Intravitreal Ranibizumab for neovascular Age-related macular degeneration in clinical practice: five-year treatment outcomes

Zhu, Meidong; Chew, Jamie; Broadhead, Geoffrey; Luo, Kehui; Joachim, Nichole; Hong, Thomas; Syed, Adil; Chang, Andrew

doi:10.1007/s00417-014-2799-8

Cited by 34 publications

(27 citation statements)

References 29 publications

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“…20 In addition, the improvement in macular edema on OCT often precedes VA improvement. 21,22 Because the present investigation was a study of short duration, it is possible that longer-duration topical therapy may show VA benefit. The further decline in CST and SRF at the third study visit for the 8 eyes that remained on dorzolamide-timolol therapy suggests that there may be added benefit over time.…”

Section: Discussionmentioning

confidence: 98%

Topical Dorzolamide-Timolol With Intravitreous Anti–Vascular Endothelial Growth Factor for Neovascular Age-Related Macular Degeneration

et al. 2016

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IMPORTANCE There is a subset of eyes with neovascular age-related macular degeneration (AMD) that have persistent exudation despite fixed-interval intravitreous anti-vascular endothelial growth factor (VEGF) injections.OBJECTIVE To evaluate the effect of topical dorzolamide hydrochloride-timolol maleate on anatomic and functional outcomes in eyes with neovascular AMD and incomplete response to anti-VEGF therapy.DESIGN, SETTING, AND PARTICIPANTS An exploratory, prospective single-arm interventional study at a tertiary referral academic private practice. Patients with neovascular AMD and persistent macular edema despite fixed-interval intravitreous anti-VEGF therapy were enrolled. Baseline spectral-domain optical coherence tomography and clinical data, including visual acuity and intraocular pressure, were obtained at enrollment and from one visit before enrollment. The study was performed at the Retina Service of Wills Eye Hospital and the offices of Mid Atlantic Retina from February 1, 2015, through September 30, 2015. Patients were followed up for at least 2 visits after enrollment. Central subfield thickness, maximum subretinal fluid height, and maximum pigment epithelial detachment height from spectral-domain optical coherence tomography were recorded at each visit.INTERVENTIONS Enrolled eyes received a regimen of topical dorzolamide-timolol twice daily and continued to receive the same intravitreous anti-VEGF therapy at the same interval as received before enrollment for the duration of the study. MAIN OUTCOMES AND MEASURESChange in central subfield thickness was the primary outcome measure. Changes in maximum subretinal fluid height, maximum pigment epithelial detachment height, and visual acuity were the secondary outcome measures. RESULTSTen patients (10 eyes) completed the study. The mean age of the patients was 78.2 years (age range, 65-91 years), and 6 were male. Eight eyes received intravitreous aflibercept, and 2 eyes received intravitreous ranibizumab. All study eyes had been receiving long-term anti-VEGF therapy with the same medication before study enrollment for a mean of 21.9injections. The mean central subfield thickness decreased from 419.7 μm at enrollment to 334.1 μm at the final visit (P = .01). The mean maximum subretinal fluid height decreased from 126.6 μm at enrollment to 49.5 μm at the final visit (P = .02). The mean maximum pigment epithelial detachment height decreased from 277.4 μm at enrollment to 239.9 μm at the final visit (P = .12). The mean logMAR visual acuity were 0.54 at enrollment and 0.48 at the final visit (P = .60). CONCLUSIONS AND RELEVANCEThese data suggest that topical dorzolamide-timolol may reduce central subfield thickness and subretinal fluid in eyes with persistent exudation despite consistent, fixed-interval intravitreous anti-VEGF treatment for neovascular AMD.

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Section: Discussionmentioning

confidence: 98%

Topical Dorzolamide-Timolol With Intravitreous Anti–Vascular Endothelial Growth Factor for Neovascular Age-Related Macular Degeneration

et al. 2016

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“…Numerous studies (especially with ranibizumab) have shown the challenges of bringing the efficacy demonstrated in clinical trials into the real world [53–57]. Given that anti-VEGF therapies for the treatment of DME were only approved in 2012, robust studies on the real-world effectiveness of anti-VEGF therapies for this indication have not yet been published.…”

Section: Introductionmentioning

confidence: 99%

Fundamental principles of an anti-VEGF treatment regimen: optimal application of intravitreal anti–vascular endothelial growth factor therapy of macular diseases

