습성 나이관련황반변성치료에 있어서 베바시주맙 약제의 사용 비율과 원인
Proportion of and Reason for Bevacizumab Usage in the Treatment of Wet Age-related Macular Degeneration
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목적: 습성 나이관련황반변성의 치료에 있어서 베바시주맙이 이용되는 비율을 확인하고 베바시주맙을 이용한 이유를 알아보고자 한다. 대상과 방법: 습성 나이관련황반변성치료를 위해 라니비주맙, 애플리버셉트, 혹은 베바시주맙 주사를 시행 받은 1,541명을 대상으로 후향적 의무기록 분석을 시행하였다. 6개월 동안 시행된 전체 주사 횟수에서 베바시주맙 주사가 차지하는 비율을 확인하였다. 추가적으로 베바시주맙을 선택한 이유를 확인하였다. 결과: 연구 기간 동안 총 2,929회의 항혈관내피성장인자 주사가 시행되었으며, 라니비주맙 혹은 애플리버셉트 주사는 2,236회(76.3%), 베바시주맙 주사는 693회(23.7%)였다. 베바시주맙 약제를 이용한 가장 주된 이유는 ‘0.1 이하의 교정시력 혹은 심한 반흔이나 지도모양위축의 발생으로 급여치료가 어려운 경우’로 297회(42.9%)의 베바시주맙 주사가 시행되었다. 그 다음으로는 ‘중심와 바깥 혹은 망막하액이나 부종 등 혈관 활동성이 명확하지 않은 경우’로 201회(29.0%)의 베바시주맙 주사가 시행되었다. 결론: 습성 나이관련황반변성치료를 위한 주사의 약 23.7%에서 베바시주맙이 이용되고 있었다. 환자들의 치료 부담 분석 및 치료의 재정적 영향 분석에 있어서 본 연구의 결과가 유용할 수 있을 것으로 생각된다. 항혈관내피성장인자 약제 이용에 대하여 보다 정확히 확인하기 위해서는 향후 다기관 연구가 필요할 것이다.
Abstract
Purpose: To evaluate the proportion of bevacizumab and the reason for its usage in wet age-related macular degeneration (AMD). Methods: Retrospective analysis of medical records was performed for 1,541 patients who received ranibizumab, aflibercept, or bevacizumab injection to treat wet AMD. The proportion of bevacizumab among the entire set of injections was identified. The reason for selecting bevacizumab was additionally identified. Results: During the study period, a total of 2,929 anti-vascular endothelial growth factor (anti-VEGF) injections were performed; 2,236 (76.3%) were ranibizumab or aflibercept injections and 693 (23.7%) were bevacizumab injections. The most common reason for bevacizumab usage was ‘having a 0.1 or worse best-corrected visual acuity or being unable to assure reimbursement due to the development of extensive scarring or geographic atrophy’ (297 bevacizumab injections, 42.9%). The second most common reason was ‘the inability to assure reimbursement such as extrafoveal choroidal neovascularization (CNV) or early CNV without definite fluid in the foveal region’ (201 bevacizumab injections, 29.0%). Conclusions: Bevacizumab was used in 23.7% of the anti-VEGF injections to treat wet AMD. When analyzing patients’ treatment burden and financial impact, the results of the present study may provide useful information. Further multi-center studies are required to evaluate more precisely the usage of anti-VEGF drugs.
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