Anti-VEGF treatment of diabetic macular edema in clinical practice: effectiveness and patterns of use (ECHO Study Report 1).
Anti-VEGF treatment of diabetic macular edema in clinical practice: effectiveness and patterns of use (ECHO Study Report 1).
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DOI：
10.2147/opth.s128509
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Scott LC
中科院分区：
文献类型：
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作者：
Blinder KJ;Dugel PU;Chen S;Jumper JM;Walt JG;Hollander DA;Scott LC
评价血管内皮生长因子（VEGF）抑制剂在糖尿病性黄斑水肿临床治疗中的有效性、安全性和注射频率。多中心（10个地点），对接受≥3次抗vegf注射的患者（n=156）进行回顾性图表回顾。首次注射后≥6个月，通过时域或光谱域光学相干断层扫描（TD-OCT或SD-OCT）收集Snellen最佳矫正视力（BCVA）和中央视网膜厚度（CRT）数据。抗vegf注射的平均次数（贝伐单抗627次，雷尼单抗594次，阿非利塞1次）分别为5.8次（第1年），5.0次（第2年）和3.4次（第3年）。首10次注射后，同一次就诊时BCVA为20/40或更好，TD-OCT CRT≤250 μm或SD-OCT≤300 μm的患者（主要终点）所占比例为16.4% ~ 38.9%；51.9% ~ 62.3% BCVA≥20/40,26.2% ~ 48.0%达到CRT标准。治疗耐受良好，有19例治疗相关不良事件（全眼）报告。与雷尼单抗注册试验相比，抗vegf注射的频率更低，效果也更差。在前9次注射后，<25%的患者BCVA达到20/40或更好，并且黄斑干燥。相当大比例的患者对抗vegf治疗反应不佳；这些患者可能是其他治疗的候选者，包括玻璃体内皮质类固醇和激光治疗。
To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) inhibitors as used in clinical practice for the treatment of diabetic macular edema. Multicenter (10 sites), retrospective chart review in patients (n=156) who received ≥3 anti-VEGF injections. Data collected for ≥6 months after the first injection included Snellen best-corrected visual acuity (BCVA) and central retinal thickness (CRT) by time-domain or spectral-domain optical coherence tomography (TD-OCT or SD-OCT). Mean number of anti-VEGF injections (627 bevacizumab, 594 ranibizumab, 1 aflibercept) was 5.8 (year 1), 5.0 (year 2), and 3.4 (year 3). Percentage of patients with BCVA of 20/40 or better and CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT at the same visit (primary endpoint) ranged from 16.4% to 38.9% after the first 10 injections; 51.9%–62.3% achieved ≥20/40 BCVA and 26.2%–48.0% met CRT criteria. Therapy was well tolerated with 19 treatment-related adverse events (all ocular) reported. Anti-VEGF injections were administered less frequently and were less effective than those in the ranibizumab registration trials. After each of the first 9 injections, <25% of patients achieved both BCVA of 20/40 or better and a dry macula. A substantial proportion of patients are suboptimal responders to anti-VEGF therapy; these patients may be candidates for other therapies, including intravitreal corticosteroid and laser therapy.