Evidence for Step Therapy in Diabetic Macular Edema.
Evidence for Step Therapy in Diabetic Macular Edema.
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糖尿病黄斑水肿阶梯疗法的证据。
DOI：
10.1056/nejme2208454
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Chew,EmilyY
中科院分区：
文献类型：
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作者：
Musch,DavidC;Chew,EmilyY
阶梯疗法是一种治疗方法，通常是健康保险公司为控制成本而要求的。它包括首先用一种低成本的药物治疗，只有在事实证明无效的情况下，才会转向另一种更昂贵的药物。虽然阶梯疗法通常用于治疗高血压、糖尿病、癌症和其他疾病，但由于担心其可能对患者造成长期伤害，一些人认为它是“先失败”的疗法。1、2对阶梯疗法的一个有效的批评是缺乏关于其有效性和安全性的证据基础。在本期杂志中，Jhaveri、Glassman和他的同事3描述了一项治疗一种流行的、可能致盲的疾病的严格的阶梯疗法试验。这项多中心、随机的临床试验由糖尿病视网膜病变临床研究视网膜网络进行，该网络包括160多个学术和社区临床站点和500多名眼科医生，他们治疗美国和加拿大的视网膜疾病。该网络此前报道了一项“非步骤”试验的结果，结果表明，在治疗糖尿病黄斑水肿时，当最初视力下降20/50或更差时，afLibercept对视力的平均改善比贝伐单抗更大。4、5
Step therapy is a treatment approach often required by health insurers to control costs. It involves treating first with a lower-cost medication and, only if that proves ineffective, switching to another, more costly medication. Although step therapy is commonly applied in treating hypertension, diabetes, cancer, and other conditions, concerns regarding its potential for long-term harm to the patient have led some to view it as “fail first” therapy. 1, 2 One valid criticism of step therapy is a lack of an evidence base for its efficacy and safety. In this issue of the Journal, Jhaveri, Glassman, and colleagues3 describe a rigorous trial of step therapy to treat a prevalent, potentially blinding condition.This multicenter, randomized clinical trial was conducted by the Diabetic Retinopathy Clinical Research Retina Network, which includes more than 160 academic and communitybased clinical sites and more than 500 ophthalmologists who treat retinal disorders throughout the United States and Canada. This network previously reported the results of a “non-step” trial showing that aflibercept resulted in greater mean improvement in visual acuity than bevacizumab in the treatment of diabetic macular edema when the initial loss in visual acuity was 20/50 or worse. 4, 5