over the 24 months, a mean total of 14.9 ± 4.0 injections and 8.6 ± 1.4 consultations were performed. Mean 24-month injection interval was 7.9 ± 2.3 weeks. Initial and 24-month ophthalmic outcomes for eyes in the strict (47%) versus modified (53%) groups were not significantly different, but mean time interval to first recurrence of disease activity was significantly shorter for the modified group (7.3 ± 2.4 vs. 9.9 ± 2.5 weeks; p < 0.001). Patients in the strict RTE group received significantly less injections (13.9 ± 3.6 vs. 16.5 ± 3.9; p = 0.006) and mean 24-month injection interval was significantly longer (9.5 ± 2.7 vs. 6.5 ± 2.1 weeks; p < 0.001). Consultation number was similar (8.5 ± 1.9 vs. 8.8 ± 1.6; p = 0.93). Treatment with aflibercept versus ranibizumab did not influence ophthalmic or management outcomes. CONCLUSIONS The RTE protocol, even when modified, reduced consultations but improved ophthalmic outcomes. The RTE protocol could reduce hospital visits and overall burden while also encouraging better patient compliance. Video Abstract available for this article. VIDEO ABSTRACT Vincent Soler and François-Philippe Roubelat summarize the Reinforced Treat-and-Extend Protocol and main results (MP4 225022 KB).
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Affiliation(s)
- François-Philippe Roubelat
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Lisa Barioulet
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Fanny Varenne
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Clément Escudier
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Pauline Meyer
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Clément Gomane
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Jacqueline Butterworth
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Véronique Pagot-Mathis
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Pierre Fournié
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
- Faculty of Medicine, University of Toulouse III, Toulouse, France
| | - Vincent Gualino
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
- Ophthalmology Department, Clinique Honoré-Cave, Montauban, France
| | - Vincent Soler
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France.
- Faculty of Medicine, University of Toulouse III, Toulouse, France.
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Fernandez-Crehuet P, Haselgruber S, Padial-Gomez A, Vasquez-Chinchay F, Fernandez-Ballesteros MD, López-Riquelme I, Jimenez-Gallo D, Segura-Palacios JM, Contreras-Steyls M, Osorio-Gómez GF, Hernández-Rodríguez JC, Sanchez-Diaz M, Cuenca-Barrales C, Arias-Santiago S, Molina-Leyva A. Short-Term Effectiveness, Safety, and Potential Predictors of Response of Secukinumab in Patients with Severe Hidradenitis Suppurativa Refractory to Biologic Therapy: A Multicenter Observational Retrospective Study. Dermatol Ther (Heidelb) 2023; 13:1029-1038. [PMID: 36892752 DOI: 10.1007/s13555-023-00906-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/14/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Biologic drugs have a key role in the long-term anti-inflammatory treatment of moderate to severe patients due to their immunomodulatory properties. The aim of this study is to evaluate the effectiveness and safety of secukinumab in patients with moderate to severe HS after 16 weeks of treatment, and to explore potential predictors of clinical response to the drug. METHODS Multicenter observational retrospective study. Patients treated with secukinumab 300 mg every 2 or 4 weeks who had completed at least 16 weeks of follow-up from nine hospitals based in southern Spain (Andalusia) were included in this study. Treatment effectiveness was assessed using the Hidradenitis Suppurativa Clinical Response (HiSCR). Information about adverse events was collected, the therapeutic burden of the patients was calculated as the summation of systemic medical treatments and surgical interventions (excluding incision and drainage) experienced until the start of secukinumab treatment. RESULTS Forty-seven patients with severe HS were included for analysis. At week 16, 48.9% (23/47) of patients achieved HiSCR. Adverse events were present in 6.4% (3/47) of the patients. The multivariate analysis showed that female sex and, to a lesser extent, lower body mass index (BMI) and a lower therapeutic burden were potentially associated with a higher probability of HiSCR achievement. CONCLUSIONS Favorable short-term effectiveness and safety of secukinumab in the treatment of severe HS patients were observed. Female sex, lower BMI and a lower therapeutic burden may be associated with a higher probability of achieving HiSCR.
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Affiliation(s)
| | - Sofía Haselgruber
- Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain.,Hidradenitis Suppurativa Clinic, Granada, Spain
| | - Alicia Padial-Gomez
- Dermatology Department, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | | | - Irene López-Riquelme
- Dermatology Department, Hospital Universitario Regional de Málaga, Málaga, Spain
| | | | | | | | | | | | - Manuel Sanchez-Diaz
- Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain.,Hidradenitis Suppurativa Clinic, Granada, Spain
| | - Carlos Cuenca-Barrales
- Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain.,Hidradenitis Suppurativa Clinic, Granada, Spain
| | - Salvador Arias-Santiago
- Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain.,Hidradenitis Suppurativa Clinic, Granada, Spain
| | - Alejandro Molina-Leyva
- Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain.,Hidradenitis Suppurativa Clinic, Granada, Spain.,European Hidradenitis Suppurativa Foundation, Dessau-Roßlau, Germany
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