Author: Evgenii Bobykin (Russian Federation)
Co-authors: Irina Kulakova, Vadim Krokhalev
Purpose
Purpose: to assess the long-term (within 60 months follow-up) results of anti-VEGF therapy for macular diseases in real clinical practice.
Setting/Venue
Setting: Ural State Medical University (Yekaterinburg, Russian Federation).
Methods
Methods. A single-center retrospective uncontrolled cohort study of 169 patients (109 women, 60 men) who received anti-VEGF therapy for eye diseases (treatment started from May 2010 to August 2015) was carried out. The study group included 57 patients (43 women, 14 men; median age 62 years) who received anti-VEGF therapy (ranibizumab, aflibercept) and remained under regular observation for 60 months (“wet” age-related macular degeneration (wAMD) - 24 cases, myopic choroidal neovascularization (mCNV) - 20, macular edema due to retinal vein occlusions – 10 (MERVO), diabetic macular edema – 3 (DME)), 112 lost to follow-up patients made up the comparison group. We studied the results of clinical and instrumental examination changes of patients in both groups, as well as data from a phone survey of the comparison group about the reasons for the termination of observation in the clinic. Statistical analysis of demographic indicators and treatment results was carried out using the licensed program STATISTICA 13.3 (conditions of normality for variables, nonparametric and parametric criteria were determined, and rank analysis of variance was carried out).
Results
Results: Patients in the study group were statistically significantly younger (p = 0.0029), had a higher initial (p = 0.0019) and final (p = 0.00027) best corrected visual acuity (BCVA), and also received a significantly greater number of intravitreal injections (IVI, p <0.000001), but had a significantly lower rate of therapy intensity factor (the ratio of the number of injections to the duration of observation, expressed in months) during treatment (p <0.000001). In addition, in the study group, there was a significantly lower proportion of men (p = 0.041) and patients with wAMD (p = 0.0010). The BCVA in the study group increased from 0.29 0.35 0.42 to 0.47 0.54 0.61 (p <0.00001), 91.2% of patients maintained or improved vision from baseline, and the proportion of subjects with a BCVA ≥ 0.5 increased from 61.4% to 73.7% during the study. The central retinal thickness decreased in the study group from 336.0 363.2 390.3 μm to 221.7 237.2 252.8 μm (p <0.00001). The average number of IVI received by the patients of the study group was 8.93 10.84 12.75. A tendency towards a gradual decrease in the intensity of treatment was revealed and confirmed (p <0.00001).
Conlusions
Conclusion. This study confirms that in daily practice favorable long-term results of anti-VEGF therapy in macular diseases could be achieved. 57 out of 169 (33.7%) patients were adhered to follow-up for 60 months, while their proportion significantly differed among different nosologies: 80.0% for mCNV, 50.0% for MERVO, 21.8% for wAMD, 21.4% for DME. The most important remains the problem of untimely / insufficient treatment. The reasons for the termination of observation in the comparison group (n = 112), studied using a phone survey, were as follows: stopped regular observation / treatment - 57 people (33.7%), continue treatment in another clinic - 3 (1.8%), died - 13 (7.7%), status unknown - 39 (23.1%). To solve it, in addition to improving treatment approaches, organizational measures to increase the availability of antiangiogenic therapy are needed.
Financial Disclosure
I am a consultant for Bayer and Novartis
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