Patients' preferences in treatment for neovascular age-related macular degeneration in clinical routine
Patients' preferences in treatment for neovascular age-related macular degeneration in clinical routine
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DOI：
10.1136/bjophthalmol-2011-301201
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发表时间：
2012-07-01
影响因子：
4.1
通讯作者：
Hirneiss, Christoph
中科院分区：
文献类型：
--
作者：
Finger, Robert;Hoffmann, Andrea E.;Hirneiss, Christoph
目的评价雷尼比珠单抗治疗新生血管性老年性黄斑变性(NvAMD)对患者喜好和视力相关生活质量(VRQOL)的影响。方法对55例初治的初治患者在首次3次每月注射0.5 mg雷尼比珠单抗前后进行检查。使用Rasch调整的NEI-VFQ-25对VRQL进行评估。使用时间权衡(TTO)、标准赌博、视觉模拟量表和欧洲生活质量问卷(EQ-5D)计算效用，并采用多元Logistic回归模型确定与效用相关的独立因素。结果平均+/-SD年龄为7567岁，其中女性40例(73%)。治疗眼的平均+/-SD最佳矫正视力从基线时的20/80(logMAR0.60+/-0.35)增加到随访时的20/63(logMAR0.52+/-0.36；p=0.020)。效用分数的增加范围从2个实用工具(标准赌博固定到死亡)到6.6util(EQ-5D德国TTO，p=0.023)和视觉功能改善(Rasch调整后的综合NEI-VFQ分数50+/-21到54+/-21，p=0.042)。接受治疗的眼睛是更好还是更差，与效用或VRQL的改善没有显著关系，而接受治疗的眼睛的视力改善与效用的增加有关(TTO，p=0.020)。结论在接受抗血管内皮生长因子治疗的老年nvAMD患者中，TTO效果最好。在新诊断的nvAMD患者中，眼睛治疗的好坏与报告的效用或视觉功能的变化无关。通过TTO获得的直接引出的、特定于视觉的实用工具似乎对视觉状态的变化很敏感。
Purpose To assess the effect of ranibizumab treatment for neovascular age-related macular degeneration (nvAMD) on patients' preferences and vision-related quality of life (VRQoL) in a routine clinical setting. Methods 55 treatment naive patients were examined before and after the initial upload of three monthly injections of 0.5 mg ranibizumab. VRQoL was assessed using a Rasch-adjusted NEI-VFQ-25. Time trade-off (TTO), standard gamble, a visual analogue scale and the European Quality of Life Questionnaire (EQ-5D) were used to calculate utilities, and multiple logistic regression models were conducted to determine independent factors associated with utilities. Results Mean +/- SD age was 7567 years, and 40 patients (73%) were female. Mean +/- SD best-corrected visual acuity of the treated eye increased from 20/80 at baseline (logMAR 0.60 +/- 0.35) to 20/63 (logMAR 0.52 +/- 0.36; p=0.020) at follow-up after three injections. Utility score increases ranged from 2 utils (standard gamble anchored for death) up to 6.6 utils (EQ-5D German TTO, p=0.023) and visual functioning improved (Rasch adjusted composite NEI-VFQ score 50 +/- 21 to 54 +/- 21, p=0.042). Whether the worse or better eye was treated was not significantly associated with improvements in utility or VRQoL, whereas VA improvement in the treated eye was associated with an increase in utility (TTO, p=0.020). Conclusions TTO performed best in this sample of elderly nvAMD patients undergoing anti-VEGF therapy. Better or worse eye treatment was not associated with a change in reported utilities or visual functioning in patients with newly diagnosed nvAMD. Directly elicited, vision-specific utilities gained with TTO seem to be sensitive to a change in vision status.