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Viggiano P, Landini L, Grassi MO, Boscia G, Borrelli E, Sborgia G, Alessio G, Boscia F. Effects of diabetic retinopathy on longitudinal morphological changes in AMD-associated type 1 macular neovascularization. Sci Rep 2023; 13:16337. [PMID: 37770616 PMCID: PMC10539526 DOI: 10.1038/s41598-023-43635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
The purpose of this study was to investigate the effect of diabetic retinopathy (DR) on longitudinal morphological changes in AMD-associated type 1 macular neovascularization using optical coherence tomography angiography (OCTA). We enrolled fifty treatment-naïve eyes with a diagnosis of exudative AMD and type 1 MNV. Twenty of 50 eyes were affected by mild DR. En face OCT angiography were examined for the MNV lesion area (mm2), the MNV flow area (mm2), the central macular thickness (CMT) and the BCVA. The OCTA acquisition was performed at the following visits: (i) before the loading phase (LP) of intravitreal injection of aflibercept (T1), and (ii) 1 month after the last intravitreal injection of loading phase comprising 3 monthly injections (T2). All morpho-functional parameters showed a significantly change at T2 compared to T1 values in both groups. Furthermore, we found a greater MNV area reduction after LP in eyes without DR (P = 0.023). With regard to the remaining parameters, no significant changes were found between two groups (P > 0.05). Our analysis revealed a less MNV area reduction after loading dose of anti-VEGF therapy in eyes affected by diabetic retinopathy.
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Affiliation(s)
- Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, Bari, Italy.
| | - Luca Landini
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, Bari, Italy
| | - Maria Oliva Grassi
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, Bari, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, Bari, Italy
| | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Giancarlo Sborgia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, Bari, Italy
| | - Giovanni Alessio
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, Bari, Italy
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, Bari, Italy
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Lüke JN, Alquoqa H, Alsamman A, Aljabary B, Schaub F, Heindl LM. Retrospective analysis of OCT parameters after intravitreal anti-VEGF inhibitors in neovascular AMD patients in a real-world setting. Int Ophthalmol 2023; 43:13-25. [PMID: 35781595 PMCID: PMC9902313 DOI: 10.1007/s10792-022-02383-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the present study was to evaluate changes of best corrected visual acuity (BCVA), retinal nerve fiber layer thickness (RNFL), total macular volume (TMV), intraocular pressure (IOP) and central retinal thickness (CRT) after intravitreal injection of ranibizumab, bevacizumab and aflibercept in patients with neovascular age-related macular degeneration (nAMD) in a clinical real world setting. METHODS In a retrospective clinical study design, 120 patients (80 women and 40 men) were analyzed after being diagnosed with nAMD within 8 years (2010-2018). Every patient received at least 6 anti-VEGF injections in a Pro-Re-Nata or Treat-and-Extend regimen. OCT parameters (RNFL, TMV, CRT) and visual acuity (BCVA) were assessed at first diagnosis, at treatment day and during the course. RESULTS Intraretinal fluid was reduced significantly in a magnitude of 88-64 µm (CRT) and 0.75-0.55 mm3 (TMV). Apart from a significant reduction immediately after the therapy start (post-3 injections) with ranibizumab (- 1.4 µm, p = 0.03), RNFL thickness remained constant. A slight improvement in visual acuity of 0.06 logMAR could initially be observed. If further injections were required, only stabilization was achieved compared to baseline visual acuity. CONCLUSION The changes of OCT parameters CRT, TMV, and RNFL as well as the stabilization of functional results (BCVA) as illustrated in this study comparing effects of different anti-VEGF-agents provide evidence for the transferability of former results to a clinical real-world setting.
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Affiliation(s)
- Jan Niklas Lüke
- Department of Ophthalmology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | | | | | | | - F Schaub
- Department of Ophthalmology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Universitätsmedizin Rostock, Klinik und Poliklinik für Augenheilkunde, Rostock, Germany
| | - L M Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Zarranz‐Ventura J, Parrado‐Carrillo A, Nguyen V, Sararols L, Garay‐Aramburu G, Puzo M, Arruabarrena C, Figueras‐Roca M, Gillies MC, Casaroli‐Marano RP, Ventura JZ, Carrillo AP, Roca MF, Udina AM, Serra JI, Morales CB, Alforja S, Casaroli Marano RP, Ramsay LS, Londoño G, Olivera M, Bañon K, Rethati C, Calvo P, Sánchez J, Puzo M, Moreno OR, Aramburu GG, Arana AL, Moreno AG, Feijoo DR, Durana Santa Coloma ED, Echeveste MA, Barrio Lopez de Ipiña Z, Díaz IH, Arumí JG, Brosa H, Vela LS, Zapata MA, Arruabarrena C, Milner RM, Aragón F, Veiga MJAL, Lidia M, Conde G, Cid MJR, Rodríguez MIF, Almuiña P, Hortelano VAF, Gallardo JZ, Soriano RC, Escobar IL, Martín PM, Moreno JMR, González RV, Zamora MG, Valldeperas IFMX, Iturralde LB, Mira FV, Sánchez SG, Figueroa PC, Barranco JJE, Bonet MF, Marín BP, Salinas E, Guijarro MJG, García MA, Sanchís SA, Fernández JC, Grau MB, Puyuelo FJA, Grijalbo AH, Murillo AB, Dolores M, Barreda D, Rivasés GP, El Bakkali IB, Pinazo RG, Cholbi M, Marco RD, Figueroa MS, Ciancas E, José J, López G, Haskour CA, Sánchez AP, Sanz NM, Carreño E, Ventura N, Méndez PC, Vázquez CM, Borrego CT, Villoria DV, Layana AG, Viteri MS, Alonso E, Castillón Torre LJ, Muñoz PC, Sempere MET, Fátima Álvarez Gil M, García PP, Eugenia M, Bermejo M, Javier F, Mozos L, Duran MA, Barquet LA, Martín EC, Parra DL, Núñez MR, Gesto AC, Esteban JP, Pilar Ruiz del Tiempo MD, Maqueda MR, Angeles M, Periñan E, Toribio MS. Creation of a neovascular age‐related macular degeneration national database using a web‐based platform:
Fight Retinal Blindness Spain.
Report 1: Visual outcomes. Clin Exp Ophthalmol 2022; 50:312-324. [DOI: 10.1111/ceo.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/14/2022] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Javier Zarranz‐Ventura
- Hospital Clínic de Barcelona Barcelona Spain
- Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
| | - Alba Parrado‐Carrillo
- Hospital Clínic de Barcelona Barcelona Spain
- Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
| | - Vuong Nguyen
- Save Sight Institute, Sydney Medical School, University of Sydney Sydney Australia
| | - Laura Sararols
- Fundació Privada Hospital Asil Granollers Granollers Spain
| | | | - Martín Puzo
- Hospital Universitario Miguel Servet Zaragoza Spain
| | | | - Marc Figueras‐Roca
- Hospital Clínic de Barcelona Barcelona Spain
- Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
| | - Mark C. Gillies
- Save Sight Institute, Sydney Medical School, University of Sydney Sydney Australia
| | - Ricardo P. Casaroli‐Marano
- Hospital Clínic de Barcelona Barcelona Spain
- Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
- Department of Surgery, School of Medicine, Universitat de Barcelona Barcelona Spain
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Stemplewitz B, Luethy J, Eddy MT, Spitzer M, Brocks U, Kieckhoefel J, Schneemann C, Schaudig U, Schargus M. Impact of the COVID-19 pandemic's first wave on the care and treatment situation of intravitreal injections in a German metropolitan region. Graefes Arch Clin Exp Ophthalmol 2022. [PMID: 35006330 DOI: 10.1007/s00417-021-05521-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose This study aims to evaluate the impact of the first coronavirus 2019 (COVID-19) wave in 2020 on patients scheduled for intravitreal injections (IVI) in a German metropolitan region. Methods We performed a multicentre prospective survey and retrospective analysis of the records of patients treated with intravitreal injections during the 20-week period from March to July 2020 in all four hospital eye departments in the city of Hamburg using a questionnaire (on treatment adherence, SarsCoV2-related personal, familial and social data) and treatment data. Results A total of 1038 patients (2472 IVI, 1231 eyes) and 818 questionnaires were evaluated. Longer duration of therapy, lower visual acuity (VA) of the treated and higher VA of the fellow untreated eye was were associated with a higher probability of visit cancellation. Every additional year of life posed a 2.6% lower risk of noncompliance. A COVID-19 infection in the family environment displayed a 5.5-fold chance of visit cancellation. Patients treated for neovascular age-related macular degeneration (nAMD) had a 36% reduced risk of visit cancellation compared to patients with diabetic macular oedema (DME). Conclusion A long preceding treatment period, low VA of the treated eye, high VA of the untreated eye, COVID-19 in the family and DME were identified as risk factors for IVI visit cancellations during the COVID-19 pandemic. Compliance to treatment might be improved in the future by taking these risk factors into account when scheduling patients for IVI during the exceptional circumstances of a pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00417-021-05521-5.
