Visual Acuity Outcomes and Anti-Vascular Endothelial Growth Factor Therapy Intensity in Neovascular Age-Related Macular Degeneration Patients A Real-World Analysis of 49 485 Eyes
Visual Acuity Outcomes and Anti-Vascular Endothelial Growth Factor Therapy Intensity in Neovascular Age-Related Macular Degeneration Patients A Real-World Analysis of 49 485 Eyes
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DOI：
10.1016/j.oret.2019.05.017
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发表时间：
2020-01-01
影响因子：
4.5
通讯作者：
Williams, David F.
中科院分区：
文献类型：
--
作者：
Ciulla, Thomas A.;Hussain, Rehan M.;Williams, David F.
目的：本研究评估了现实世界新生血管性年龄相关性黄斑变性（nAMD）患者的抗血管内皮生长因子（VEGF）治疗强度及其与视力（VA）变化的关系。设计：这项回顾性分析是在一个大型数据库中进行的，从美国视网膜专家的地理和人口统计学上不同的患者样本中去除识别的电子医疗记录参与者：在2012年1月1日至2016年10月31日期间接受抗VEGF注射的未经治疗的nAMD患者，如果在2017年10月31日之前可获得随访数据，则符合条件。研究方法：年龄、性别、抗VEGF治疗类型、治疗次数和VA均从database.Main Outcome Measure中提取：1年时评估的平均VA变化，并根据1年内接受的抗VEGF注射次数进行分层。平均年龄为80.9岁，64%为女性。平均基线VA为53.8个字母（Snellen等效，20/80）。1年时，平均注射7.3次抗VEGF后，平均增加1个字母（0.95个字母; VA变化的95%置信区间[CI]，+0.77至+1.13个字母; P < 0.001）。当按抗VEGF药物分层时，1年时平均VA变化几乎相同。获得的平均字母与平均注射次数之间存在线性关系，1年内注射4次至10次，4次或更少或10次或更多次注射分别与视力丧失或平台期相关。VA的平均1年变化较大也有基线VA较差的趋势;就诊时VA较好的患者往往特别容易发生视力丧失。接受最少注射的患者往往年龄较大，基线VA较差。结论：与随机对照试验中接受固定、频繁治疗的患者相比，现实世界的nAMD患者接受较少的抗VEGF注射，视力结局较差。VA的平均变化与1年时的治疗强度相关，但与治疗强度和基线VA相关的上限效应相关。老年患者和基线VA较差的患者可能特别容易治疗不足。(C)2019年美国眼科学会。
Purpose: This study assessed anti-vascular endothelial growth factor (VEGF) therapy intensity and its relationship with visual acuity (VA) change in real-world neovascular age-related macular degeneration (nAMD) patients.Design: This retrospective analysis was performed on a large database of aggregated, longitudinal, de-identified electronic medical records from a geographically and demographically diverse sample of patients of United States retina specialists (Vestrum Health Retina Database).Participants: Treatment-naive nAMD patients who underwent anti-VEGF injections between January 1, 2012, and October 31, 2016, were eligible if follow-up data were available before October 31, 2017. Methods: Age, gender, anti-VEGF treatment type, number of treatments, and VA were extracted from the database.Main Outcome Measure: Mean VA change assessed at 1 year and stratified based on number of anti-VEGF injections received over 1 year.Results: In this analysis, 49 485 eyes were included. The mean age was 80.9 years, and 64% were female. Mean baseline VA was 53.8 letters (Snellen equivalent, 20/80). At 1 year, after a mean of 7.3 anti-VEGF injections, there was a mean gain of 1 letter (0.95 letter; 95% confidence interval [CI] for change in VA, +0.77 to +1.13 letter; P < 0.001). When stratified by anti-VEGF agent, the mean VA changes were nearly identical at 1 year. There was a linear relationship between mean letters gained and mean number of injections, between 4 and 10 injections over 1 year, with 4 or fewer or 10 or more injections associated with loss of vision or a plateau, respectively. Greater mean 1-year change in VA also trended with worse baseline VA; those patients with better VA at presentation tended to be particularly vulnerable to vision loss. Those who received the fewest injections tended to be older and have worse baseline VA.Conclusions: Real-world nAMD patients receive fewer anti-VEGF injections and experience worse visual outcomes compared with patients receiving fixed, frequent therapy in randomized controlled trials. Mean change in VA correlates with treatment intensity at 1 year, but with ceiling effects related to treatment intensity and baseline VA. Older patients and those with poor baseline VA may be particularly prone to undertreatment. (C) 2019 by the American Academy of Ophthalmology.