Population-based incidence of exudative age-related macular degeneration and ranibizumab treatment load

Geirsdóttir, Ásbjörg; Jönsson, Oskar; Thórisdóttir, Sigríđur; Helgadottir, G.P.; Jónasson, Friðbert; Stefánsson, Einar; Sigurðsson, H.

doi:10.1136/bjophthalmol-2011-300304

Cited by 10 publications

(13 citation statements)

References 19 publications

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“…The Blue Mountains Eye Study found a 10-year neovascular AMD incidence of 2.2% for patients past the age of 49 years, 2.0% for those from 60–69 years, and 12.4% for those 80 years and older [4]. Similar average incidence rates were found in a comprehensive study of the Icelandic population [5]. …”

Section: Introductionmentioning

confidence: 57%

Individualized Treatment of Neovascular Age-Related Macular Degeneration: What are Patients Gaining? Or Losing?

Stewart

2015

JCM

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The widespread use of drugs that bind diffusible vascular endothelial growth factor (VEGF) has revolutionized the treatment of neovascular age-related macular degeneration (AMD). The pivotal ranibizumab and aflibercept registration trials featured monthly intravitreal injections for 12 months, during which visual acuities and macular edema rapidly improved for the first 3 months and modest gains or stabilization continued until the primary endpoint. In many subsequent trials, patients were evaluated monthly and treated as-needed (PRN) according to the results of visual acuity (VA) testing, fundus examinations and optical coherence tomography scans. Compared to monthly-treated control groups, PRN treated patients require fewer injections during the first year but they also experience smaller VA gains (1–3 letters). A small number of prospective trials that directly compared monthly with PRN therapy showed that VA gains with discontinuous therapy lag slightly behind those achieved with monthly injections. Physicians recognize that monthly office visits with frequent intraocular injections challenge patients’ compliance, accrue high drug and professional service costs, and clog office schedules with frequently returning patients. To decrease the numbers of both office visits and anti-VEGF injections without sacrificing VA gains, physicians have embraced the treat-and-extend strategy. Treat-and-extend has not been studied as rigorously as PRN but it has become popular among both vitreoretinal specialists and patients. Despite the possible risks associated with discontinuous therapy (decreased VA and increased macular fluid), most physicians individualize treatment (PRN or treat-and-extend) for the majority of their patients. This review chapter explores the many advantages of individualized therapy, while balancing these against suboptimal responses due to the decreased frequency of anti-VEGF injections.

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Section: Introductionmentioning

confidence: 57%

Individualized Treatment of Neovascular Age-Related Macular Degeneration: What are Patients Gaining? Or Losing?

Stewart

2015

JCM

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“…Both genetic susceptibility and behavioral and lifestyle factors modify the risk of developing AMD [23]. As seen also in this study, AMD has a strong association with age [4, 6-12, 21-23]. Other risk factors associated with AMD include cigarette smoking, previous cataract surgery, higher body mass index, history of cardiovascular disease, hypertension, diabetes, and higher plasma fibrinogen [21-23].…”

Section: Discussionmentioning

confidence: 74%

“…Accordingly, in this study the 146 new patients with exudative AMD should need a mean 818 (range 438-1898) injections per year. Approximately 1200 injections were given in Iceland for the on average 147 exudative AMD patients per year which suits well with the range of the suggested regimen [4]. …”

Section: Discussionmentioning

confidence: 99%

“…While treatment for dry AMD remains to be established, treatment for exudative AMD using anti-vascular endothelial growth factors (anti-VEGF) is being increasingly used to limit progression of the condition [3, 4]. In order to plan adequate healthcare provision, estimates of incidence of especially exudative AMD are required [4, 5]. Large population-based cohort studies by using grading of fundus photographs showed that the incidence of AMD increased with age [6-9].…”

Section: Introductionmentioning

confidence: 99%

“…Some recent studies used literature search to obtain prevalence estimates of AMD [10-12], and the prevalence estimates were used to estimate annual incidence of AMD [11]. There is only one earlier study showing an average number of exudative AMD in a defined population [4]. …”

Section: Introductionmentioning

confidence: 99%

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Population-Based Age Group Specific Annual Incidence Rates of Symptomatic Age-Related Macular Degeneration

