습성 나이관련황반변성에서 진단연도에 따른 주사 빈도의 변화와 시력 결과 차이
Injection Frequency and Differences in Visual Outcomes based on Diagnosis Year in Neovascular Age-related Macular Degeneration
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목적: 습성 나이관련황반변성에서 진단연도에 따른 주사 빈도의 변화를 확인하고 이러한 변화에 따른 시력 결과의 차이를 추가적으로분석하고자 한다. 대상과 방법: 2013년(2013군), 2015년(2015군), 2017년(2017군) 및 2019년(2019군)에 습성 나이관련황반변성과 결절맥락막혈관병증으로 진단된 667명(667안)의 환자를 대상으로 후향적 의무기록 분석을 시행하였다. 진단 후 24개월 동안의 항혈관내피성장인자 주사횟수와 시력 변화를 네 군 사이에 서로 비교하였다. 결과: 평균 주사 횟수는 2013군에서 5.7 ± 2.7회, 2015군에서 6.0 ± 2.8회, 2017군에서 6.6 ± 3.0회, 2019군에서 6.9 ± 3.3회였다. 2013군 및 2015군과 비교하였을 때 2019군에서의 주사 횟수는 유의하게 더 높았다(p<0.001). 동일 기간 동안의 시력 변화의 경우2013군에서는 평균 logarithm of minimal angle of resolution (logMAR) 0.07 ± 0.55 악화, 2015군의 경우 평균 0.01 ± 0.51 악화, 2017군의 경우 평균 0.08 ± 0.50 호전, 2019군의 경우 평균 0.04 ± 0.48 호전되었다. 네 군 사이에 시력 변화에는 유의한 차이가있었다(p=0.020). 결론: 보다 최근에 진단된 환자일수록 더 높은 빈도로 주사를 시행받은 경향이 확인되었고, 더 나은 시력 결과를 보였는데, 보다 적극적인 주사가 시력 결과에 영향을 미쳤을 것으로 추측된다. 향후 습성 나이관련황반변성에 대한 사회경제적 부담을 예측할 때 이러한경향이 고려되어야 할 것이다.
Abstract
Purpose: To evaluate the changes in injection frequency based on the diagnosis year in neovascular age-related macular degeneration (AMD) and the differences in visual outcomes associated with these changes. Methods: This retrospective study included 667 patients (667 eyes) diagnosed with treatment-naïve neovascular AMD and polypoidal choroidal vasculopathy in 2013, 2015, 2017, and 2019. The number of anti-vascular endothelial growth factor (VEGF) injections and degree of changes in visual acuity during the first 24 months after diagnosis were compared among the 4 years. Results: The 2013, 2015, 2017, and 2019 groups had a mean of 5.7 ± 2.7, 6.0 ± 2.8, 6.6 ± 3.0, and 6.9 ± 3.3 anti-VEGF injections, respectively. The number of injections was significantly higher in 2019 than in 2013 and 2015 (p < 0.001). The mean degree of visual change during the 24-month follow-up period was 0.07 ± 0.55, 0.01 ± 0.51, 0.08 ± 0.50, and 0.04 ± 0.48 in 2013, 2015, 2017, and 2019, respectively. There was a significant difference in the degree of visual change among the four groups (p = 0.020). Conclusions: Patients diagnosed more recently tend to receive more injections and have better visual outcomes. We speculate that more injections contributed to these results. This trend should be considered when predicting the future socioeconomic burden of neovascular AMD.