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Oca AI, Pérez-Sala Á, Pariente A, Ochoa R, Velilla S, Peláez R, Larráyoz IM. Predictive Biomarkers of Age-Related Macular Degeneration Response to Anti-VEGF Treatment. J Pers Med 2021; 11:1329. [PMID: 34945801 DOI: 10.3390/jpm11121329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/10/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023] Open
Abstract
Age-related macular degeneration (AMD) is an incurable disease associated with aging that destroys sharp and central vision. Increasing evidence implicates both systemic and local inflammation in the pathogenesis of AMD. Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is currently the first-line therapy for choroidal neovascularization in AMD patients. However, a high number of patients do not show satisfactory responses to anti-VEGF treatment after three injections. Predictive treatment response models are one of the most powerful tools for personalized medicine. Therefore, the application of these models is very helpful to predict the optimal treatment for an early application on each patient. We analyzed the transcriptome of peripheral blood mononuclear cells (PBMCs) from AMD patients before treatment to identify biomarkers of response to ranibizumab. A classification model comprised of four mRNAs and one miRNA isolated from PBMCs was able to predict the response to ranibizumab with high accuracy (Area Under the Curve of the Receiver Operating Characteristic curve = 0.968), before treatment. We consider that our classification model, based on mRNA and miRNA from PBMCs allows a robust prediction of patients with insufficient response to anti-VEGF treatment. In addition, it could be used in combination with other methods, such as specific baseline characteristics, to identify patients with poor response to anti-VEGF treatment to establish patient-specific treatment plans at the first visit.
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Sobolewska B, Sabsabi M, Ziemssen F. Importance of Treatment Duration: Unmasking Barriers and Discovering the Reasons for Undertreatment of Anti-VEGF Agents in Neovascular Age-Related Macular Degeneration. Clin Ophthalmol 2021; 15:4317-4326. [PMID: 34737546 PMCID: PMC8558036 DOI: 10.2147/opth.s325763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose Since non-adherence (NA) to intravitreal therapy with VEGF drugs is one of the most important modifiable factors compromising treatment outcome of nAMD, the purpose of this study was to investigate the contributing factors and barriers during long-term nAMD treatment. Methods Barriers and potential reasons for NA were prospectively measured using the Adherence Barriers Questionnaire Intravitreal Therapy (ABQ-IVT). A random sample of patients receiving intravitreal therapy was drawn based on data for different treatment periods. Three age-sex matched groups included the treatment periods of ≤30 months (group 1), between >30 months and ≤60 months (group 2), and >60 months (group 3). The occurrence of gaps between treatments and/or OCT visits was evaluated. Results NA with gaps of >56 days after the scheduled appointment was detected in 39%, 89%, and 100% of patients in group 1, 2, and 3, respectively (groups 1 and 2 vs group 3, p < 0.001). Two or more of such gaps were observed in 6%, 72%, and 94% of patients in group 1, 2, and 3, respectively. The overall ABQ-IVT score showed corresponding differences between the groups: 25.89 ± 7.68 (group 1, 95% CI 22.07–29.71), 34.72 ± 10.32 (group 2, 95% CI: 29.59–38.86), and 33.28 ± 9.04 (group 3, 95% CI 28.78–37.77). Accordingly, the score was inversely correlated with the number of regular follow-up visits in groups 2 and 3 (Pearson correlation coefficient r = −0.65 (p = 0.003) and r = −0.5 (p = 0.034), respectively). Within the groups of longer treatment duration, univariate logistic regression analysis showed higher odds of time commitment and challenge accompanying person to be relevant barriers. Conclusion NA is an arising problem with increasing duration of intravitreal therapy. Treatment barriers, detected by the ABQ-IVT, might change or increase during the course of the treatment.
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Affiliation(s)
- Bianka Sobolewska
- Center for Ophthalmology, Eberhard- Karls University, Tuebingen, Germany
| | - Muhammed Sabsabi
- Center for Ophthalmology, Eberhard- Karls University, Tuebingen, Germany
| | - Focke Ziemssen
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tuebingen, Germany.,Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
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Rossi S, Gesualdo C, Tartaglione A, Scazzi GB, D’Alessio AC, Ragucci A, Melillo P, Simonelli F. Therapy of Age-related Exudative Macular Degeneration with Anti-vascular Endothelial Growth Factor Drugs: An Italian Real Life Study. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim:
To evaluate the real utilization of ranibizumab and aflibercept in the daily management of patients with neovascular age-related macular degeneration (nAMD) treated at the Eye Clinic of Campania University L.Vanvitelli.
Background:
Therapy with anti-vascular endothelial growth factor represents the gold standard in wet age-related macular degeneration. There are nonreal life italian studies of this therapy in the literature.
Objective:
To analyze in our sample the post-therapy variations of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) observed at the end of a 12-month follow-up period.
Methods:
This real-life study analyzes 109 patients that underwent monthly checks for the first 4 months and then every 2 months until the end of the 12-month follow-up. The sample was first analyzed in its entirety, subsequently subdivided into 3 groups based on baseline BCVA, age, and the number of intravitreal injections performed, in order to identify possible predictive elements of the anti-VEGF response.
Results:
On average, patients underwent 4.16 ± 1.58 intravitreal anti-VEGF injections in 1 year. At the end of the 12-month follow-up, the patients’ average BCVA increased from 33.01 letters to 33.75 letters (+0.74 ± 9,4 letters), while the average CRT decreased from 346.86 µm to 265.39 µm (-81.47 ± 121 µm).
Conclusion:
The study shows the efficacy of anti-VEGF therapy in the stabilization of BCVA in nAMD, confirming the differences in visual outcomes compared to clinical trials, mainly for economic-organizational reasons.
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Holz FG, Figueroa MS, Bandello F, Yang Y, Ohji M, Dai H, Wykrota H, Sharma S, Dunger-Baldauf C, Lacey S, Macfadden W, Mitchell P; all the LUMINOUS study investigators. RANIBIZUMAB TREATMENT IN TREATMENT-NAIVE NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Results From LUMINOUS, a Global Real-World Study. Retina 2020; 40:1673-85. [PMID: 31764612 DOI: 10.1097/IAE.0000000000002670] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effectiveness, safety, and treatment patterns of ranibizumab 0.5 mg in treatment-naive patients with neovascular age-related macular degeneration enrolled in LUMINOUS study. METHODS This 5-year, prospective, multicenter, observational study recruited 30,138 adult patients (treatment-naive or previously treated with ranibizumab or other ocular treatments) who were treated according to the local ranibizumab label. RESULTS Six thousand two hundred and forty-one treatment-naive neovascular age-related macular degeneration patients were recruited. Baseline (BL) demographics were, mean (SD) age 75.0 (10.2) years, 54.9% females, and 66.5% Caucasian. The mean (SD) visual acuity (VA; letters) gain at 1 year was 3.1 (16.51) (n = 3,379; BLVA, 51.9 letters [Snellen: 20/92]) with a mean (SD) of 5.0 (2.7) injections and 8.8 (3.3) monitoring visits. Presented by injection frequencies <3 (n = 537), 3 to 6 (n = 1,924), and >6 (n = 918), visual acuity gains were 1.6 (14.93), 3.3 (16.57), and 3.7 (17.21) letters, respectively. Stratified by BLVA <23 (n = 382), 23 to <39 (n = 559), 39 to <60 (n = 929), 60 to <74 (n = 994), and ≥74 (n = 515), visual acuity change was 12.6 (20.63), 6.7 (17.88), 3.6 (16.41), 0.3 (13.83), and -3.0 (11.82) letters, respectively. The incidence of ocular/nonocular adverse events was 8.2%/12.8% and serious adverse events were 0.9%/7.4%, respectively. CONCLUSION These results demonstrate the effectiveness and safety of ranibizumab in treatment-naive neovascular age-related macular degeneration patients.
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Müller S, Junker S, Wilke T, Lommatzsch A, Schuster AK, Kaymak H, Ehlken C, Ziemssen F. Questionnaire for the assessment of adherence barriers of intravitreal therapy: the ABQ-IVT. Int J Retina Vitreous 2021; 7:43. [PMID: 34078475 PMCID: PMC8170736 DOI: 10.1186/s40942-021-00311-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/09/2021] [Indexed: 01/26/2023] Open
Abstract
Objective To develop and validate a questionnaire for the investigation of non-adherence (NA) barriers in patients receiving intravitreal injection (IVT). Design Questionnaire development and cross-sectional patient survey combined with a retrospective medical chart review. Participants German patients with neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME) receiving anti-vascular endothelial growth factor (anti-VEGF) treatment via IVT. Methods The previously validated (indications: atrial fibrillation, human immunodeficiency virus, chronic inflammatory lung disease) Adherence Barriers Questionnaire (ABQ) was revised according to specifications of IVT, within the framework of an expert panel. The ABQ-IVT, which initially consisted of 24 items formulated as statements (4-point-Likert-scale ranging from “strongly agree” to “strongly disagree”), was applied in a cross-sectional survey. Evaluation of the questionnaire included an assessment of internal consistency and factor analysis. The occurrence of potential barriers in the patient sample was evaluated using descriptive statistics. To identify patient subpopulations, hierarchical cluster analysis was performed using ABQ-IVT answers as predictors. Due to difficulties in capturing NA as an external criterion, the evaluation of the questionnaire was limited to its internal validity and reliability. Main outcome measures Patients’ answers to the ABQ-IVT questionnaire and interviews. Results Of 253 patients, 234 (92%) were able to complete the ABQ-IVT questionnaire. Within the reliability analysis, the ABQ-IVT was reduced to 17 items. The condensed questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0.78), and factor analysis showed no evidence for subscales of the questionnaire. Nearly half of the patients (49%) reported being affected by at least three different barriers. On average, a patient was affected by 3.1 barriers. The most frequently reported barriers were “Challenge due to time commitment of physician visits” (45% of the patients), “Depression” (29%) and “Travel and opportunity costs” (27%). Cluster analysis identified six patient subpopulations, each affected by different sets of barriers and differed regarding their patient characteristics. Conclusions The ABQ-IVT is a practical and reliable instrument for identifying patient-specific barriers to IVT treatment adherence. In practice, the questionnaire may be useful in assessing whether individual patients are at higher risk of NA due to specific adherence barriers. Aside from better awareness, this allows earlier interventions, though these still need to be validated. Patient subpopulations face different barriers and may, therefore, need distinct preventative care. Supplementary Information The online version contains supplementary material available at 10.1186/s40942-021-00311-x.
