Cost-Effectiveness of Ranibizumab Versus Aflibercept for Macular Edema Secondary to Branch Retinal Vein Occlusion: A UK Healthcare Perspective

Adedokun, Lola; Burke, Christina

doi:10.1007/s12325-015-0279-0

Cited by 10 publications

(4 citation statements)

References 19 publications

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“…Based on meticulous analysis from the National Health Insurance Research Database, we are confident to demonstrate a higher risk of optic neuropathy among amiodarone-treated patients and suggest that physicians be alert to the new onset of visual disturbance in these patients. HUI-CHEN CHENG, MD 1,2 HUAN-JUI YEH, MD 3,4 NICOLE HUANG, PHD 5 AN-GUOR WANG, MD, PHD This study not only showed comparable letter gain with the BRAVO study 2 at 6 months, but also revealed the maintenance of this gain at 1 year. Although this confirms aflibercept to be efficacious in macular edema owing to BRVO, its uniqueness, in terms of longer action, from other antievascular endothelial growth factor agents has not been completely explored.…”

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confidence: 80%

“…3,4 In many cases, the results from multivariable regression and propensity score analysis are similar. 5 Moreover, both statistical methods have their own limitations and none of them solve the problem of unknown confounders. 2 The instrumental variable approach may be a better option, because it may help to adjust for unobserved confounders.…”

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confidence: 99%

“…Studies have shown ranibizumab to be more economical than aflibercept, even though it has a longer biological effect, 5 highlighting the need for assessment of as-needed dosing of IAI and the best timing of combination treatment.…”

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REPLY: We thank Mindel et al 1 for their interest in our recent study regarding amiodarone-associated optic neuropathy. Multivariable regression analysis and propensity score analysis are 2 of the most widely used methods for adjusting observed confounders. 2 As the application of propensity score analysis becomes increasingly popular, its limitations are also widely discussed. 3,4 In many cases, the results from multivariable regression and propensity score analysis are similar. 5 Moreover, both statistical methods have their own limitations and none of them solve the problem of unknown confounders. 2 The instrumental variable approach may be a better option, because it may help to adjust for unobserved confounders. 2 However, it is difficult to find an instrument closely related to the use of amiodarone, but not related to optic neuropathy. Therefore, we did not adopt this approach. We acknowledged this limitation of unobservable confounding in our article and chose Cox multivariable regression analysis as the analytic method for the current study.The second concern raised by Mindel et al may be a misunderstanding. The variables included in the main Cox regression model were age, sex, amiodarone use, and variables with a P value of <0.05 in the univariate analysis. A similar approach was adopted for our stratification analyses. In addition, we conducted the sensitivity analyses (Table 1; also Table 3 in the original article, available at www.aaojournal.org) by including all variables (age, sex, 7 comorbidities, and amiodarone use). The results remained robust. Obstructive sleep apnea was not included in the analysis because none of these patients with obstructive sleep apnea had the occurrence of optic neuropathy during the study period.In our study, 7764 patients in the control group, which accounted for 31.4% of all control subjects, had >1 comorbidity, compared with 3412 patients (55.3%) in amiodarone group. Of the 7764 control subjects with >1 comorbidity, 14 subjects (0.2%) had optic neuropathy, compared with 14 patients (0.4%) in the amiodarone group. After reconstructing the model by including age, sex, taking amiodarone or not, and having >1 comorbidity or not, patients with >1 comorbidity were significantly more likely to incur optic neuropathy (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.17e4.03; P ¼ 0.01). The impact of amiodarone use on the optic neuropathy also remained robust in this model (OR, 2.20; 95% CI, 1.19e4.05; P ¼ 0.01).The final concern from Mindel et al is whether these patients had unilateral or bilateral ocular involvement. In this study, we retrieved our data from the Taiwan's National Health Insurance Research Database, which is secondary information and contains data for insurance, such as diagnostic code, examination code, medication, and date of visit. We used inclusion criteria with visual field and fundus examination, which were recognized from the examination codes in the database, to make our diagnosis more precise. However, this database did not provide access t...

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“…4,5,6 The release of inflammatory mediators like TNFalpha, leukotrienes, integrins, prostaglandins, and vascular endothelial growth factor (VEGF) follows endothelial damage in the affected blood vessels, resulting in an inflammatory response. 7 As proved, VEGF has a crucial role in the persistence and development of secondary M E. 8 This condition may lead to severe vision loss owing to possible complications including vitreous bleeding, retinal neovascularization, and macular ischemia, but the most frequent cause of diminution of vision is M E. 9 For many years, the first line of treatment for this M E was grid laser photocoagulation. With the presence of anti-VEGF agents, intravitreal injections of Ranibizumab and Aflibercept have become the first-line therapy methods for M E. As reported in the VIBRANT study, the use of anti-VEGF contributed to a large improvement in visual acuity and a decrease in CM T in eyes with M E secondary to BRVO.…”

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Comparative study between the effect of intravitreal injection of Ranibizumab and Aflibercept on macular oedema secondary to branch retinal vein occlusion

Tawfik

Toson²,

Elmalah³

2022

Al-Azhar International Medical Journal

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Background: Occlusion of retinal veins is a mutual disorder that affect the retina usually occurs when blood clot obstructs a retinal vein. Aim of The Work:To compare the effects of Ranibizumab versus Aflibercept intravitreal injections on macular edema (M E) caused by branch retinal vein occlusion (BRVO). Patients and Methods: This study was carried out on two groups of patients of either sex with an age ranging from 35 to 70 years. Every patient injected 3 loading doses. Ranibizumab dose is 0.5 mg dose vial (0.05 mL). Aflibercept dose is 2 mg dose vial (0.05 mL). Follow up was done 1st day post operation then monthly for 4 months. The eyes were followed for VA, IOP, OCT, FFA and any complications. Results: Both groups showed a significant reduction in central macular thickness (CM T) as well as an improvement in best-corrected visual acuity (BCVA). As regard CM T, the reduction and improvement in Aflibercept group was 71.6%, while the reduction and improvement in Ranibizumab group was 61.2%. Regarding to BCVA, the improvement in Aflibercept group was 70.8%, while the improvement in Ranibizumab group was 44.4%. The majority of the patients were satisfied from improvement of vision after injections. Conclusion: Both Ranibizumab and Aflibercept were efficient drugs in resolving M E secondary to BRVO with a superior improvement in VA and CM T in Aflibercept group compared with basal values.

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