Anti‐vascular endothelial growth factors treatment of wet age‐related macular degeneration: from neurophysiology to cost‐effectiveness

Vottonen, Pasi

doi:10.1111/aos.13706

Cited by 3 publications

(6 citation statements)

References 271 publications

(328 reference statements)

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“…Per-dose cost is approximately US $772.94 per syringe, per pill, or unit, for pegaptanib; US $1216.65 per syringe, per pill, or unit for ranibizumab; US $1920.04 per vial, per pill, or unit, for aflibercept; and US $50 for bevacizumab. 60 – 62 According to the model developed by Kuopio University Hospital, 63 the direct medical costs include: (a) the costs of diagnosis including medical visit, FA, and OCT; (b) the cost of intravitreal injection of the medication; (c) the costs of follow up, including a medical visit and OCT; and (d) rehabilitation of legally blind persons. For one patient, a 6-week regimen with pegaptanib costs US $7729.40 per year, while bevacizumab PRN costs US $1610.40, ranibizumab PRN costs US $16,687.70, bevacizumab monthly costs US $2924.60, ranibizumab monthly US $25,759.20, aflibercept monthly costs US $13,954.70, aflibercept bimonthly costs US $6977.3, bevacizumab treat-and-extend regimen costs US $2167.9, ranibizumab treat-and-extend regimen costs US $18,678.9, and afliber-cept treat-and-extend regimen costs US $11,280.1.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis

Zhao

Wang

et al. 2020

Therapeutic Advances in Chronic Disease

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Background: As a debilitating neurodegenerative disease, neovascular age-related macular degeneration (nAMD) accounts for more than 90% of severe visual loss or legal blindness among AMD patients. Anti-vascular endothelial growth factor (VEGF) had been applied widely in nAMD treatment. To date, debate regarding efficacy and safety still exists among different anti-VEGF regimens as management of nAMD. To provide substantial evidence for clinical nAMD treatment, this study ranks the priority of anti-VEGF regimens via Bayesian network meta-analysis (NMA), comparing data collected from randomized controlled trials (RCTs). Methods: We searched PubMed Central, MEDLINE Ovid, Embase Ovid, ISRCTN, ICTRP and ClinicalTrials. gov from a database established until 1 April 2019 systematically for anti-VEGF regimens. Bayesian NMA with random-effect was conducted to compare efficacy and safety and rank priority of anti-VEGF regimens. The primary efficacy and safety outcomes were the proportion of patients gaining 15 or more letters, and the incidence of arterial thromboembolic (ATC) events. The effect measure is the standard mean difference (SMD), or the odds ratio (OR) with their 95% confidence interval (CI). The study protocol is registered with PROSPERO, number CRD42019132243. Results: We obtained 6467 citations and identified 29 RCTs including 13,596 participants; 86% of these trials were low risk or of uncertain risk bias. In NMA, ORs compared with sham injection for the proportion of patients gaining 15 or more letters (12,699 participants from 23 trials) ranged from 4.05 [95% Bayesian credible interval (CrI) 1.62–10.11] for ranibizumab quarterly regimen to 8.57 (95% CrI 4.66–15.73) for a ranibizumab treat-and-extend regimen. No difference was found between sham injection and anti-VEGF regimens for ATC events (11,500 participants from 18 trials). Results for the primary outcome did not substantially change in sensitivity analyses after removing studies at high risk of bias and small sample size ( n < 100), respectively. Conclusion: The treat-and-extend regimen of ranibizumab and aflibercept are the preferred anti-VEGF regimens for nAMD. Bevacizumab treat-and-extend regimens need more head-to-head comparisons with other regimens or sham injection for advanced application. The treat-and-extend regimen proved to be the most effective regimen for each anti-VEGF drug in the NMA. Pegaptanib every 6 weeks and Conbercept quarterly are unable to satisfy the best corrected visual acuity (BCVA) improvement requirement of nAMD patients.

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Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis

Zhao

Wang

et al. 2020

Therapeutic Advances in Chronic Disease

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“…A degeneração macular relacionada à idade (DMRI) é uma doença degenerativa que acomete a região central da retina (mácula), responsável pela visão de cores e detalhes, cuja progressão leva à perda de visão central. 1 Pode ser classificada como seca, responsável pela maior parte dos casos (85%-90%), ou exsudativa, também denominada neovascular ou úmida, correspondendo a 10%-15% do total de casos. 2 A DMRI exsudativa caracteriza-se pelo crescimento de novos vasos sanguíneos a partir de vasos preexistentes, em um processo denominado angiogênese ou neovascularização.…”

