Anti-vascular endothelial growth factor in neovascular age-related macular degeneration – a systematic review of the impact of anti-VEGF on patient outcomes and healthcare systems

Abstract

Background Systematically review the evidence describing the impact of anti–vascular endothelial growth factor (anti-VEGF) therapy on neovascular age-related macular degeneration (nAMD) patient outcomes and healthcare resource utilization. Methods A systematic literature review was completed using Medline and EMBASE for publications prior to July 2018, and proceedings from major ophthalmology conferences (January 2016 to July 2018). The search strategy combined terms for nAMD with terms for anti-VEGF and study design. The review focused on publications describing the impact of anti-VEGF on blindness, visual impairment, vision-related quality of life (VRQoL), mortality, and costs. The search targeted data collected in epidemiological or observational studies to reflect real-world outcomes but also considered modeling-based approaches. Results The use of anti-VEGF in clinical practice was associated with significant reduction in the incidence of blindness by nAMD. Population-based analyses reported reduction in incidence among the general population of 47% (9.1 cases/100,000 in 2006 to 4.8 cases/100,000 in 2011). Among patients aged ≥50 years, a reduction of 50% was observed (52.2 cases/100,000 in 2000 to 25.7 cases/100,000 in 2010). In some cases, the odds of decreased vision (defined as decline from normal to moderate, moderate to severe, or severe to blindness) fell by 41% following introduction of anti-VEGF. Patients’ VRQoL improved with treatment, with patients reporting a positive impact shortly after treatment was initiated. Change on National Eye Institute 25-Item Visual Function Questionnaire score from baseline to month 12 ranged from 0.7 to 4.4. Although nAMD patients report signs of depression and anxiety, the evidence suggests that there is no association between the use of anti-VEGF and the prevalence or diagnosis of depression. The introduction of anti-VEGF led to increased overall treatment costs due to replacement of existing less frequently administered treatments (e.g. photodynamic therapy) and increased number of patients treated (prior to anti-VEGF, only ~ 20% of patients were eligible for treatment). Conclusions The introduction of anti-VEGF agents has been associated with a positive impact on patient-relevant outcomes, including a significant reduction in incidence of blindness and visual impairment by nAMD. Anti-VEGF agents replaced less-effective treatments, improving patient outcomes and broadening the patient population eligible for treatment.

The Timecourses of Functional, Morphological, and Molecular Changes Triggered by Light Exposure in Sprague–Dawley Rat Retinas

“…Although a variety of new therapeutic strategies have been suggested (including stem cell transplantation to replace photoreceptors [ 6 , 7 ], bionic implants [ 8 , 9 ], and optogenetics approaches [ 10 , 11 , 12 ]), currently there are no effective cures. Common pharmacological approaches studied on rodents [ 13 , 14 ] and tested on humans [ 15 , 16 , 17 , 18 ] have as their primary objective slowing down photoreceptor death to preserve surviving retinal function, increase tissue resilience, and prevent retinal reorganization. Indeed, it is well known that photoreceptors stress initiate an unavoidable chain of events, collectively termed retinal remodeling [ 19 , 20 ], in the remnant inner retina, independently of the molecular defects that initially trigger retinal degeneration [ 21 , 22 , 23 , 24 ].…”

Acceptability of intravitreal injections in geographic atrophy: protocol for a mixed-methods pilot study

“…Anti-VEGF injections have substantially reduced the prevalence of sight loss attributable to nAMD. 8 However, studies of patients receiving intravitreal injections for nAMD show evidence of significant anxiety, stress, discomfort and pain associated with these injections. [9][10][11][12] A recent metasynthesis of qualitative research on experiences of patients with nAMD summarises potential negative impacts of repeated injections:…”

“…Anti-VEGF injections have substantially reduced the prevalence of sight loss attributable to nAMD. 8 …”

Characterizing New-Onset Exudation in the Randomized Phase 2 FILLY Trial of Complement Inhibitor Pegcetacoplan for Geographic Atrophy

“…9 The exudative form of AMD (eAMD) can be treated with intravitreal injections of vascular endothelial growth factor (VEGF) A inhibitors. 10 Although anti-VEGF therapy has been shown to improve vision and reduce the risk of severe vision loss over several years in eyes with eAMD, 11e13 the nonexudative form of AMD can continue to progress to macular atrophy, apparently independent of the exudative process. 14 For most patients with late AMD, macular atrophy is the characteristic end stage of the disease process, resulting in progressive and irreversible loss of visual function as the area of macular atrophy enlarges.…”