Three-year real-world outcomes of intravitreal anti-VEGF therapies in patients affected by myopic choroidal neovascularization

Corazza, Paolo; Kabbani, Jamil; Soomro, Taha; Alam, Mostafa; D'Alterio, Francesco Maria; Younis, Saad

doi:10.1177/1120672120963455

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…Thus, unsurprisingly, such pathologies also share some common molecular drivers. One key molecule is vascular endothelial growth factor (VEGF), which has attracted huge attention in the past 50 years, for its central role in DR, diabetic macular oedema (DMO) and nvAMD [3][4][5][6]. VEGF was originally identified as a vascular permeability factor, and was later shown to be a potent mitogen for endothelial cells (ECs) with an ED 50 of 2-10 picomolar [7].…”

Section: Introductionmentioning

confidence: 99%

LRG1 as a novel therapeutic target in eye disease

Rossi

Lobo

Greenwood

et al. 2022

Eye

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Retinal and choroidal diseases are major causes of blindness and visual impairment in the developed world and on the rise due to an ageing population and diabetes epidemic. Standard of care is centred around blockade of vascular endothelial growth factor (VEGF), but despite having halved the number of patients losing sight, a high rate of patient non-response and loss of efficacy over time are key challenges. Dysregulation of vascular homoeostasis, coupled with fibrosis and inflammation, are major culprits driving sight-threatening eye diseases. Improving our knowledge of these pathological processes should inform the development of new drugs to address the current clinical challenges for patients. Leucine-rich α-2 glycoprotein 1 (LRG1) is an emerging key player in vascular dysfunction, inflammation and fibrosis. Under physiological conditions, LRG1 is constitutively expressed by the liver and granulocytes, but little is known about its normal biological function. In pathological scenarios, such as diabetic retinopathy (DR) and neovascular age-related macular degeneration (nvAMD), its expression is ectopically upregulated and it acquires a much better understood pathogenic role. Context-dependent modulation of the transforming growth-factor β (TGFβ) pathway is one of the main activities of LRG1, but additional roles have recently been emerging. This review aims to highlight the clinical and pre-clinical evidence for the pathogenic contribution of LRG1 to vascular retinopathies, as well as extrapolate from other diseases, functions which may be relevant to eye disease. Finally, we will provide a current update on the development of anti-LRG1 therapies for the treatment of nvAMD.

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Section: Introductionmentioning

confidence: 99%

LRG1 as a novel therapeutic target in eye disease

Rossi

Lobo

Greenwood

et al. 2022

Eye

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“…A recent retrospective study 22 of 96 eyes comparing real-world outcomes of intravitreal anti-VEGF therapies in patients with myopic CNV demonstrated no significant difference in visual improvement after 1 year of treatment between bevacizumab, ranibizumab and aflibercept. By year 3, visual improvement was not significant in the ranibizumab and bevacizumab groups.…”

Section: Discussionmentioning

confidence: 99%

Real-World Anti-Vascular Endothelial Growth Factor Therapy Outcomes in Myopic Choroidal Neovascularization

Bhatia¹,

Mehta²,

DaCosta³

et al. 2021

OPTH

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Aim Evaluation of real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in the primary treatment of choroidal neovascularization (CNV) secondary to pathological myopia. Patients and Methods A retrospective cohort analysis of treatment naive patients with myopic CNV who received treatment with either intravitreal ranibizumab or aflibercept over a 12-year period from September 2007 to May 2020 was performed. Baseline features, treatment factors and outcomes were compared between younger and older patients and final visual outcome was assessed for associated factors. Results Thirty-seven eyes of 36 patients (24 females, 12 males) were included. Mean age was 58 years (range=26–89 years). Of these patients, 11/36 (31%) were ≤50 years of age and 25/36 (69%) were ≥51 years of age. Seventy-three percent (27/37) of eyes were phakic. One patient received bilateral treatment for myopic CNV. Median spherical equivalent was −8.50 diopters. Seventy percent (26/37) of eyes commenced primary treatment with ranibizumab, and 11/37 (30%) eyes commenced treatment with aflibercept. There were no significant differences between treatment factors and outcomes of younger and older patients. Median number of injections was 3 over a median follow-up period of 24.6 months. Mean CRT decreased by 126μm and median visual improvement was +6 letters. Analysis showed that younger age (p=0.022) and fewer injections (p=0.004) were associated with better visual outcomes. Conclusion Myopic CNV requires less frequent anti-VEGF intravitreal therapy over a shorter follow-up period than both neovascular age-related macular degeneration and diabetic macular edema. Increased frequency of administration of intravitreal anti-VEGF treatment did not improve vision. Younger age is associated with a better final visual outcome. These findings may help to advise patients about the prognosis of treatment and help guide treatment decisions.

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“…Data was collected via Medisoft Software (Medisoft Limited, Leeds, UK), a well-known method of collecting and revising patient data that has been utilised in many published papers. [17][18][19][20] Patients not receiving any intravitreal injections for RVO were not included in the study, and neither were those switched to a different anti-VEGF treatment or to a different drug. Patients with other ocular comorbidities, such as dry or wet age-related macular degeneration, diabetic retinopathy, those who had retinal surgery, advanced cataract, or glaucoma, or in whom baseline BCVA was not recorded, were excluded from the analysis.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Long-term outcomes of anti-VEGF treatment of macular oedema due to retinal vein occlusions

Corazza

D'Alterio

Savastano

et al. 2022

European Journal of Ophthalmology

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Purpose retinal vein occlusion (RVO) is classified as either branch (BRVO) or central (CRVO) RVO. The gold standard treatment for macular oedema (MO) secondary to RVO is intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Our study aimed to compare ranibizumab and aflibercept outcomes over a maximum follow-up of five years. Methods this retrospective study assessed treatment-naïve RVO patients. Active disease was treated with three loading injections followed by a pro-re-nata (PRN) regimen of an anti-VEGF agent. Visual outcomes and injection frequency were analyzed, with patients stratified according to RVO subtype, anti-VEGF agent used, baseline vision, and age. Results 316 CRVO-affected eyes and 467 BRVO-affected eyes were analysed. Visual benefits between different treatments did not significantly differ, except in year 1 in ranibizumab-treated BRVO eyes. However, aflibercept-treated CRVO and BRVO eyes required significantly fewer injections during the follow up period. Furthermore, our results confirm that younger patients achieve better visual outcomes with fewer intravitreal injections. Overall, half of our patients did not require further injections after 1 year from diagnosis. Conclusion the results demonstrate that anti-VEGF treatment of RVO benefits vision for up to 5 years. Our findings are the first to suggest that compared to ranibizumab, fewer aflibercept injections may be required over five years follow up. Prospective randomised trials are needed to confirm this, alongside further attention to OCT scan features and the effect of patient demographics on treatment outcomes.

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Three-year real-world outcomes of intravitreal anti-VEGF therapies in patients affected by myopic choroidal neovascularization

Cited by 9 publications

References 22 publications

LRG1 as a novel therapeutic target in eye disease

LRG1 as a novel therapeutic target in eye disease

Real-World Anti-Vascular Endothelial Growth Factor Therapy Outcomes in Myopic Choroidal Neovascularization

Long-term outcomes of anti-VEGF treatment of macular oedema due to retinal vein occlusions

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