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Affiliation(s)
- Sabrina Müller
- IPAM e.v, University of Wismar, University of Applied Sciences, Alter Holzhafen 19, 23966, Wismar, Germany.
| | - Sophia Junker
- Ingress-Health HWM GmbH, Alter Holzhafen 19, 23966, Wismar, Germany
| | - Thomas Wilke
- IPAM e.v, University of Wismar, University of Applied Sciences, Alter Holzhafen 19, 23966, Wismar, Germany
| | - Albrecht Lommatzsch
- Augenzentrum Am St. Franziskus-Hospital Münster, Hohenzollerning 74, 48145, Münster, Germany
| | - Alexander K Schuster
- MORE Reading Center, Augenklinik Und Poliklinik Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Hakan Kaymak
- Augenchirugie Clinic, Theo-Champion-Str. 1, 40549, Düsseldorf, Germany
| | - Christoph Ehlken
- Universitaetsklinikum Schleswig-Holstein Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Focke Ziemssen
- Universitäts-Augenklinik Tübingen, Elfriede-Aulhorn-Straße 7, 72076, Tübingen, Germany
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Eter N, Hasanbasic Z, Keramas G, Rech C, Sachs H, Schilling H, Wachtlin J, Wiedemann P, Framme C; PERSEUS Study Group. PERSEUS 24-month analysis: a prospective non-interventional study to assess the effectiveness of intravitreal aflibercept in routine clinical practice in Germany in patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2021; 259:2213-23. [PMID: 33547967 DOI: 10.1007/s00417-021-05073-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the real-world effectiveness of intravitreal aflibercept injections in Germany in patients with neovascular age-related macular degeneration over 24 months. METHODS PERSEUS was a prospective, non-interventional cohort study. The primary endpoint was the mean change in visual acuity (VA) from baseline. Secondary endpoints included the proportion of patients with a VA gain or loss of ≥ 15 letters and the frequency of injections and examinations. Patients with regular (bimonthly after 3 monthly injections during year 1 and ≥ 4 injections in year 2) and irregular (any other) treatment were analyzed. The last observation carried forward (LOCF) and the observed cases (OC) approach was applied for primary endpoint analysis to account for missing data. RESULTS 803 patients were considered for effectivity analysis. At month 24, only 38% of the patients were still under observation. The LOCF population included 727, the OC population 279 patients. Treatment-naïve patients improved by 6.3 (LOCF)/8.1 (OC) letters with regular treatment over 24 months but only by 3.3 (LOCF)/3.1 (OC) letters with irregular treatment. The proportion of treatment-naïve patients achieving a VA improvement of ≥ 15 letters was similar between regularly and irregularly treated cohorts. However, considerably more patients in the irregular cohorts experienced a VA worsening of ≥ 15 letters than in the regular cohorts (LOCF: 18.7% vs. 7.4%). CONCLUSIONS Regular IVT-AFL treatment resulted in better VA outcomes than irregular treatment at month 24. However, only a minority of patients received regular treatment over a 2-year period.
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Glück S, Brandlhuber U, Gerbutavicius R, Kortüm GF, Kortüm I, Navarrete Orozco R, Rakitin M, Strodtbeck M, Kortüm K. [Impact of a more stringent organization of intravitreal injection treatment on the number of treatments and examinations in routine practice]. Ophthalmologe 2020; 118:1134-1139. [PMID: 33252769 DOI: 10.1007/s00347-020-01267-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/31/2020] [Accepted: 11/08/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Results from recent studies show that less intravitreal injections are often performed in everyday practice than in controlled trials, which subsequently leads to worse treatment success. In this study we analyzed the introduction of a more stringent organization of treatment using workflow optimization and new IT systems and analyzed the effect on treatment continuity. MATERIAL AND METHODS In the second quarter of 2019 a new medical practice management software and a software for automated injection planning were implemented. There was also a change of the treatment regimen from pro re nata (PRN) to treat and extend (T&E ). We analyzed the results of the patients regarding the frequency of injections and treatment controls three quarters before (Q3/2018-Q1/2019) and three quarters after the change (Q2/2019-Q4/2019). Treatment-naive and pretreated patients were analyzed. RESULTS In group 1 (Q3/2018-Q1/2019) the average number of injections per quarter was 1.74 (SD = 0.4). Eyes of patients from group 2 (Q2/2019-Q4/2019) received on average 2.17 (SD = 0.3) injections. The number of check-ups per quarter was 1.71 (SD = 0.3) before the introduction, and thereafter 2.16 (SD = 0.3). There was a significant increase in the number of OCTs from 1.18 (SD = 0.2) to 1.98 (SD = 0.3). The visual acuity was stable in both groups. CONCLUSION We were able to show that the introduction of the medical practice management software and the change of the regimen from PRN to T&E can achieve numbers of injections, check-ups and OCT similar to those in studies. A standardized procedure facilitates efficient treatment planning and enables a better patient management.
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Affiliation(s)
- S Glück
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Deutschland.
| | - U Brandlhuber
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Deutschland
| | - R Gerbutavicius
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Deutschland
| | - G-F Kortüm
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Deutschland
| | - I Kortüm
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Deutschland
| | - R Navarrete Orozco
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Deutschland
| | - M Rakitin
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Deutschland
| | - M Strodtbeck
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Deutschland
| | - K Kortüm
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Deutschland.,Augenklinik, Universität München, München, Deutschland
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Framme C, Greb O, Bayer S, Buley P, Pielen A, Hufendiek K, Junker B, Volkmann I. Development of a Patient-Oriented Organizational Management System for Intravitreal Injection Therapy in a Standardized "Treat-and-Extend" Regime at a University Eye Clinic. Klin Monbl Augenheilkd 2020; 238:1312-1324. [PMID: 33242883 DOI: 10.1055/a-1266-3546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The treatment of macular edema with intravitreal injections has revolutionized the treatment of associated diseases in ophthalmology. However, with a few exceptions, this is a chronic treatment where patients require many injections and usually need to stay in treatment for years. Patient adherence and control of patient flow are critical to treatment success. In this manuscript, we describe the development of a patient-oriented organization management for intravitreal injections in a university hospital. MATERIAL AND METHODS In 2015, the intravitreal treatment in our clinic was switched to the treat-and-extend regime. At the same time, the optimization of the previous organizational processes in perioperative management was evaluated. For the period 2015 to 2018, we analyzed and gradually optimized the procedures of our intravitreal injection therapy in a survey with a specialized service provider. RESULTS Through the analysis of the original processes, the patient appointment was optimized, work processes were summarized, spatially reorganized and there was only a slight increase in the number of staff involved compared with the significant increase in the number of injections. Through these measures, the total in-hospital-time of the patients could be drastically reduced and at the same time the number of patients on one operation day could be multiplied. CONCLUSION In the context of chronic treatment with intravitreal injections, the care of an increased number of patients is a logistical challenge. By optimizing processes, existing resources can be better used to meet the increased demands. An optimized system offers the patient greater adherence and a better visual outcome largely independent of the medication used.
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Affiliation(s)
- Carsten Framme
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Deutschland
| | - Oliver Greb
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Deutschland
| | - Sascha Bayer
- Niederlassung Schweiz, Q_PERIOR, Zürich, Schweiz
| | - Pascal Buley
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Deutschland
| | - Amelie Pielen
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Deutschland
| | - Katerina Hufendiek
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Deutschland
| | - Bernd Junker
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Deutschland
| | - Ingo Volkmann
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Deutschland
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13
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Take P, Dittmann CA, Mackerodt L, Callizo J, Striebe NA, Hoerauf H, Feltgen N, Bemme S. [The modified treat and extend scheme with injection blocks in intravitreal injection treatment : Retrospective analysis from the routine clinical application]. Ophthalmologe 2021; 118:578-86. [PMID: 32894329 DOI: 10.1007/s00347-020-01218-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 01/04/2023]
Abstract
Hintergrund Die regelmäßige Therapie mittels intravitrealer operativer Medikamentenapplikation (IVOM) und die damit verbundenen Kontrolluntersuchungen stellen für viele Patienten eine große Herausforderung dar, die bis zum Behandlungsabbruch führen kann. Das modifizierte blockweise Treat-and-Extend(TAE)-Schema verfolgt das Ziel, mit möglichst wenigen Kontrollvisiten stabile Netzhaut- und Visusbefunde zu erreichen und dadurch die Belastung der Patienten zu minimieren. Methoden Diese monozentrische retrospektive Studie untersuchte Behandlungsverläufe von insgesamt 387 Patienten mit neovaskulärer altersbedingter Makuladegeneration (AMD), diabetischem Makulaödem (DMÖ), Venenastverschluss (VAV) und Zentralvenenverschluss (ZVV), bei denen das TAE-Regime jeweils in 3er-Blöcken angewendet wurde. Primärer Endpunkt war das Erreichen eines Injektionsintervalls von 12 Wochen. Ergebnisse Durch die blockweise applizierte IVOM konnte die Netzhautdicke signifikant reduziert und der Visus verbessert werden. Über die verschiedenen Indikationen konnte im Mittel ein Behandlungsintervall von 2 Monaten erreicht werden. Schlussfolgerung Ein in 3er-Blöcken angepasstes TAE-Schema im Rahmen der IVOM kann bei reduzierter Patientenbelastung zu stabilen Netzhaut- und Visusbefunden führen. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00347-020-01218-y) enthalten.
