Comparing the Efficacy of anti-VEGF Drugs in the Treatment of Neovascular AMD based on Visual and Morphological Parameters
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ar vecumu saistītā makulas deģenerācija (VMD) ir nozīmīgs, progresējošs faktors, kas var izraisīt aklumu indivīdiem, kas ir vecāki par 75 gadiem. No visiem šiem indivīdiem neovaskulāra VMD ir atbildīga par lielāko daļu smaga redzes zuduma gadījumu. Primārā neovaskulās VMD ārstēšana vēl līdz šai dienai ir intravitreālā anti-VEGF terapija. Lai gan pašreiz tiek izmantoti daudz dažādu anti-VEGF preparāti, tie atšķiras gan cenas ziņā, gan pieejamībā. Tādēļ ir nepieciešami tālāki pētījumi, lai izprastu to efektivitāti un varētu veikt informētu ārstēšanas izvēli.
Metodes: Literatūras apskats sastāv no teorētiskās daļas un salīdzinājuma daļas. Teorētiskajā daļā tiek izskatīti vairāki raksti no PubMed, IOV un daudziem citiem žurnāliem un grāmatām. Salīdzinājuma daļā tika savākti 24 randomizēti kontrolēti pētījumi un savā starpā tika salīdzināta efektivitāte dažādiem anti-VEGF medikamentiem atkarībā no izmaiņām redzes asumā (ETDRS burtu ieguvums), izmaiņas centrālajā tīklenes biezumā mikrometros un intraretinālā vai subretinālā šķidruma uzkrājuma daudzums OCT izmeklējumā.
Mērķis: Apskata mērķis ir izzināt un salīdzināt visbiežāk lietoto anti-VEGF medikamentu efektivitāti neovaskulāras VMD ārstēšanā, pamatojoties uz izvēlētiem kritērijiem. Kritēriji iekļauj redzes asumu, morfoloģiskos iznākumus, kā piemēram, izmaiņas centrālajā tīklenes biezumā un intraretinālā un subretinālā šķidruma līmenī.
Rezultāti: Dozēšanas režīmam ir kritiska loma redzes asuma rezultātam mitrās formas VMD ārstēšanā ar T&E režīmu ar aflibercept un ranibizumab, kuri dod vislabākos rezultātus. Neskatoties uz to, pareizi izpildīts PRN režīms var dramatiski uzlabot anti-VEGF ārstēšanas efektivitāti, neatkarīgi no lietotā medikamenta. No otras puses, izvēlētajam medikamentam ir liela ietekme uz anatomiskajiem iznākumiem (IRF/sSRF un CRT) ar jaunākiem, specializētiem medikamentiem kā - aflibercept un brolucizumab, kas sniedz vislabākos rezultātus. Attiecība starp CRT, IRF/SRF un redzes asumu ir daudz sarežģītāka un ir nepieciešami tālāki pētījumi.
Secinājumi: T&E aflibercept tiek rekomendēts neovaskulāras VMD ārstēšanā, lai gan alternatīvas terapijas var būt tikpat efektīvas, ievērojot pareizu dozēšanas režīmu.
Age related macular degeneration (AMD) is a significant, progressive cause of blindness worldwide in individuals older than 75, with neovascular AMD being responsible for the majority of severe vision loss in diagnosed cases. The mainstay of treatment in neovascular AMD is the intravitreal anti-VEGF therapy. Although numerous anti-VEGF drugs are currently being used to treat AMD, they vary significantly in both price and availability. Therefore, further research into their efficacy would greatly aid in making informed treatment choices. Method: This thesis comprises a theoretical part, and a comparison part. In the theoretical part, articles from Pubmed, Investigative Ophthalmology & Visual Science, as well as other journals and books were reviewed. In the comparison part of this paper, 24 randomized controlled trials were gathered and used to compare the efficacy of selected anti-VEGF therapies according to changes in visual acuity (in ETDRS letters gained), changes in central retinal thickness (CRT) in m, and absence of intra retinal/sub-retinal fluid (IRF/SRF) on OCT. Aim: The aim of this review is to examine and compare the efficacy of the most commonly used anti-VEGF drugs in the treatment of neovascular AMD, based on visual acuity outcomes, and morphological outcomes such as changes in central retinal thickness and intra- retinal and subretinal fluid. Results: dosing regimen plays a critical role in determining visual acuity outcomes in the treatment of “wet”-AMD, with T&E regimen of aflibercept and ranibizumab yielding the best results. Nevertheless, correctly implemented PRN regimen may dramatically improve the efficacy of anti-VEGF treatment irrespective of the drug being used. On the other hand, the type of drug used appears to have a larger impact on anatomic outcomes (IRF/SRF and CRT), with newer/specialized drugs such as aflibercept and brolucizumab generally yielding superior results. The relationship between CRT, IRF/SRF, and visual acuity is more complex and warrants further research. Conclusion: T&E aflibercept is recommended for the treatment of neovascular AMD, although alternative therapies may be comparably effective given the correct dosing regimen.
Age related macular degeneration (AMD) is a significant, progressive cause of blindness worldwide in individuals older than 75, with neovascular AMD being responsible for the majority of severe vision loss in diagnosed cases. The mainstay of treatment in neovascular AMD is the intravitreal anti-VEGF therapy. Although numerous anti-VEGF drugs are currently being used to treat AMD, they vary significantly in both price and availability. Therefore, further research into their efficacy would greatly aid in making informed treatment choices. Method: This thesis comprises a theoretical part, and a comparison part. In the theoretical part, articles from Pubmed, Investigative Ophthalmology & Visual Science, as well as other journals and books were reviewed. In the comparison part of this paper, 24 randomized controlled trials were gathered and used to compare the efficacy of selected anti-VEGF therapies according to changes in visual acuity (in ETDRS letters gained), changes in central retinal thickness (CRT) in m, and absence of intra retinal/sub-retinal fluid (IRF/SRF) on OCT. Aim: The aim of this review is to examine and compare the efficacy of the most commonly used anti-VEGF drugs in the treatment of neovascular AMD, based on visual acuity outcomes, and morphological outcomes such as changes in central retinal thickness and intra- retinal and subretinal fluid. Results: dosing regimen plays a critical role in determining visual acuity outcomes in the treatment of “wet”-AMD, with T&E regimen of aflibercept and ranibizumab yielding the best results. Nevertheless, correctly implemented PRN regimen may dramatically improve the efficacy of anti-VEGF treatment irrespective of the drug being used. On the other hand, the type of drug used appears to have a larger impact on anatomic outcomes (IRF/SRF and CRT), with newer/specialized drugs such as aflibercept and brolucizumab generally yielding superior results. The relationship between CRT, IRF/SRF, and visual acuity is more complex and warrants further research. Conclusion: T&E aflibercept is recommended for the treatment of neovascular AMD, although alternative therapies may be comparably effective given the correct dosing regimen.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
VMD; neovaskulārs; anti-VEGF; redzes asums; centrāls tīklenes biezums; intraretināls škidrums; subretināls šķidrums; dozēšanas režīms., AMD; neovascular; anti-VEGF; visual acuity; central retinal thickness; intra- retinal fluid; subretinal fluid; dosing regimen.