Switching from aflibercept to brolucizumab for the treatment of refractory neovascular age-related macular degeneration
Switching from aflibercept to brolucizumab for the treatment of refractory neovascular age-related macular degeneration
复制标题
DOI：
10.1007/s10384-022-00908-1
复制
发表时间：
2022-03-02
影响因子：
2.4
通讯作者：
Kataoka, Keiko
中科院分区：
文献类型：
--
作者：
Ota, Hikaru;Takeuchi, Jun;Kataoka, Keiko
目的：研究阿非利赛普难治性新生血管性年龄相关性黄斑变性（nAMD）患者转用brolucizumab治疗16周后的结果。研究设计回顾性观察性研究。方法收集因阿非利西普耐药而改用布卢珠单抗治疗的nAMD患者的资料。分析光学相干断层扫描的最佳矫正视力（BCVA，以最小分辨角的对数表示）、视网膜中央厚度（CRT）、脉络膜中央厚度（CCT）和渗出情况。结果48例患者共48眼。切换后4 ~ 7周，BCVA由0.26 +/- 0.19变为0.25 +/- 0.21 （P = 0.95，无统计学意义），CRT由298.9 +/- 108.4 mu m降至241.9 +/- 92.5 mu m (P < 0.001)， CCT由182.6 +/- 89.3 mu m降至169.7 +/- 82.6 mu m （P < 0.001）。在23只眼中，12只（52.2%）在1个月后出现了干性黄斑，8只（34.8%）在1个月后减少了渗出变化。16周时，31只眼（64.6%）达到治疗间隔>= 8周。2例患者（4.2%）退出治疗，7例（14.6%）发生眼内炎症（IOI）， 8例（16.7%）因未能延长治疗间隔（>= 8周）而重新使用阿伯西普。结论对阿非利西普难治性的眼睛改用brolucizumab在控制渗出变化方面具有良好的效果。然而，IOI和在维持期将治疗间隔调整为至少8周扰乱了brolucizumab治疗的继续。
Purpose To examine the 16-week outcomes of switching to brolucizumab in eyes with neovascular age-related macular degeneration (nAMD) refractory to aflibercept. Study design Retrospective observational study. Methods Data of eyes with nAMD who switched to brolucizumab because of resistance to aflibercept were collected. The best-corrected visual acuity (BCVA; in logarithm of the minimum angle of resolution), central retinal thickness (CRT), central choroidal thickness (CCT), and exudative status on optical coherence tomography were analyzed. Results A total of 48 eyes of 48 patients were reviewed. At 4 to 7 weeks after switching, BCVA changed from 0.26 +/- 0.19 to 0.25 +/- 0.21 (not significant; P = 0.95), but CRT significantly decreased from 298.9 +/- 108.4 mu m to 241.9 +/- 92.5 mu m (P < 0.001) and CCT from 182.6 +/- 89.3 mu m to 169.7 +/- 82.6 mu m (P < 0.001). Of the 23 eyes refractory to monthly aflibercept injections, 12 (52.2%) achieved a dry macula, and 8 (34.8%) reduced exudative changes at 1 month. At 16 weeks, 31 eyes (64.6%) achieved the treatment interval >= 8 weeks. Two patients (4.2%) dropped out, 7 eyes (14.6%) developed intraocular inflammation (IOI), and 8 eyes (16.7%) switched back to aflibercept because of the failure to extend the treatment interval >= 8 weeks. Conclusion Switching to brolucizumab in eyes refractory to aflibercept conferred favorable outcomes in controlling exudative changes. However, IOI and the regulation of the treatment interval to at least 8 weeks during the maintenance phase disrupted the continuation of brolucizumab treatment.