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14
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Wachtlin J, Eter N, Hasanbasic Z, Keramas G, Rech C, Sachs H, Schilling H, Wiedemann P, Framme C. Importance of continuous treatment with intravitreal aflibercept injections in patients with neovascular age-related macular degeneration-12-month post hoc analysis of the PERSEUS real-world evidence study. Graefes Arch Clin Exp Ophthalmol 2020; 259:601-611. [PMID: 32789651 PMCID: PMC7904558 DOI: 10.1007/s00417-020-04803-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/29/2020] [Accepted: 06/13/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the influence of treatment regularity with intravitreal aflibercept injections (IVT-AFL injections) on visual acuity (VA) outcomes in patients with neovascular age-related macular degeneration (nAMD) enrolled in the PERSEUS trial who received at least 7 IVT-AFL injections during the first year. METHODS This was a post hoc analysis of the PERSEUS trial, a prospective, non-interventional, multicenter cohort study, and included 370 patients with nAMD who had received ≥ 7 IVT-AFL injections during year 1. In addition to the prespecified subgroups of treatment-naïve and previously treated patients, results were compared between patients with regular (n = 209) and irregular (n = 161) treatment. Regular treatment was defined as initial dosing with monthly IVT-AFL injections for 3 months, then bimonthly IVT-AFL injections until month 12. Irregular treatment was defined as any deviation from regular treatment (provided ≥ 7 injections were received). The outcome of primary interest was the mean change in VA from baseline after 12 months. Further outcomes of interest included VA gain or loss, proportion of patients achieving reading vision, and percentage of patients with fluid. RESULTS At month 12, the mean (± standard deviation, SD) VA improvement from baseline was 6.1 ± 15.6 Early Treatment Diabetic Retinopathy Study letters in the regular cohort and 2.5 ± 16.7 letters in the irregular cohort with ≥ 7 IVT-AFL injections (P = 0.0514). Best results were obtained in the treatment-naïve regular sub-cohort with a mean ± SD VA improvement of 8.0 ± 17.7 letters, whereas treatment-naïve patients with irregular treatment experienced a considerably lower VA gain (2.8 ± 20.0 letters). Irregular treatment consistently correlated with inferior results in treatment-naïve patients. At month 12, the proportion of treatment-naïve patients who had experienced a worsening of ≥ 5 letters was 29.6% in the irregular sub-cohort versus 13.6% in the regular sub-cohort (P = 0.0049). However, among the treatment-naïve patients, the mean number of injections was significantly higher in the irregular than in the regular sub-cohort (8.0 ± 1.2 vs. 7.4 ± 0.6; P = 0.0001). Furthermore, compared with the treatment-naïve, regular sub-cohort, patients in the irregular sub-cohort had more visits (19.1 ± 8.6 vs. 16.1 ± 5.7), VA tests (14.2 ± 6.9 vs. 12.0 ± 4.6), and optical coherence tomography examinations (5.1 ± 3.7 vs. 3.4.0 ± 3.0). CONCLUSIONS Although irregularly treated patients received more injections and more monitoring visits during the first year of IVT-AFL treatment, they experienced worse VA outcomes than regularly treated patients.
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Affiliation(s)
- Joachim Wachtlin
- Abteilung für Augenheilkunde, Sankt Gertrauden-Krankenhaus, Paretzer Straße 12, 10713, Berlin, Germany.
- MHB, Medizinische Hochschule Brandenburg, Neuruppin, Germany.
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Münster, Germany
| | - Zoran Hasanbasic
- Medizinische Fachabteilung, Bayer Vital GmbH, Leverkusen, Germany
| | - Georgios Keramas
- Medizinische Fachabteilung, Bayer Vital GmbH, Leverkusen, Germany
| | | | - Helmut Sachs
- Augenklinik, Städtisches Klinikum Dresden-Friedrichstadt, Dresden, Germany
| | - Harald Schilling
- Klinik für Augenheilkunde, St.-Johannes-Hospital, Dortmund, Germany
| | - Peter Wiedemann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Carsten Framme
- Klinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Germany
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15
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Wachtlin J, Spital G, Schmitz-Valckenberg S, Liakopoulos S, Vögeler J, Müller B, Ziemssen F, Ocean Study Group. Use of Imaging Modalities in Real Life: Impact on Visual Acuity Outcomes of Ranibizumab Treatment for Neovascular Age-Related Macular Degeneration in Germany. J Ophthalmol 2020; 2020:8024258. [PMID: 32724669 DOI: 10.1155/2020/8024258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/19/2020] [Indexed: 02/06/2023] Open
Abstract
Background To date, there are limited prospective real-world data on the impact of optical coherence tomography (OCT) diagnostics on treatment outcomes in neovascular age-related macular degeneration (nAMD). Therefore, the prospective, noninterventional OCEAN study (NCT02194803) evaluated the use of OCT imaging and its impact on functional outcomes in Germany. Methods The use of OCT imaging for treatment decisions was documented in nAMD patients receiving intravitreal ranibizumab injections at 347 study centres. Best-corrected visual acuity (BCVA) testing and treatment were performed according to routine clinical practice and documented over 24 months. Results The majority of the 3,631 nAMD patients (59.6%) received a combination of OCT and fluorescein angiography imaging within the first 6 months. Over the remaining study course, this combination was used infrequently (range: 7.6% to 13.4%) and continually decreased over time; most patients received only OCT examinations (range: 48.9% to 52.5%; median: 3 within 12 months and 4 within 24 months). Subgroups according to the number of OCT examinations (≤4, rarely OCT examined; 5–8, moderately OCT examined; ≥8, well monitored) were associated with different treatment frequencies and outcomes: Rarely OCT-examined patients had received a median of 4 injections (range: 1–19) at 24 months; well-monitored patients had received a median of 8 injections (range: 1–21) at 24 months. Rarely OCT-examined patients had a mean change of BCVA of −0.3 letters (±26.1) at 24 months (n = 165); well-monitored patients showed a change of +2.0 letters (±20.8) at 24 months (n = 249). Time-to-response was greater for rarely examined than well-monitored patients, while duration-of-response was similar. Conclusion Low number of visits as well as high number of treatment decisions without the use of OCT may contribute to undertreatment and poorer functional outcomes in patients undergoing ranibizumab treatment for nAMD in Germany. One potential reason for this could be that OCT was not covered by insurance for all patients during the study.
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16
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Ehlken C, Ziemssen F, Eter N, Lanzl I, Kaymak H, Lommatzsch A, Schuster AK. Systematic review: non-adherence and non-persistence in intravitreal treatment. Graefes Arch Clin Exp Ophthalmol 2020; 258:2077-90. [PMID: 32572607 DOI: 10.1007/s00417-020-04798-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Intravitreal injection of VEGF inhibitors has become the standard of care for different macular diseases within the last years resulting in improved visual outcomes. Under real-life conditions, however, the necessity for frequent retreatments and reexaminations poses a burden for patients and treatment centers. Non-adherence and non-persistence to intravitreal treatment may lead to inferior clinical outcomes, and knowledge of contributing factors is crucial to improve adherence. This systematic review analyzes current literature for potential factors involved in non-adherence and non-persistence. Methods A systematic search was conducted in PubMed and Embase including three different aspects of intravitreal injection therapy: (1) diseases with intravitreal injections as treatment, (2) intravitreal injection, and (3) aspects of therapy adherence or therapy persistence. Data from identified quantitative studies were further extracted and grouped according to WHO criteria (condition, socio-economy, therapy, patient, and health system). The methodological quality of identified studies was graded. Identified qualitative studies (i.e., interviews) were descriptively analyzed and their findings narratively reported. Results Twenty-four publications were included. In 16 of those publications, a quantitative data analysis was conducted, analyzing factors associated with non-adherence. Worse visual acuity at baseline and unfavorable development of visual acuity, higher age, and greater distance to the treatment center were associated with non-adherence, while there was inconsistent evidence for an association of comorbidity. In qualitative studies, high follow-up/treatment burden, fear and anxiety, disappointed patient expectations, and lack of motivation to continue treatment were reported as reasons for non-persistence. Conclusions Knowledge of potential barriers in IVT treatment may improve adherence and potentially clinical results. Improvements can be achieved particularly in the healthcare complex (organizational improvements) and the “patient” complex by establishing realistic expectations. Recurrent education of the patient may be necessary. Electronic supplementary material The online version of this article (10.1007/s00417-020-04798-2) contains supplementary material, which is available to authorized users.