Lanzetta

Loewenstein

2017

Graefes Arch Clin Exp Ophthalmol

130

146

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BackgroundIntravitreal anti–vascular endothelial growth factor (VEGF) therapy is now considered the gold standard for the treatment of various retinal disorders. As therapy has evolved, so too have the treatment regimens employed by physicians in clinical practice; however, visual outcomes observed in the real world have typically not reflected those reported in clinical trials. Possible reasons for this include a lack of consensus on treatment regimens and a lack of clarity about what the aims of treatment should be.MethodsThe Vision Academy Steering Committee met to discuss the principles of an ideal treatment regimen, using evidence from the literature to substantiate each point. Literature searches were performed using the MEDLINE/PubMed database (cut-off date: March 2016) and restricted to English-language publications. Studies with fewer than ten patients were excluded from this review.ResultsThe Steering Committee identified the following four key principles for the ideal treatment regimen for anti-VEGF management of retinal diseases:Maximize and maintain visual acuity (VA) benefits for all patientsDecide when to treat next, rather than whether to treat nowTitrate the treatment intervals to match patients’ needsTreat at each monitoring visit. ConclusionsIt is proposed that the adoption of a proactive and more personalized approach in the clinic such as a treat-and-extend regimen will lead to benefits for both the patient and the physician, through a reduction in the associated treatment burden and better utilization of clinic resources. Implementation of the four principles should also lead to better VA outcomes for each patient, with a minimized risk of vision loss.

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“…Previous treatments included photo dynamic therapy (PDT) (n = 3) 22,24,25 and anti-VEGF intravitreal injections (n = 4). 17,18,26,27 Most studies (n = 18) were conducted in a single country, of which 15 were European, 1 was Australian, 24 and 2 were Japanese. 22,28 The country with the largest number of studies (n = 7) was the UK.…”

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confidence: 99%

Ranibizumab for the treatment of wet AMD: a summary of real-world studies

Chong

2015

Eye

111

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Data from real-world studies of ranibizumab in neovascular (wet) age-related macular degeneration suggest that outcomes in clinical practice fail to match those seen in clinical trials. These real-world studies follow treatment regimens that differ from the fixed dosing used in the pivotal clinical trial programme. To better understand the effectiveness of ranibizumab in clinical practice, we conducted a comprehensive evaluation of 12-month outcomes reported in peer-reviewed 'realworld' publications. Key measures included in our analysis were mean change in visual acuity (VA) and the proportion of patients gaining ≥ 15 letters or losing ≤ 15 letters. Twenty studies were eligible for inclusion in our study, with 18 358 eyes having sufficient data for analysis of 12-month outcomes. Mean baseline VA ranged from 48.8 to 61.6 Early Treatment Diabetic Retinopathy Study letters. Mean change in VA was between − 2.0 and +5.5 letters, with a grand mean of +2.9 ± 3.2, and a weighted mean (adjusted for the number of eyes in the study) of +1.95. Eleven studies reported that 19 ± 7.5 (mean value) of patients gained ≥ 15 letters, while in 12 studies the mean percentage of patient losing ≤ 15 letters was 89 ± 6.5%. Our comprehensive analysis of real-world ranibizumab study data confirm that patient outcomes are considerably poorer than those reported in randomised control trials of both fixed and pro re nata regimens.

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Intravitreal Ranibizumab for neovascular Age-related macular degeneration in clinical practice: five-year treatment outcomes

Abstract: The use of intravitreal ranibizumab in an as-needed treatment regimen over a five-year period was effective in maintaining vision in patients with nAMD and in reducing macular thickness, with a relatively low rate of adverse and serious adverse events.

Cited by 34 publications

References 29 publications

Topical Dorzolamide-Timolol With Intravitreous Anti–Vascular Endothelial Growth Factor for Neovascular Age-Related Macular Degeneration

Topical Dorzolamide-Timolol With Intravitreous Anti–Vascular Endothelial Growth Factor for Neovascular Age-Related Macular Degeneration

Fundamental principles of an anti-VEGF treatment regimen: optimal application of intravitreal anti–vascular endothelial growth factor therapy of macular diseases

Ranibizumab for the treatment of wet AMD: a summary of real-world studies

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