Saari¹

2014

TOOPHTJ

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Purpose To study the population-based annual incidence rates of exudative, dry and all cases of symptomatic age-related macular degeneration (AMD) in different age and sex groups.Methods. This is a one year, prospective, population-based study on all consecutive new patients with AMD in the hospital district of Central Finland. The diagnosis was confirmed in all patients with slit lamp biomicroscopy, optical coherence tomography (OCT) using a Spectralis HRA + OCT device, and the Heidelberg Eye Explorer 1.6.2.0 program. Fluorescein angiograms were taken when needed.Results. The population-based annual incidence rates of all cases of symptomatic AMD increased from 0.03% (95% CI, 0.01-0.05%) in the age group 50-59 years to 0.82% (95% CI, 0.55-1.09%) in the age group 85-89 years and were 0.2% (95% CI, 0.17-0.24%) in exudative, 0.11% (95% CI, 0.09-0.14%) in dry, and 0.32% (95% CI, 0.28-0.36%) in all cases of AMD in the age group 60 years and older. During the next 20 years in Central Finland the population-based annual incidence rates can be estimated to increase to 0.27% (95% CI, 0.24-0.30%) in exudative, to 0.13% (95% CI, 0.11-0.15%) in dry, and to 0.41% (95% CI, 0.37-0.45%) in all cases of AMD in the age group 60 years and older. The population-based annual incidence of AMD did not show statistically significant differences between males and females (p>0.1).Conclusion: The population-based age-group specific annual incidence rates of symptomatic AMD of this study may help to plan health care provision for patients of AMD.

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Ranibizumab and Risk of Hospitalisation for Ischaemic Stroke and Myocardial Infarction in Patients with Age-Related Macular Degeneration: A Self-Controlled Case-Series Analysis

et al. 2014

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BackgroundRanibizumab, a vascular endothelial growth factor (VEGF) inhibitor, is used in the treatment of age-related macular degeneration. Inhibition of VEGF has an anti-angiogenic action and is associated with thrombogenicity, thus, myocardial infarction and ischaemic stroke are potential side effects of VEGF inhibitors.ObjectiveOur objective was to assess the association between use of ranibizumab and risk of hospitalisation for ischaemic stroke (IS) and myocardial infarction (MI).MethodsThe self-controlled case series design was used, including subjects exposed to ranibizumab (Anatomical Therapeutic Chemical [ATC] code S01LA04) who were hospitalized for IS (International Classification of Diseases, tenth edition [ICD-10] code I63) or the combined endpoint of stroke or transient ischaemic attack (TIA) (ICD-10 code G45) or MI (ICD-10 code I21) were identified between August 2007 and March 2013. Rate ratios in exposed periods compared with unexposed periods were calculated using conditional Poisson regression.ResultsA total of 323 subjects received ranibizumab and were hospitalized for IS, 490 for IS or TIA, and 391 for MI. Median period of exposure was 8–9 months with follow-up times of approximately 2.8 years. No elevated risk of IS was seen in the 1–30 days post initiation (incidence rate ratio [IRR] 1.36; 95 % confidence interval [CI] 0.98–1.88); however, elevated risk was observed for those who received therapy for 31–60 days (IRR 1.91; 95 % CI 1.13–3.24). Sensitivity analyses adjusting for time-varying confounders found elevated risk in both the 1–30 days and 31–60 days periods. Similar results to those for IS were observed for the combined endpoint of IS or TIA. No association was seen for MI in either time period (1–30 days IRR 0.90, 95 % CI 0.65–1.23; 31–60 days IRR 0.98, 95 % CI 0.54–1.79).ConclusionThis case-series analysis suggests an increased risk of hospitalisation for ischaemic stroke for patients receiving ranibizumab in the 31–60 days risk period. Studies with larger populations are required to confirm the risk in the 1–30 days risk period. No evidence of increased risk of hospitalisation for MI was observed.

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Population-based incidence of exudative age-related macular degeneration and ranibizumab treatment load

Abstract: These data allow an estimation of the incidence of exudative AMD in a Caucasian population and the treatment load with ranibizumab, which may help plan anti-vascular endothelial growth factor treatment programmes and estimate costs.

Cited by 10 publications

References 19 publications

Individualized Treatment of Neovascular Age-Related Macular Degeneration: What are Patients Gaining? Or Losing?

Individualized Treatment of Neovascular Age-Related Macular Degeneration: What are Patients Gaining? Or Losing?

Population-Based Age Group Specific Annual Incidence Rates of Symptomatic Age-Related Macular Degeneration

Ranibizumab and Risk of Hospitalisation for Ischaemic Stroke and Myocardial Infarction in Patients with Age-Related Macular Degeneration: A Self-Controlled Case-Series Analysis

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