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Stasch-Bouws J, Eller-Woywod SM, Schmickler S, Inderfurth J, Hoffmann P, Ohlmeyer C, Kammering B, Pauleikhoff D. [IVOM quality assurance in Westfalen-Lippe : Structure of quality assurance and results of the pilot study Q-VERA]. Ophthalmologe 2020; 117:336-342. [PMID: 31912271 DOI: 10.1007/s00347-019-01030-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The KVWL-QS assists ophthalmologists in the transfer for good clinical praxis into real life. In addition the QS-commission initiated a pilotstudy "Qualitäts-Versorgung bei AMD" (Q‑VERA) in order to test new instruments for improvements. It was analized, if Reading Center (RC) based controls in combination with specific case-management modules can improve the results of IVOM treatment. PATIENTS AND METHODS In 5 treatment centers 878 consecutive patients with newly diagnosed AMD (Neu-Patienten) were included, who were treated with the IVAN-scheme. Initial FA and OCT images were transferred electronically to the RC. Also 781 retreatment patients (mean 20.7 IVOM before) with retreatment due to lesion activity were observed. RESULTS In 5% of the 878 newly treated patients a discrepancy between RC and treatment center was recorded. In this group the 481 patients, who finished up to the analysis date the 12-month follow-up, the visual function (increase in BCVA) and SD-OCT (reduction in central retinal thickness) results were comparable with large prospective cohorts. This was achieved with 6.5 injections and 10.6 visits over 12 months. In the group of 781 patients with repeated injections the number of injections over 12 months was 7.7 and the number of visits 11.6. CONCLUSION Quality assessment can improve the efficacy of IVOM therapy for AMD patients in real life. In addition to existing structures, electronical exchange by a RC assisted evaluation can further improve the quality by reducing the number of unnecessary treatment visits. The case-management with adherence control, re-call-system and specific information for patients and relatives can specifically increase the long-term adherence and thus the success of the therapy.
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Affiliation(s)
| | - S M Eller-Woywod
- Augenärztliche Gemeinschaftspraxis Gütersloh, Gütersloh, Deutschland
| | | | | | - P Hoffmann
- Augen- & Laserklinik Castrop-Rauxel, Castrop-Rauxel, Deutschland
| | - C Ohlmeyer
- Augenzentrum am St. Franziskus-Hospital Münster, Hohenzollernring 74, 48155, Münster, Deutschland
| | - B Kammering
- Kassenärztliche Vereinigung Westfalen Lippe, Dortmund, Deutschland
| | - D Pauleikhoff
- AMD-Netz e. V., Münster, Deutschland. .,Augenzentrum am St. Franziskus-Hospital Münster, Hohenzollernring 74, 48155, Münster, Deutschland. .,Universitätsaugenklinik, Universität Duisburg-Essen, Essen, Deutschland.
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18
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Liakopoulos S, Spital G, Brinkmann CK, Schick T, Ziemssen F, Voegeler J, Koch M, Kirchhof B, Holz FG, Pauleikhoff D, Schmitz-Valckenberg S. ORCA study: real-world versus reading centre assessment of disease activity of neovascular age-related macular degeneration (nAMD). Br J Ophthalmol 2020; 104:1573-1578. [PMID: 32066561 PMCID: PMC7587226 DOI: 10.1136/bjophthalmol-2019-315717] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/21/2022]
Abstract
Background/aims The prospective, non-interventional ORCA module of the OCEAN study (Observation of Treatment Patterns with Lucentis in Approved Indications) evaluated the qualiy of spectral domain-optical coherence tomography (SD-OCT) image interpretation and treatment decisions by clinicians in Germany and the impact on visual outcomes over 24 months in patients with neovascular age-related macular degeneration (nAMD). Methods 2286 SD-OCT scans of 205 eyes were independently evaluated by clinicians and reading centres (RCs) regarding signs of choroidal neovascularisation (CNV) activity, including presence of intraretinal fluid, subretinal fluid, and/or increase in pigment epithelial detachments. Agreement between clinicians and RCs was calculated. Treatment decisions by clinicians and the impact on treatment outcomes were evaluated. Results CNV activity was detected by RCs on 1578 scans (69.0%) and by clinicians on 1392 scans (60.9%), with agreement in 74.9% of cases. Of the 1578 scans with RC detected CNV activity, anti-vascular endothelial growth factor injections were performed by clinicians in only 35.5% (560/1578). In 19.7% of cases (311/1578), lack of treatment was justified by patients request, termination criteria or chronic cystoid spaces without other signs for CNV activity. In 44.8% of cases (707/1578) with RC detected CNV activity, clinicians claimed no treatment was necessary despite having correctly detected CNV activity in about 2/3 of these cases. In 34% of cases with presumed undertreatment, visual acuity declined in the following visit. Conclusion Although broad agreement on CNV activity parameters was observed between clinicians and RCs, correct identification of CNV activity did not always lead to the initiation of (re-)treatment. To preserve vision over time, correct interpretation of SD-OCT scans and careful retreatment decisions are required. Trial registration number NCT02194803.
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Affiliation(s)
- Sandra Liakopoulos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Georg Spital
- M3 Reading Center, Eye Center, St. Franziskus-Hospital Muenster, Muenster, Germany
| | - Christian K Brinkmann
- Department of Ophthalmology, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Tina Schick
- Ophthalmology, University of Cologne, Cologne, Germany
| | - Focke Ziemssen
- Department for Ophthalmology, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | | | - Mirja Koch
- Novartis Pharma GmbH, Nuremberg, Germany
| | - Bernd Kirchhof
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Frank G Holz
- Department of Ophthalmology, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
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Erden B, Bölükbaşı S, Özkaya A, Karabaş L, Alagöz C, Alkın Z, Artunay Ö, Bayramoğlu SE, Demir G, Demir M, Demircan A, Erdoğan G, Erdoğan M, Eriş E, Kaldırım H, Onur İU, Osmanbaşoğlu ÖA, Özdoğan Erkul S, Öztürk M, Perente İ, Sarıcı K, Sayın N, Yaşa D, Yılmaz İ, Yılmazabdurrahmanoğlu Z. Comparison of two different treatment regimens' efficacy in neovascular age-related macular degeneration in Turkish population-based on real life data-Bosphorus RWE Study Group. Int J Ophthalmol 2020; 13:104-111. [PMID: 31956577 DOI: 10.18240/ijo.2020.01.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/27/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To compare two different anti-vascular endothelial growth factor (anti-VEGF) treatment regimens'-a priori pro re nata (PRN) and PRN regimen following the loading phase-anatomical and functional results in neovascular age-related macular degeneration (nAMD) patients. METHODS Totally 544 nAMD patients followed and treated with aflibercept (n=135) and ranibizumab (n=409) at 9 different centers between 2013 and 2015 were enrolled into this retrospective multicenter study. Patients with initial best corrected visual acuity (BCVA) interval of 1.3-0.3 (logMAR) and a minimum follow-up of 12mo were included. Patients under two different regimens-a priori pro re nata (1+PRN) or 3 consecutive intravitreal injections followed by a PRN regimen (3+PRN)-were compared in BCVA at 3th, 6th and 12th months, and in central macular thickness (CMT) at 6th and 12th months. The total study group, intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) groups were evaluated separately. RESULTS The mean CMT decreased in the 1+PRN (n=101) regimen from 407 to 358 and 340 µm and in the 3+PRN (n=443) group from 398 to 318 and finally to 310 µm at months 6 and 12, respectively. Anatomically, the CMT reduction at 6th month (48.5 vs 76.4; P<0.05) was statistically significant in favor of 3+PRN group. BCVA changed in 1+PRN group from 0.77 to 0.78, 0.75 and 0.75; in 3+PRN group from 0.81 to 0.69, 0.72, and 0.76 at months 3, 6, and 12, respectively. Visual gain was statistically better in 3+PRN group at 3th month (-0.01 vs 0.12; P<0.001). In IVR group, CMT reduction was in greater in 3+PRN at 6th (44 vs 72) and 12th month (61 vs 84), but statistically insignificant. The 3+PRN group revealed statistically better visual results at 3th month (-0.02 vs 0.11, P<0.05). In IVA group, although statistically insignificant, CMT reduction (61 vs 89, 6th month; 85 vs 97, 12th month) and visual gain (0.02 vs 0.16; 0.02 vs 0.14; 0.05 vs 0.11) was found in favor of 3+PRN group at all visits. CONCLUSION The loading dose of anti-VEGF treatments in nAMD leads to significantly better anatomical and functional results, regardless of the agent, specially in early follow-up interval.