참고문헌 (26)
- Flaxman SR, "Global causes of blindness and distance vision impairment 1990-2020 : a systematic review and meta-analysis", Lancet Glob Health, 5, pp.e1221~e1234 (2017)
- Sloan FA, "The effects of technological advances on outcomes for elderly persons with exudative age-related macular degeneration", JAMA Ophthalmol, 132, pp.456~463 (2014)
- Lanzetta P, "Anti-VEGF therapies for age-related macular degeneration:a powerful tactical gear or a blunt weapon? The choice is ours", Graefes Arch Clin Exp Ophthalmol, 259, pp.3561~3567 (2021)
- Fung AE, "An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab(Lucentis)for neovascular age-related macular degeneration", Am J Ophthalmol, 143, pp.566~583 (2007)
- Holz FG, "Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration", Br J Ophthalmol, 99, pp.220~226 (2015)
- Writing Committee for the UK Age-Related Macular Degeneration EMR Users Group, "The neovascular age-related macular degeneration database : multicenter study of 92 976 ranibizumab injections : report 1 : visual acuity", Ophthalmology, 121, pp.1092~1101 (2014)
- Lad EM, "Anti-VEGF treatment patterns for neovascular age-related macular degeneration among medicare beneficiaries", Am J Ophthalmol, 158, pp.537~543 (2014)
- Spaide R, "Ranibizumab according to need : a treatment for age-related macular degeneration", Am J Ophthalmol, 143, pp.679~680 (2007)
- Freund KB, "Treat-and-extend regimens with anti-vegf agents in retinal diseases : a literature review and consensus recommendations", Retina, 35, pp.1489~1506 (2015)
- Okada M, "The treat-and-extend injection regimen versus alternate dosing strategies in age-related macular degeneration : a systematic review and meta-analysis", Am J Ophthalmol, 192, pp.184~197 (2018)
- Spaide RF, "Anti-vascular endothelial growth factor dosing and expected acuity outcome at 1 year", Retina, 41, pp.1153~1163 (2021)
- Hatz K, "Changing from a pro re nata treatment regimen to a treat and extend regimen with ranibizumab in neovascular age-related macular degeneration", Br J Ophthalmol, 100, pp.1341~1345 (2016)
- Kim JH, "Results of switching from pro re nata to treat-and-extend regimen in treatment of patients with type 3 neovascularization", Semin Ophthalmol, 35, pp.33~40 (2020)
- Wong WL, "Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040 : a systematic review and meta-analysis", Lancet Glob Health, 2, pp.e106~e116 (2014)
- Baek SK, "Increase in the population of patients with neovascular age-related macular degeneration who underwent long-term active treatment", Sci Rep, 9, pp.13264~ (2019)
- Lalwani GA, "A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration : year 2 of the PrONTO study", Am J Ophthalmol, 148, pp.43~58 (2009)
- Martin DF, "Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration : two-year results", Ophthalmology, 127, pp.S135~S145 (2020)
- Holz FG, "Key drivers of visual acuity gains in neovascular age-related macular degeneration in real life : findings from the AURA study", Br J Ophthalmol, 100, pp.1623~1628 (2016)
- Rim TH, "Incidence of exudative age-related macular degeneration and treatment load under the Korean national health insurance system in 2010-2015", Br J Ophthalmol, 103, pp.1361~1366 (2019)
- Kim JH, "A real-world study assessing the impact of retinal fluid on visual acuity outcomes in patients with neovascular age-related macular degeneration in Korea", Sci Rep, 12, pp.14166~ (2022)
- Sharma A, "Biosimilars for retinal diseases : an update", Am J Ophthalmol, 224, pp.36~42 (2021)
- Semeraro F, "Aflibercept in wet AMD : specific role and optimal use", Drug Des Devel Ther, 7, pp.711~722 (2013)
- Kim JH, "Difference between the incidence of retinal fluid subtypes and their association with visual outcomes according to the types of macular neovascularization in a Korean population", J Ocul Pharmacol Ther, 38, pp.261~268 (2022)
- Patil NS, "Association between visual acuity and residual retinal fluid following intravitreal anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration : a systematic review and meta-analysis", JAMA Ophthalmol, 140, pp.611~622 (2022)
- Gillies MC, "Effect of ranibizumab and aflibercept on best-corrected visual acuity in treat-and-extend for neovascular age-related macular degeneration : a randomized clinical trial", JAMA Ophthalmol, 137, pp.372~379 (2019)
- García-Quintanilla L, "Pharmacokinetics of intravitreal anti-VEGF drugs in age-related macular degeneration", Pharmaceutics, 11, pp.365~ (2019)