라니비주맙과 애플리버셉트에 모두 반응이 제한적인 습성 나이관련황반변성의 경과
Course of Neovascular Age-related Macular Degeneration that Showed Limited Response to Both Ranibizumab and Aflibercept
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 라니비주맙과 애플리버셉트 치료에 반응이 제한적인 습성 나이관련황반변성의 임상 경과를 알아보고자 한다. 대상과 방법: 습성 나이관련황반변성에 진단 후 라니비주맙과 애플리버셉트 치료를 시행받았으나 두 약제 모두에 효과가 제한적인것으로 판명된 14안을 대상으로 후향적 연구를 시행하였다. 추적 관찰 기간 동안의 시력 변화를 확인하였으며, 0.1 이하로 시력이떨어지는 비율과 시기를 추가적으로 확인하였다. 베바시주맙 치료를 시행받은 경우의 추적 관찰 기간과 0.2 이상의 시력을 유지한비율을 확인하였다. 결과: 평균 43.3 ± 33.2개월의 추적 관찰 기간 동안 평균 logarithm of minimum angle of resolution (logMAR) 시력은 진단 시 0.42 ± 0.34에서 최종 추적 관찰 시 0.91 ± 0.68로 유의하게 악화되었으며(p=0.021), 6안(42.9%)에서 logMAR 0.3 이상의 시력 악화가나타났다. 초기 치료 직후 0.2 이상의 시력을 보인 13안 중 6안(46.2%)에서 평균 29.7 ± 18.3개월에 0.1 이하로 시력이 악화되었다. 베바시주맙 치료를 시행받은 8안의 경우 평균 51.4 ± 35.5개월 추적 관찰 기간 동안 4안(50.0%)에서 0.2 이상의 시력을 유지하였다. 결론: 라니비주맙과 애플리버셉트 치료에 반응이 제한적인 환자들의 임상 경과는 전반적으로 좋지 않았으나 0.1 이하로의 시력 악화가 나타날 때까지 비교적 긴 기간이 소요되었으며, 약 절반에서 0.2 이상의 시력이 장기적으로 유지되는 결과를 보였다.
Abstract
Purpose: To evaluate the clinical course of neovascular age-related macular degeneration (nAMD) that has shown limited response to ranibizumab and aflibercept. Methods: This retrospective study included 14 eyes with nAMD that showed a limited response to initial treatment using ranibizumab and aflibercept. The changes in visual acuity (VA) during the follow-up period and the incidence and timing of VA deterioration to the level of 0.1 or worse were identified. In cases involving bevacizumab treatment, the follow-up duration and the proportion of patients maintaining a VA of 0.2 or better were identified. Results: During the mean 43.3 ± 33.2 months of follow-up, the VA deteriorated significantly from a mean logarithm of minimum angle of resolution (logMAR) of 0.42 ± 0.34 at diagnosis to 0.91 ± 0.68 at the final follow-up (p = 0.021). A logMAR of 0.3 or greater degree of VA deterioration was noted in six eyes (42.9%). Among the 13 eyes exhibiting a VA of 0.2 or better after the initial treatment, a deterioration to a VA of 0.1 or worse was noted in 6 eyes (46.2%) at a mean 29.7 ± 18.3 months. In eight eyes undergoing bevacizumab treatment, four eyes (50.0%) maintained 0.2 or better VA during the 51.4 ± 35.5 months of follow-up. Conclusions: The clinical course of patients with limited response to ranibizumab and aflibercept was generally unfavorable. However, a relatively long period was required for the deterioration in VA to reach 0.1 or worse. In addition, 0.2 or better VA was maintained in approximately half of the patients.