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Affiliation(s)
- Burak Erden
- Ophthalmology Clinic, Okmeydanı Training and Research Hospital, Istanbul 34384, Turkey
| | - Selim Bölükbaşı
- Ophthalmology Clinic, Okmeydanı Training and Research Hospital, Istanbul 34384, Turkey
| | - Abdullah Özkaya
- Ophthalmology Clinic, Memorial Şişli Hospital, Istanbul 34384, Turkey
| | - Levent Karabaş
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli 41380, Turkey
| | - Cengiz Alagöz
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
| | - Zeynep Alkın
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
| | - Özgür Artunay
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
| | - Sadık Etka Bayramoğlu
- Ophthalmology Clinic, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul 34303, Turkey
| | - Gökhan Demir
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
| | - Mehmet Demir
- Ophthalmology Clinic, Şişli Etfal Training and Research Hospital, Istanbul 34360, Turkey
| | - Ali Demircan
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
| | - Gürkan Erdoğan
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
| | - Mehmet Erdoğan
- Ophthalmology Clinic, Şişli Etfal Training and Research Hospital, Istanbul 34360, Turkey
| | - Erdem Eriş
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
| | - Havva Kaldırım
- Ophthalmology Clinic, Bağcılar Training and Research Hospital, Istanbul 34200, Turkey
| | - İsmail Umut Onur
- Ophthalmology Clinic, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul 34147, Turkey
| | | | - Sezin Özdoğan Erkul
- Ophthalmology Clinic, Istanbul Training and Research Hospital, Istanbul 34098, Turkey
| | - Mine Öztürk
- Ophthalmology Clinic, Haseki Training and Research Hospital, Istanbul 34096, Turkey
| | - İrfan Perente
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
| | - Kübra Sarıcı
- Ophthalmology Clinic, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul 34303, Turkey
| | - Nihat Sayın
- Ophthalmology Clinic, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul 34303, Turkey
| | - Dilek Yaşa
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
| | - İhsan Yılmaz
- Ophthalmology Clinic, Beyoğlu Eye Training and Research Hospital, Istanbul 34421, Turkey
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Holz FG, Johnson KT, Bauer-Steinhusen U, Rech C, Machewitz T, Müller S, Finger RP. [ANDROMEDA-an investigation of factors influencing the adherence of patients with neovascular age-related macular degeneration using the newly developed patient questionnaire LAF-IVT]. Ophthalmologe 2020; 117:765-74. [PMID: 31720846 DOI: 10.1007/s00347-019-01005-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lack of adherence to treatment is a widespread problem in the anti-VEGF (Vascular Endothelial Growth Factor) treatment of patients with neovascular age-related macular degeneration (nAMD). In contrast to the extent of the lack of treatment adherence, there is so far insufficient evidence for elucidating the causes of nonadherence. The ANDROMEDA study was initiated to investigate the influencing factors on the adherence of nAMD patients to treatment. The focus of the study was on patient reported endpoints, as the perceptions and experiences of the patients are of enormous importance for the investigation of the various aspects of adherence to treatment. OBJECTIVE This publication presents the design of the ANDROMEDA study as well as the development of a new patient questionnaire for the assessment of barriers to treatment within the design of the study. MATERIAL AND METHODS This prospective noninterventional observational study to assess the compliance of patients with nAMD and anti-VEGF treatment was started at the end of January 2019. It is planned to include 1000 patients in 120 study centers throughout Germany with an observational period of 24 months. Patient interviews on general and vision-related quality of life, treatment satisfaction and possible barriers to treatment will be conducted at the beginning and after 4, 12 and 24 months. All patient visits will be documented by the study centers as part of the clinical routine. To date, there has been no suitable instrument for recording patient-related circumstances and potential barriers to anti-VEGF treatment. Therefore, a specific patient questionnaire for longitudinal assessment of adherence factors to intravitreal (anti-VEGF) therapy (LAF-IVT) was developed as part of the study concept. The questionnaire, developed by an expert panel, was tested via qualitative interviews for its cognitive characteristics ahead of its use. RESULTS The results of the study are expected in early 2023. The cognitive examination of the LAF-IVT confirmed the feasibility of the new questionnaire. The practicability and significance of the new instrument can be assessed after completion of the quantitative data collection. CONCLUSION The symptoms, barriers, burdens and quality of life effects experienced by patients influence the adherence to treatment and thus the outcome. A better understanding of the patient's views and experiences is the basis for long-term optimization of care.
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Battaglia Parodi M, Romano F, Arrigo A, Sacchi R, Scanzi G, Ferri C, Bandello F. Real-life anti-vascular endothelial growth factor treatment for age-related macular degeneration and diabetic macular edema in an Italian tertiary referral hospital. Eur J Ophthalmol 2019; 30:1461-1466. [PMID: 31617403 DOI: 10.1177/1120672119880386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the real-life outcomes of intravitreal anti-vascular endothelial growth factor treatment in patients affected by age-related macular degeneration and diabetic macular edema in an Italian tertiary referral hospital over a 2-year follow-up. METHODS Patients with confirmed diagnosis of age-related macular degeneration or diabetic macular edema and 2 years of follow-up were retrospectively analyzed. They underwent a loading dose of three monthly anti-vascular endothelial growth factor injections, with re-treatment performed following a "pro-re-nata" regimen. Best-corrected visual acuity and central retinal thickness were collected and statistically analyzed. RESULTS In total, 167 diabetic macular edema eyes and 108 age-related macular degeneration eyes were included. Mean age was 63.4 ± 11.8 years for diabetic macular edema and 75.6 ± 8.4 years for age-related macular degeneration. For diabetic macular edema patients, mean number of injections was 5.0 ± 1.7 at 1 year and 2.8 ± 1.8 at 2 years. Mean best-corrected visual acuity improved from 60 Early Treatment for Diabetic Retinopathy Study letters to 66.7 letters at 1 year, and to 70 letters at 2 years (p < 0.001). Mean central retinal thickness decreased from 459 ± 148 µm to 327 ± 163 µm and 261 ± 89 µm, respectively, at the first and the second year (p < 0.001).With respect to age-related macular degeneration patients, mean number of injections was 5.3 ± 2.2 at 1 year and 3.3 ± 1.5 at 2 years. Mean best-corrected visual acuity improved from 63 Early Treatment for Diabetic Retinopathy Study letters to 68 letters at 1 year and to 70 letters at 2 years (p < 0.001). Mean central retinal thickness was 411 ± 146 µm, decreasing to 271 ± 93 µm at 1 year and 260 ± 68 µm at 2 years (p < 0.001). CONCLUSIONS Our study described the 2-year real-life outcome of anti-vascular endothelial growth factor treatment of diabetic macular edema and age-related macular degeneration.
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Affiliation(s)
| | - Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milan, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology and IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Raffaele Sacchi
- Department of Ophthalmology and IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Gianluca Scanzi
- Department of Ophthalmology and IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Camilla Ferri
- Department of Pharmacy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology and IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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Wintergerst MWM, Bouws J, Loss J, Heimes B, Pauleikhoff D, Holz FG, Finger RP. [Reasons for delayed and discontinued therapy in age-related macular degeneration]. Ophthalmologe 2019; 115:1035-1041. [PMID: 29138977 DOI: 10.1007/s00347-017-0610-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Critical prerequisites for successful therapy of neovascular age-related macular degeneration (nvAMD) are an early initiation and continuous monitoring; however, delays in starting therapy and non-medically indicated discontinuation of therapy are frequent, which limits therapy efficacy and, thus, visual outcomes. OBJECTIVE To identify the reasons for delay in therapy and non-medically indicated termination of therapy. MATERIAL AND METHODS Patients who had started a new therapy (starters) and those who independently terminated therapy (dropouts) were interviewed by telephone with a specific, standardized questionnaire. Results were summarized descriptively. RESULTS A total of 100 starters and 55 dropouts were interviewed. The mean therapy delay was 22 (±28 SD) days. This was mainly due to the time until the decision to see an ophthalmologist was made. Main reasons for dropping out were: transportation issues (27%), poor general health (25%) and the assumption that there is no benefit from therapy (11%). Of the patients who dropped out 63% would have liked to continue therapy. CONCLUSION There is potential for improvement in nvAMD management regarding therapy start as well as therapy maintenance. Sensitizing for initial nvAMD symptoms is important as is reduction of barriers to therapy maintenance, since most therapy dropouts would like to continue the therapy.
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Affiliation(s)
| | - J Bouws
- AMD-Netz, Münster, Deutschland
| | - J Loss
- Medizinische Soziologie, Institut für Epidemiologie und präventive Medizin, Universität Regensburg, Regensburg, Deutschland
| | - B Heimes
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - D Pauleikhoff
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - F G Holz
- Universitäts-Augenklinik Bonn, Bonn, Deutschland
| | - R P Finger
- Universitäts-Augenklinik Bonn, Bonn, Deutschland.
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Treder M, Gaber A, Rudloff B, Eter N. Real-Life-Daten-Analyse der Therapiequalität bei Patienten mit exsudativer altersabhängiger Makuladegeneration (AMD) und venösen Gefäßverschlüssen an einer deutschen Universitätsaugenklinik. Ophthalmologe 2019; 116:553-562. [DOI: 10.1007/s00347-018-0746-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ziemssen F, Wachtlin J, Kuehlewein L, Gamulescu MA, Bertelmann T, Feucht N, Voegeler J, Koch M, Liakopoulos S, Schmitz-Valckenberg S, Spital G. Intravitreal Ranibizumab Therapy for Diabetic Macular Edema in Routine Practice: Two-Year Real-Life Data from a Non-interventional, Multicenter Study in Germany. Diabetes Ther 2018; 9:2271-2289. [PMID: 30288700 PMCID: PMC6250630 DOI: 10.1007/s13300-018-0513-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The prospective, non-interventional OCEAN study examined the use of intravitreal ranibizumab injections for the treatment of diabetic macular oedema (DME) in a real-world setting in Germany. METHODS Adults with DME receiving ≥ 1 ranibizumab (0.5 mg) injections were recruited by 250 ophthalmologists. Best-corrected visual acuity (VA) testing, imaging and treatments were performed according to the investigators' routine practice and documented over 24 months. RESULTS The full analysis set included 1226 participants. Mean baseline VA was 60.6 [95% CI: 59.7; 61.5] Early Treatment Diabetic Retinopathy Study letters. VA improved by ≥ 15 letters in 21.5% and 23.5% of the participants at 12 months and 24 months, respectively. They received a mean number of 4.42 [95% CI: 4.30; 4.54] injections in the first year and 5.52 [95% CI: 5.32; 5.73] injections over 24 months, which was markedly lower than in clinical trials. Only 33.4% of the participants received an upload with four initial monthly injections as recommended by the German ophthalmologic societies. Time-to-event analyses that account for missing data inherent to a non-interventional study design demonstrated that participants receiving ≥ 7 injections in the first year had a faster response, but the duration of the response was shorter compared to the subgroups receiving 1-3 and 4-6 injections. Serious adverse events were reported for 143/1250 (11.4%) participants in the safety population. CONCLUSION Under-treatment is a major problem of DME anti- vascular endothelial growth factor therapy under real life conditions. Despite fewer injections given compared to randomised controlled trials with a consequently reduced overall mean visual gain, a profound functional improvement (≥ 15 letters) was achieved over 2 years in 23.5% of eyes with DME. TRIAL REGISTRATION NUMBER NCT02194803, ClinicalTrials.gov. FUNDING Novartis Pharma GmbH, Nuremberg, Germany.
