습성 나이관련황반변성에서 애플리버셉트로 교체투여 후 추적 관찰 중 나타나는 제한적 치료 반응
Limited Treatment Response during Follow-up after Switching to Aflibercept in Neovascular Age-related Macular Degeneration
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목적: 습성 나이관련황반변성에서 애플리버셉트로 교체투여한 후 발생하는 애플리버셉트에 대한 제한적 반응에 대해 분석하였다. 대상과 방법: 습성 나이관련황반변성으로 라니비주맙 치료를 시행 받다 애플리버셉트로 교체투여한 70안을 대상으로 후향적 연구를시행하였다. 애플리버셉트 약제에 제한적 반응이 나타난 빈도와 시기를 확인하였으며, 제한적 반응을 보인 경우와 그렇지 않은 경우 사이에 시력 결과를 비교하였다. 추가적으로 제한적 반응을 예측할 수 있는 인자를 분석하였다. 결과: 습성 나이관련황반변성에서 애플리버셉트로 교체투여 후 약 1/5에서 약제에 대한 제한적 반응이 나타났다. 교체투여는 진단 후 평균 16.2 ± 12.7개월 시점에 시행되었는데, 교체투여 후 평균 34.7개월의 추적 관찰 기간 동안 15안(21.4%)에서 평균 22.0 ± 13.9 개월에 제한적 반응이 나타났다. 교체투여 시부터 최종 추적 관찰 시까지 시력저하 정도는 제한적 반응을 보인 안에서 평균 logMAR 0.34 ± 0.41로 그렇지 않은 경우의 평균 0.06 ± 0.20에 비해 유의하게 더 큰 값을 보였다(p=0.002). 또한 제한적 반응이 나타난안은 그렇지 않은 안에 비해 최초 진단부터 애플리버셉트 교체투여까지의 기간이 더 짧았으며(p=0.012), 교체투여 전까지 시행된 라니비주맙 주사 횟수가 더 적었다(p=0.016). 결론: 애플리버셉트로 교체투여 후 약제에 대한 제한적 반응이 나타나는 경우 시력예후가 더 나쁜 경향을 보였다. 애플리버셉트 교체투여가 더 빨리 시행되는 경우 약제에 제한적 반응이 나타날 가능성이 높은 것으로 나타났다.
Abstract
Purpose: To investigate the limited response to aflibercept after switching to aflibercept in neovascular age-related macular degeneration (AMD). Methods: This retrospective study included 70 eyes with neovascular AMD that were initially treated with ranibizumab and then switched to aflibercept. The incidence and timing of the limited response to aflibercept were identified and visual outcome was compared between eyes with and without limited response. In addition, factors predictive of limited response were analyzed. Results: A limited response to aflibercept was noted in approximately 1/5 of the patients who underwent switching to aflibercept in neovascular AMD. Switching to aflibercept was performed at a mean of 16.2 ± 12.7 months after diagnosis. During the mean 34.7 months of follow-up after switching, limited response was noted in 15 eyes (21.4%) at a mean of 22.0 ± 13.9 months after switching. The degree of reduction in visual acuity was mean logMAR 0.34 ± 0.41 in eyes with limited response and mean 0.06 ± 0.20 in eyes without (p = 0.002). In addition, the duration between the diagnosis and the switching was shorter (p = 0.012), and the number of ranibizumab injections before switching was lower (p = 0.016) in eyes with limited response than in eyes without. Conclusions: Patients who showed limited response to aflibercept after switching to aflibercept showed a worse visual outcome. The probability of having a limited response is higher when the switching is performed earlier.
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