나이관련황반변성에 대한 항혈관내피성장인자 14회 유리체내주사: 완료시기와 임상결과
Fourteen Anti-vascular Endothelial Growth Factor Injections for Age-related Macular Degeneration: Ending Period and Clinical Outcome
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목적: 단안 습성 나이관련황반변성 환자를 대상으로 14회의 라니비주맙 혹은 애플리버셉트 유리체내주사의 임상결과를 분석하고자 한다. 대상과 방법: 단안 습성 나이관련황반변성으로 진단된 후 건강보험이 적용되는 14회의 라니비주맙 혹은 애플리버셉트 유리체내주사를 시행 받은 24명(24안)을 대상으로 후향적 의무기록 분석을 시행하였다. 14회 유리체내주사가 완료되기까지의 기간을 확인하였으며, 교체투여를 시행 받은 환자의 비율과 시기를 분석하였다. 진단 당시 및 14회 유리체내주사 시행 시점의 최대교정시력을 비교하여 시력의 호전, 유지, 악화 여부를 확인하였다. 추가적으로 14회 종료 시점까지의 기간과 연관된 인자를 분석하였다. 결과: 진단 시부터 14회 유리체내주사 완료 시점까지의 기간은 평균 32.3 ± 6.2개월(21-48개월)이었으며, 상기 기간 동안 17안(70.8%)에서 약제의 교체투여가 시행되었다. 첫 번째 교체투여는 평균 약 9.4 ± 2.1회(4-14회)의 유리체내주사 후 시행되었다. 진단시의 시력과 비교하여 14회 유리체내주사 시행 시점에 최대교정시력이 호전된 경우는 6안(25.0%), 차이가 없었던 경우는 8안(33.3%) 이었으며, 저하된 경우는 10안(41.7%)이었다. 첫 3회 유리체내주사 후 망막내액/망막하액이 완전히 소실된 20안에서 첫 재발까지의 기간과 14회 주사 완료 시점까지의 기간 사이에 유의한 연관관계가 나타났다(p=0.007, r=0.583). 결론: 건강보험이 적용되는 14회 유리체내주사가 완료되기까지는 평균 약 32.3개월이 소요되었으며, 70.8%에서 치료 도중 교체투여가 시행되었다. 첫 재발까지의 기간이 길수록 14회 주사 완료 시점까지의 기간도 긴 경향이 있었다. 본 연구의 결과는 국내의 의료보험환경에서 환자와 치료방침에 대해 상의할 때 유용한 정보를 제공해 줄 수 있을 것으로 생각된다.
Abstract
Purpose: To evaluate the clinical course of patients who had completed 14 ranibizumab or aflibercept monocular treatments. Methods: Retrospective medical record analysis was performed to 24 patients who were diagnosed with monocular neovascular age-related macular degeneration and had completed 14 ranibizumab or aflibercept monocular injections, allowed by the Korean National Health Care system. Time to completion was measured along with the percentage and timing of medication switch. Best-corrected visual acuity (BCVA) was measured at the time of diagnosis, after 3-loading injections, and the time of completion. Additionally, we searched for any other factors that had influenced the time to completion. Results: The average time to completion of 14 injections was 32.3 ± 6.2 months (21–48 months). The switching was performed in 17 eyes (70.8%), and it was done after 9.4 ± 2.1 injections (4–14 injections) with prior medication. After 14 injections, the BCVA improved in 6 eyes (25.0%), unchanged in 8 eyes (33.3%), and worsened in 10 eyes (41.7%). Complete resolution of intraretinal fluid and subretinal fluid after 3 loading injections were observed in 20 eyes, and it was significantly related to time to the first recurrence and time to the completion of 14 injections (p = 0.007, r = 0.583). Conclusions: The average time to completion of 14 injections was 32.3 months, and switching of medication was performed in 70.8%. Longer time to the first recurrence was related to longer completion time. This study will provide useful facts when informing the patients their future treatment plans under the Korean Health Care system.
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