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Affiliation(s)
- Focke Ziemssen
- Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
| | - Joachim Wachtlin
- St. Gertrauden Krankenhaus, Berlin, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Laura Kuehlewein
- Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | | | - Thomas Bertelmann
- Artemis Eye Clinic, Dillenburg, Dillenburg, Germany
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - Nikolaus Feucht
- Klinikum Rechts der Isar, Technical University, Munich, Germany
| | | | - Mirja Koch
- Novartis Pharma GmbH, Nuremberg, Germany
| | - Sandra Liakopoulos
- Centre for Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | | | - Georg Spital
- Augenzentrum am St. Franziskus Hospital, Muenster, Germany
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Özkaya A, Karabaş L, Alagöz C, Alkın Z, Artunay Ö, Bölükbaşı S, Demir G, Demir M, Demircan A, Erden B, Erdoğan G, Erdoğan M, Eriş E, Kaldırım H, Onur İU, Osmanbaşoğlu Ö, Özdoğan Erkul S, Öztürk M, Perente İ, Sarıcı K, Sayın N, Yaşa D, Yılmaz İ, Yılmazabdurrahmanoğlu Z. Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1. Turk J Ophthalmol 2018; 48:232-237. [PMID: 30405944 PMCID: PMC6216527 DOI: 10.4274/tjo.31697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/11/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients. Materials and Methods Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year. Results Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 μm (range: 91-1582), 330±115 μm (range: 99-975), and 332±114 μm (range: 106-1191), respectively. Conclusion The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen.
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Affiliation(s)
- Abdullah Özkaya
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Levent Karabaş
- Bosphorus Retina Study Group.,Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Turkey
| | - Cengiz Alagöz
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Zeynep Alkın
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Özgür Artunay
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Selim Bölükbaşı
- Bosphorus Retina Study Group.,Okmeydanı Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Gökhan Demir
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Mehmet Demir
- Bosphorus Retina Study Group.,Şişli Etfal Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Ali Demircan
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Burak Erden
- Bosphorus Retina Study Group.,Okmeydanı Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Gürkan Erdoğan
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Mehmet Erdoğan
- Bosphorus Retina Study Group.,Kanuni Sultan Süleyman Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Erdem Eriş
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Havva Kaldırım
- Bosphorus Retina Study Group.,Bağcılar Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - İsmail Umut Onur
- Bosphorus Retina Study Group.,Bakırköy Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Özen Osmanbaşoğlu
- Bosphorus Retina Study Group.,İstanbul Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Sezin Özdoğan Erkul
- Bosphorus Retina Study Group.,İstanbul Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Mine Öztürk
- Bosphorus Retina Study Group.,Haseki Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - İrfan Perente
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Kübra Sarıcı
- Bosphorus Retina Study Group.,Kanuni Sultan Süleyman Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Nihat Sayın
- Bosphorus Retina Study Group.,Kanuni Sultan Süleyman Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Dilek Yaşa
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - İhsan Yılmaz
- Bosphorus Retina Study Group.,Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
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Ehlken C, Wilke T, Bauer-Steinhusen U, Agostini HT, Hasanbasic Z, Müller S. TREATMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION PATIENTS WITH VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS IN EVERYDAY PRACTICE: Identification of Health Care Constraints in Germany-The PONS Study. Retina 2018; 38:1134-44. [PMID: 28489692 DOI: 10.1097/IAE.0000000000001681] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The PONS study was conceived to analyze the extent of nonpersistence (NP) and nonadherence (NA) in the treatment of patients with neovascular age-related macular degeneration in everyday clinical practice in Germany. Further objectives were to identify factors that can affect NP and NA and to analyze clinical outcomes under everyday conditions. METHODS Nonpersistence (no contact with doctor for at least 3 months) and NA (no treatment or follow-up for at least 6 weeks) as well as clinical data were analyzed up to 24 months retrospectively and 12 months prospectively in 480 patients with neovascular age-related macular degeneration in 23 treatment centers. Patients were interviewed for factors possibly affecting NP and NA. RESULTS One third of patients fulfilled criteria of NA in the first 3 months and two thirds after 6 months. The NP was 18.8% after 12 months. Treatment exclusively at one center, a higher number of patients with neovascular age-related macular degeneration at the treating center, and fixed appointments were associated with a lower risk for NP. An initial gain in visual acuity after upload was not preserved after 12 months (mean change -0.5 Early Treatment Diabetic Retinopathy Study letters). Whereas visual acuity declined by 7.5 Early Treatment Diabetic Retinopathy Study letters in patients with good baseline visual acuity >20/40, visual acuity improved by 8.5 letters in patients with baseline visual acuity of ≤20/200. Only 7.5% of patients underwent an optical coherence tomography scan after 3 upload injections, and only 2.0 optical coherence tomographies were performed in the first 12 months. CONCLUSION The NP and NA were high in our study population and are likely to have contributed to a suboptimal clinical outcome compared with randomized clinical trials. Shortcomings in the management of patients with neovascular age-related macular degeneration, including restrictions in the timely and adequate follow-up (including optical coherence tomography) and retreatment, appear to be constraining factors in Germany.
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Framme C, Eter N, Hamacher T, Hasanbasic Z, Jochmann C, Johnson KT, Kahl M, Sachs H, Schilling H, Thelen U, Wiedemann P, Wachtlin J. Aflibercept for Patients with Neovascular Age-Related Macular Degeneration in Routine Clinical Practice in Germany. ACTA ACUST UNITED AC 2018; 2:539-49. [DOI: 10.1016/j.oret.2017.09.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/05/2017] [Accepted: 09/22/2017] [Indexed: 12/27/2022]
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Küçük B, Kadayıfçılar S, Eldem B. Assessment of the long-term visual and anatomical outcomes of ranibizumab to treat neovascular age-related macular degeneration. Int J Ophthalmol 2018; 11:645-649. [PMID: 29675385 PMCID: PMC5902371 DOI: 10.18240/ijo.2018.04.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/12/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the long-term visual and anatomical outcomes of patients who underwent intravitreal ranibizumab monotherapy to treat neovascular age-related macular degeneration (AMD) and followed-up for at least 2y. METHODS A total of 74 eyes of 74 patients who underwent ranibizumab monotherapy for neovascular AMD were included in this retrospective study. RESULTS The average patient age was 72.1±6.5 (range, 57-85)y, the average follow-up time 46.2±13.1 (range, 24-75)mo, and the average number of visits 24.1±9.5 (range, 8-48). The mean number of injections in year 1 was 4.5, 1.6 in year 2, 0.9 in year 3, 0.4 on year 4, and 0.1 in the following years. Within the entire follow-up period, the mean number of injections was 7.6±4.4 (range, 2-21). The mean visual acuity was 48.1±15 (range, 15-76) letters at baseline and 45.7±19 (range, 7-75) at year 5. The mean central macular thickness was 303±78 (range, 178-552) µm at baseline and 251±51 (range, 138-359) µm at year 5. Scars developed in 47 (63.5%) eyes at the end of the follow-up period, and atrophy was evident in 6 (8.1%) eyes. CONCLUSION Ranibizumab monotherapy can stabilize visual acuity for a mean period of 4y in patients with neovascular AMD.
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Affiliation(s)
- Bekir Küçük
- Department of Ophthalmology, Hacettepe University, Ankara 06100, Turkey
| | | | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, Ankara 06100, Turkey
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Cebeci Z, Yilmaz YC, Kir N. Real-life experience of ranibizumab therapy for neovascular age-related macular degeneration from Turkey. Int J Ophthalmol 2018; 11:267-273. [PMID: 29487818 PMCID: PMC5824083 DOI: 10.18240/ijo.2018.02.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/31/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To report the real-life experience and clinical results of intravitreal ranibizumab injections to neovascular age-related macular degeneration (nAMD) in a single institution in Turkey. METHODS A total of 101 eyes of 89 patients with nAMD treated with intravitreal ranibizumab injection, followed up for at least 24mo between 2009 and June 2014, which were evaluated retrospectively. A pro re nata (PRN) treatment protocol was performed after the patients had received three, monthly loading injections. Best corrected visual acuity (BCVA) and central macular thickness measurements were evaluated at baseline and 3, 6, 12, 18, and 24mo. Number of injections and visits were also recorded. RESULTS Of the 89 patients, 34 (38.2%) were male and 55 (61.8%) were female and the mean age was 74.0±9.5 (52-91)y. The mean follow-up period was 24.82±4.4 (24-29)mo. Mean number of visits was 8.4±1.12 (7-12) in the first year and 6.6±1.33 (4-12) in the second year. The mean number of injections was 5.8±1.6 (3-10) and 4.2±2.2 (0-9) in the first and second year, respectively. The mean BCVA was 59±15.8 letters at baseline by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The mean BCVA at 3, 12, and 24mo was 70.3±15.9, 67.9±14.3 and 67.3±16.9 letters, respectively. Improvement in visual acuity for each of the visits from baseline was found to be statistically significant (P<0.01). Visual acuity in 9 eyes at month 3, 7 eyes at month 12, and 13 eyes at month 24 did not change. The mean central macular thickness (CMT) was 437.99±164.78 µm at baseline. The mean CMT was 348.05±138.47 µm, 349.27±139.79 µm, and 344.13±146.30 µm at months 3, 12, and 24, respectively. The decrease in CMT for each of the visits from baseline was found to be statistically significant (P<0.01). CONCLUSION Anatomical and functional achievement are obtained in our study, but the mean number of injections and visits are found to be lower than the findings reported in randomized controlled clinical trials in the literature. However, the mean number of injections and visits in our study are compatible with the findings reported in real-life experience studies in the literature.