참고문헌 (28)
- Berg K, "An 8-year follow-up of anti-vascular endothelial growth factor treatment with a treat-and-extend modality for neovascular age-related macular degeneration", Acta Ophthalmol, 95, pp.796~802 (2017)
- Moisseiev E, "Treatment of neovascular age-related macular degeneration : an economic cost-risk analysis of anti-vascular endothelial growth factor agents", Ophthalmol Retina, 6, pp.205~212 (2022)
- Chen R, "Cost-effectiveness of intravitreal conbercept versus other treatments for wet age-related macular degeneration", Ann Transl Med, 8, pp.939~ (2020)
- 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)
- Rosenfeld PJ, "Ranibizumab for neovascular age-related macular degeneration", N Engl J Med, 355, pp.1419~1431 (2006)
- Heier JS, "Intravitreal aflibercept(VEGF trap-eye)in wet age-related macular degeneration", Ophthalmology, 119, pp.2537~2548 (2012)
- Dugel PU, "HAWK and HARRIER : phase 3, multicenter, randomized, double-masked trials of brolucizumab for neovascular age-related macular degeneration", Ophthalmology, 127, pp.72~84 (2020)
- Shirley M, "Faricimab : first approval", Drugs, 82, pp.825~830 (2022)
- Yannuzzi LA, "Idiopathic polypoidal choroidal vasculopathy(IPCV)", Retina, 10, pp.1~8 (1990)
- 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)
- 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)
- Heussen FM, "Clinical outcomes after switching treatment from intravitreal ranibizumab to aflibercept in neovascular age-related macular degeneration", Graefes Arch Clin Exp Ophthalmol, 252, pp.909~915 (2014)
- Kumar N, "Visual and anatomical outcomes of intravitreal aflibercept in eyes with persistent subfoveal fluid despite previous treatments with ranibizumab in patients with neovascular age-related macular degeneration", Retina, 33, pp.1605~1612 (2013)
- Saito M, "Switching to intravitreal aflibercept injection for polypoidal choroidal vasculopathy refractory to ranibizumab", Retina, 34, pp.2192~2201 (2014)
- Marquis LM, "Beneficial switch from aflibercept to ranibizumab for the treatment of refractory neovascular age-related macular degeneration", Graefes Arch Clin Exp Ophthalmol, 258, pp.1591~1596 (2020)
- Lee JS, "Short-term outcomes following"switching"to monthly ranibizumab in neovascular age-related macular degeneration showing insufficient response to bimonthly aflibercept", J Ophthalmol, 2021, pp.5547686~ (2021)
- Jeon YJ, "Short-term outcomes of switching to ranibizumab in polypoidal choroidal vasculopathy resistant to aflibercept therapy", J Clin Med, 10, pp.5739~ (2021)
- Kim JH, "Long-term switching between ranibizumab and aflibercept in neovascular age-related macular degeneration and polypoidal choroidal vasculopathy", Graefes Arch Clin Exp Ophthalmol, 258, pp.1677~1685 (2020)
- Muftuoglu IK, "Long-term results of pro re nata regimen of aflibercept treatment in persistent neovascular age-related macular degeneration", Am J Ophthalmol, 167, pp.1~9 (2016)
- Ota H, "Switching from aflibercept to brolucizumab for the treatment of refractory neovascular age-related macular degeneration", Jpn J Ophthalmol, 66, pp.278~284 (2022)
- 김재휘, "애플리버셉트에 반응이 제한적인 습성 나이관련황반변성에서 브롤루시주맙의 단기 효과", Journal of Retina, 6(2), pp.145~149 (2021), 한국망막학회
- Khanani AM, "MERLIN : phase 3a, multicenter, randomized, double-masked trial of brolucizumab in participants with neovascular age-related macular degeneration and persistent retinal fluid", Ophthalmology, 129, pp.974~985 (2022)
- Park UC, "Long-term results of rescue photodynamic therapy for type 1 neovascularization refractory to anti-vascular endothelial growth factor", Acta Ophthalmol, 99, pp.e899~907 (2021)
- Dugel PU, "Phase 1 study of OPT-302 inhibition of vascular endothelial growth factors C and D for neovascular age-related macular degeneration", Ophthalmol Retina, 4, pp.250~263 (2020)
- Brown GC, "A cost-benefit analysis of VEGF-inhibitor therapy for neovascular age-related macular degeneration in the United States", Am J Ophthalmol, 223, pp.405~429 (2021)
- Park SJ, "Prevalence and incidence of exudative age-related macular degeneration in South Korea : a nationwide population-based study", Ophthalmology, 122, pp.2063~2070 (2015)
- Larsen PP, "Ranibizumab in pigment epithelial tears secondary to age-related macular degeneration : a prospective study", Retina, 39, pp.2369~2377 (2019)
- Guymer RH, "Tolerating subretinal fluid in neovascular age-related macular degeneration treated with ranibizumab using a treat-and-extend regimen : FLUID study 24-month results", Ophthalmology, 126, pp.723~734 (2019)