Growth of geographic atrophy in the comparison of age-related macular degeneration treatments trials.
Growth of geographic atrophy in the comparison of age-related macular degeneration treatments trials.
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DOI：
10.1016/j.ophtha.2014.11.007
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发表时间：
2015-04
期刊：
影响因子：
13.7
通讯作者：
Martin, Daniel F.
中科院分区：
文献类型：
--
作者：
Grunwald, Juan E.;Pistilli, Maxwell;Ying, Gui-shuang;Maguire, Maureen G.;Daniel, Ebenezer;Martin, Daniel F.
目的：观察抗血管内皮生长因子治疗过程中地理萎缩(GA)的生长情况。临床试验中的队列。年龄相关黄斑变性(AMD)治疗试验比较试验(CATT)的患者被随机分配到雷尼比单抗或贝伐单抗注射组，并接受为期两年的每月或按月给药方案(PRN)，或每月给药1年，第二年给药PRN。评估基线、1年和2年的数码彩色照片和荧光素血管造影，并由两名蒙面治疗的评分员测量GA的总面积；判断差异。区域平方根年变化的多变量线性混合模型包括基线人口学、治疗和眼部影像特征作为候选危险因素。GA生长率。在1185名参与者中，86只眼(7.3%)在基线水平有GA，120只眼(10.1%)在第1年发生GA，36只眼(3.0%)在第2年发生GA。在194只可评估生长的眼睛中，GA的发生率为0.43(标准差[SE]：±0.03)mm/年。在多因素分析中，贝伐单抗组和雷尼比单抗组的眼球增长率分别为0.37 mm/年和0.49 mm/年(差值0.11，95%可信区间[CI]：(0.01，0.22)；p=0.03)。每月治疗的眼与PRN之间的生长速度没有差异(p=0.85)。中心凹下CNV病变的增殖率低于非中心凹下CNV病变(差异0.12，CI：0.01，0.22；P=0.03)。距离中心凹越远的GA眼，每远离中心凹1 mm，其生长率就增加0.14(CI：0.01，27)mm/年。典型病变为主的眼的年增长率为0.58 mm，轻度经典病变的眼为0.41 mm/年，仅隐匿性病变的眼为0.30 mm/年(p<；0.01)。有GA对侧眼的生长率比对侧眼高0.13(CI：0.01，0.24；P=0.03)mm/年。有视网膜前膜者较无视网膜前膜者增殖率高(差异0.16，CI：(0.03，0.30；P=0.02))。GA的生长取决于几个眼睛因素。雷尼比珠单抗可能会加速GA的生长。
To evaluate the growth of geographic atrophy (GA) during anti-VEGF therapy. Cohort within clinical trial. Patients included in the Comparison of Age-related Macular Degeneration (AMD) Treatments Trials (CATT) Participants were randomly assigned to injections of ranibizumab or bevacizumab and to a 2-year dosing regimen of monthly or pro re nata (PRN), or to monthly for 1 year and PRN the following year. Digital color photographs and fluorescein angiograms at baseline, 1 and 2 years were evaluated for GA and the total area of GA was measured by two graders masked to treatment; differences were adjudicated. Multivariate linear mixed models of the annual change in the square root of the area included baseline demographic, treatment, and ocular characteristics on imaging as candidate risk factors. GA growth rate. Among 1185 participants, 86 (7.3%) had GA at baseline, 120 (10.1%) developed GA during year 1 and 36 (3.0%) during year 2. Among 194 eyes evaluable for growth, the rate was 0.43 (standard error [SE]: ±0.03) mm/year. In multivariate analysis, the growth rate was 0.37 mm/year in eyes receiving bevacizumab and 0.49 mm/year in eyes receiving ranibizumab (difference 0.11, 95% Confidence Interval [CI]: (0.01, 0.22); p=0.03). Growth rate did not differ between eyes treated monthly and PRN (p=0.85). Eyes with subfoveal CNV lesions had a lower growth rate than eyes with non-subfoveal CNV lesions (difference 0.12, CI: 0.01, 0.22; p=0.03). Eyes with GA farther from the fovea had higher growth rates by 0.14 (CI: 0.01, 27) mm/year for every mm farther from the fovea. The growth rate was 0.58 mm/year for eyes with predominantly classic lesions, 0.41 mm/year for eyes with minimally classic lesions, and 0.30 mm/year for eyes with occult only lesions (p<0.01). The growth rate in eyes having a fellow eye with GA was higher by 0.13 (CI: 0.01, 0.24; p=0.03) mm/year than in eyes without GA in the fellow eye. Eyes with epiretinal membrane had a higher growth rate than eyes without epiretinal membrane (difference 0.16, CI: (0.03, 0.30; p=0.02). GA growth depends on several ocular factors. Ranibizumab may accelerate GA growth.
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通讯作者：
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