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“…Nesse processo, os fatores endoteliais de crescimento vascular (VEGF, do inglês vascular endothelial growth factors) são os fatores mais importantes para o estímulo à neovascularização retiniana e coroidiana; os novos vasos, por sua vez, são frágeis e mais permeáveis, levando a edemas, hemorragias e, em estágios avançados, fibrose. 1 Embora a DMRI exsudativa seja menos comum, a evolução para a cegueira é muito mais frequente nesta forma da doença.…”

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“…7 Os anti-VEGF revolucionaram o tratamento da DMRI exsudativa. 1,8 Antes da terapia anti-VEGF, a fotocoagulação retiniana e a terapia fotodinâmica eram as únicas opções de tratamento. A fotocoagulação, porém, era aplicável apenas a uma pequena parcela dos pacientes e tinha alto risco de formação de cicatriz com dano permanente na camada de fotorreceptores, 9 enquanto a terapia fotodinâmica não proporcionava ganho de acuidade visual; ambas as terapias foram praticamente abandonadas no manejo da DMRI exsudativa, sendo substituídas pela terapia anti-VEGF como modalidade terapêutica de primeira linha da DMRI exsudativa em todas as diretrizes de tratamento.…”

unclassified

“…O ranibizumabe é um fragmento de anticorpo monoclonal recombinante humanizado anti-VEGF-A e o aflibercepte é uma proteína de fusão recombinante que consiste de porções de domínios extracelulares dos receptores 1 e 2 do VEGF humano, ligados à porção do fragmento cristalizável (Fc) da imunoglobulina humana IgG1, e apresenta alta afinidade por uma ampla gama de VEGF, incluindo todas as isoformas de VEGF-A, o VEGF-B e pelo fator de crescimento placentário (PlGF). 1 A terapia anti-VEGF é aplicada por meio de injeções intravítreas no olho acometido. Os principais desfechos obtidos com o tratamento anti-VEGF são o ganho de acuidade visual, sua manutenção a longo prazo e a diminuição de fluido no exame de tomografia de coerência óptica (OCT).…”

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Opinião: Vantagens do tratar e estender como regime de utilização dos anti-VEGF para DMRI

Ramalho¹,

Medina²

2022

JAFF

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O objetivo deste artigo é auxiliar médicos e gestores nas tomadas de decisão em relação ao tratamento da degeneração macular relacionada à idade (DMRI) com anti-VEGF. A complexidade das decisões decorre do alto custo do tratamento, do fato de se tratar de uma doença que pode evoluir para a cegueira e das dificuldades trazidas pelos esquemas de tratamento. Buscamos mostrar aspectos práticos importantes do tratamento, levando em conta os desfechos clínicos, a utilização de recursos e a carga para os pacientes, com base nas melhores evidências.

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Diabetic retinopathy and age-related macular degeneration: a survey of pharmacoutilization and cost in Calabria, Italy

et al. 2019

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The aged population is constantly growing, thus fostering an increase in age-dependent diseases. Among these, diabetic retinopathy (DR) along with age-related macular degeneration entails progressive vision loss. Since such conditions are associated with the proliferation of novel vessels, their pharmacotherapeutic management consists of the intravitreal injection of anti-vascular endothelial growth factor drugs, able to hinder the driving of vascular proliferation prompted by vascular endothelial growth factor. The humanized anti-vascular endothelial growth factor monoclonal antibody ranibizumab provided evidence for efficacy in several trials, hence earning approval by the US Food and Drug Administration for therapeutic use in all the stages of DR. Due to the lack of epidemiologic and pharmacoeconomic evaluation in the local Calabria Region context, the present retrospective observational study focused on prevalence of DR and age-related macular degeneration, treatment and cost of therapy with ranibizumab in 870 patients arriving to clinical observation at the “Mater Domini” University Hospital in Calabria, Italy from January 2014 to June 2017. Data were extracted from the database of ophthalmology ward and subjected to statistical analysis. The results suggest that the most frequent retinal diseases are age-related macular degeneration and DR and that the use of ranibizumab has been decreasing over the 4-year study period together with the associated cost per patient which was similar for both disorders. Therefore, appropriateness of treatment with drugs other than ranibizumab needs to be assessed in this setting and deep monitoring of pharmacologic treatment for retinal diseases is necessary to prevent or delay visual acuity decrease and complete vision loss. Study procedures were performed in accordance with the “Mater Domini” University Hospital ethical standards of the responsible committee on human experimentation

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Anti‐vascular endothelial growth factors treatment of wet age‐related macular degeneration: from neurophysiology to cost‐effectiveness

Cited by 3 publications

References 271 publications

Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis

Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis

Opinião: Vantagens do tratar e estender como regime de utilização dos anti-VEGF para DMRI

Diabetic retinopathy and age-related macular degeneration: a survey of pharmacoutilization and cost in Calabria, Italy

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