<p>Trends in Real-World Neovascular AMD Treatment Outcomes in the UK</p>

Abstract

Purpose: To report trends in real-world outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) in the United Kingdom (UK) over the last decade. Design: Systematic review. Methods: Medline, PubMed, and Embase databases were searched from 9 April 2010 to 8 April 2020 for publications that met the inclusion criteria: treatment-naïve eyes, UK-only data and ≥1 year of follow-up. ICHOM (International Consortium for Health Outcome Measures) outcomes and study quality were assessed. Visual acuity (VA) trends were assessed in studies with ≥100 eyes at baseline. Results: Twenty-six studies (n=25,761 eyes) were included, meeting 14-17 out of 20 Institute of Health Economics Quality Appraisal of Case Series checklist domains. Only ranibizumab and aflibercept outcome data were available. The mean injection number in the first year of treatment was 5.9 in publications from 2010 to 2015 and 7.1 from 2015 to 2020. Average baseline VA and mean one-year, two-year and three-year VA gains gradually improved over the last decade. Longer-term studies reported that the visual gains achieved in the first year of treatment were rarely maintained, with under-treatment a likely contributing factor. Conclusion: UK real-world outcomes have improved over the last decade with improved service delivery and the adoption of more proactive treatment regimens but are still not always as impressive as registration clinical trial results. Access to longer-acting anti-VEGF therapies would reduce the treatment burden for patients, carers, and the healthcare system, potentially making replication of clinical trial results possible in the NHS.

Long-term outcomes of intravitreal anti-VEGF therapies in patients affected by neovascular age-related macular degeneration: a real-life study

“…The number of injections reported in our study differed significantly from the average amount of injections reported in clinical trials. However, our findings are in line with a previously published real-life study by Gayadine-Harricham et al and with a review by Metha et al showing huge variability of this parameter in previous studies ranging from 4.5 to 11.4 injections during the first year of treatment [ 32 , 33 ].…”

“…Our visual outcomes are concordant with those from Mehta et al study, which reviewed 26 studies providing outcome data on Ranibizumab and Aflibercept. They found that the visual gains achieved in the first year of treatment were rarely maintained, and suggested that under-treatment was likely a contributing factor [ 32 ].…”

Disease burden of age-related macular degeneration in China from 1990 to 2019: findings from the global burden of disease study

“…This may be due to a few reasons. First, the wide administration of anti-VEGF agents [ 18 , 19 ]. The emergence of anti-VEGF agents has revolutionized the treatment strategies against neovascular AMD, which can dramatically improve and prolong visual function, leading to alleviation of the AMD global burden.…”

Effects of delay in anti-vascular endothelial growth factor intravitreal injections for neovascular age-related macular degeneration

“…At that time, it was observed that real-world data did not always reflect smooth results from registration studies. After several years of treatment, the mean visual acuity (VA) had nevertheless improved as compared with presentation, in spite of frequency of delivered injections being actually inferior to that reported in the literature [ 5 , 6 ].…”