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Affiliation(s)
- Zafer Cebeci
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34104, Turkey
| | - Yusuf Cem Yilmaz
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34104, Turkey
| | - Nur Kir
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34104, Turkey
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30
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Abstract
Purpose Real-life clinical outcomes of patients treated with anti-VEGF drugs for neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or macular edema secondary to branch retinal vein occlusion (BRVO) are often inferior to results from randomized clinical trials. This observational cohort study investigates treatment adherence and real-life clinical outcomes within the first year of treatment. Patients and methods A total of 708 treatment-naïve patients (466 nAMD, 134 DME, and 108 BRVO) were included. Patients were followed with a PRN treatment protocol with three intravitreal injections (IVIs) and a series of 3 monthly injections in case of persistent or recurrent disease activity, as determined by monthly follow-up exams including optical coherence tomographies. Occurrence of gaps of >56 days between treatments or follow-up (nonadherence [NA]) and the reasons for NA (patient- or center-associated) as well as disease activity within the first 12 months of treatment were analyzed. Visual acuity (VA) as well as numbers and dates of optical coherence tomography and IVI were extracted from medical records. Results NA occurred significantly more often in patients with DME (44%) than nAMD (32%) or BRVO (25%, p<0.01 between groups). NA was mainly patient-associated (nAMD: 80.0%, DME: 83.1%, BRVO: 70.4%, p=0.38 between groups). Patients with nAMD and DME and appropriate treatment/follow-up adherence had a better chance of significantly gaining or maintaining VA, respectively (19.9% vs 12.0% with 3-line-gain in nAMD and 1.3% vs 15.3% 3-line loss in DME; each p<0.05). NA did not correlate with VA outcomes in BRVO (3-line gain 30.9% vs 48.1% and 3-line loss 8.6% vs 7.4%; p>0.05). Conclusion NA to treatment and follow-up regimens is a common problem in the management of patients with AMD and DME and limits clinical treatment outcomes under real-life conditions. Patients with DME have the highest risk of patient-associated NA, associated with a higher risk for significant VA loss.
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Affiliation(s)
- Christoph Ehlken
- Ophthalmology, Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau.,Ophthalmology, Eye Center, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Mandy Helms
- Ophthalmology, Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau
| | - Daniel Böhringer
- Ophthalmology, Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau
| | - Hansjürgen T Agostini
- Ophthalmology, Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau
| | - Andreas Stahl
- Ophthalmology, Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau
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Stolba U, TargetAMD Group, Ansari-shahrezaei S, Hagen S, Stattin M, Schmid S, Kropp M, Harmening N, Thumann G. Neovascular age-related macular degeneration in Austria. Spektrum Augenheilkd 2017; 31:206-211. [DOI: 10.1007/s00717-017-0356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Heimes B, Gunnemann F, Ziegler M, Gutfleisch M, Spital G, Pauleikhoff D, Lommatzsch A. [Compliance of age related macular degeneration patients undergoing anti-VEGF therapy : Analysis and suggestions for improvement]. Ophthalmologe 2017; 113:925-932. [PMID: 27272633 DOI: 10.1007/s00347-016-0275-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Activity-based treatment regimens with anti-vascular endothelial growth factor (anti-VEGF) are currently the gold standard for treatment of exudative age-related macular degeneration (nAMD). Whereas injection frequencies of approximately seven injections in the first year and six in the second year are expected with a pro re nata (PRN) regimen, retrospective real life observations have recorded significantly reduced numbers of injections. This study was carried out to investigate the reasons for the reduction in follow-up control appointments and to find out whether a telemedicine network could influence the motivation and compliance for regular control examinations and treatment. MATERIAL AND METHODS The patient collective included 210 eyes from 191 patients with nAMD treated by anti-VEGF therapy in 2010 and 2011. The activity-based anti-VEGF treatment, control examinations and treatment intervals were performed according to the guidelines over a mean follow-up of 2 years. In another collective of 100 eyes from 100 patients with treatment of nAMD 2 groups were observed: 1 group with patients for whom control examinations were carried out close to home including an online transmission of the results to the treating retinal center and another group in which the patients had to be examined in the treatment center. RESULTS After 140 weeks 50 % of the patients in the first collective regularly attended control examinations and after 1 year the number was 79 %. After 2 years the probability of continuous supervision is given for only 62 % of the patients, whereas in 38 % the treatment was terminated. Of these patients treatment was terminated in 8 % due to valid criteria, whereas in 30 % of the patients the termination was unintentional. The main reason (38 %) for an unintentional termination of examination and treatment was the frequent and long journey. Patients in the second collective had a significantly higher compliance with respect to the control examinations (p < 0.001) and number of injections (p = 0.02) over the period of nearly 2 years due to the introduction of electronic transmission of images. CONCLUSION A long-term therapy of nAMD in the clinical routine can be achieved by a close relationship with the ophthalmologist, continuous follow-up controls and therapy cycles. A close telemedical networking between the ophthalmologist and the treatment center can lead to better patient compliance. Furthermore, the construction of such platforms represents a challenge not only for the treatment of nAMD but also for other diseases.
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Affiliation(s)
- B Heimes
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland.
| | - F Gunnemann
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - M Ziegler
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - M Gutfleisch
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - G Spital
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - D Pauleikhoff
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - A Lommatzsch
- Augenärzte, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
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Müller S, Ehlken C, Bauer-Steinhusen U, Lechtenfeld W, Hasanbasic Z, Agostini H, Wilke T. Treatment of age-related neovascular macular degeneration: the patient's perspective. Graefes Arch Clin Exp Ophthalmol 2017; 255:2237-2246. [PMID: 28776095 PMCID: PMC5640748 DOI: 10.1007/s00417-017-3739-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 06/12/2017] [Accepted: 07/03/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess patients' views and expectations with regard to neovascular age-related macular degeneration (nAMD) and intravitreal anti-VEGF therapy (IVT). METHODS We conducted a multicenter, non-interventional, prospective cohort study including nAMD patients treated with IVT in Germany. Patients with at least one IVT before study enrollment and aged ≥50 years were included. Three telephone interviews were conducted during a 12-month observational period. Here, patient's beliefs/expectations with regard to the nAMD disease and the IVT treatment were discussed. Only patients who completed all three phone interviews were included in the analyses. We used a two-step cluster analysis to identify patient clusters regarding specific patient attitudes towards nAMD and its treatment. RESULTS Three hundred and thirty-two patients completed all interviews (mean age of 76.4 ± 7.2 years, 59.0% women). Out of these, 57.8% acknowledged that they needed general assistance in daily life, while 77.4% stated being able to attend general medical appointments on their own. However, 64.7% needed a driver or an accompanying person to attend their IVT appointments. In addition, 3.9% of the patients were afraid of IVT side effects. Also, 87.3% and 43.1% of the patients could name their disease or the anti-VEGF drug administered, respectively. More than three-quarters of the patients (83.1%) were aware of possible consequences of nAMD by stating vision loss or blindness, but only 16.6% knew that nAMD is a chronic disease. Generally, patients were optimistic: 70.2%, 5.1% and 13.0% of them expected stable visual acuity (VA), a significant improvement or expected worsening of VA in the next year, respectively. Almost two thirds of patients who provided their therapy expectations (47.0%) anticipated fewer injections/discontinuation of IVT. We identified five patient clusters differing significantly from each other with regard to four variables: being afraid of IVT, nAMD disease awareness, optimism with regard to effectiveness of IVT, and nAMD disease and treatment knowledge. CONCLUSIONS Only a minority of patients is aware of the chronic nature of nAMD. To motivate patients to accept a life-long IVT treatment, physicians and caregivers must know that there exist different patient types with significant differences in communication needs.
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Affiliation(s)
- S Müller
- IPAM - Institute for Pharmacoeconomics and Medication Logistics, University of Wismar, Alter Holzhafen 19, 23966, Wismar, Germany.
| | - C Ehlken
- Department of Ophthalmology, Universitäts-Klinikum Schleswig-Holstein, Campus Kiel, Germany
| | - U Bauer-Steinhusen
- Bayer Vital GmbH, Medical Affairs, Kaiser-Wilhelm-Allee 70, 51373, Leverkusen, Germany
| | - W Lechtenfeld
- PRO RETINA Deutschland e.V, Vaalser Str. 108, 52074, Aachen, Germany
| | - Z Hasanbasic
- Bayer Vital GmbH, Medical Affairs, Kaiser-Wilhelm-Allee 70, 51373, Leverkusen, Germany
| | - H Agostini
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany
| | - T Wilke
- IPAM - Institute for Pharmacoeconomics and Medication Logistics, University of Wismar, Alter Holzhafen 19, 23966, Wismar, Germany
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Sakamoto S, Takahashi H, Tan X, Inoue Y, Nomura Y, Arai Y, Fujino Y, Kawashima H, Yanagi Y. Changes in multiple cytokine concentrations in the aqueous humour of neovascular age-related macular degeneration after 2 months of ranibizumab therapy. Br J Ophthalmol 2017; 102:448-454. [PMID: 28765149 PMCID: PMC5890644 DOI: 10.1136/bjophthalmol-2017-310284] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 12/12/2022]
Abstract
Purpose To determine changes in multiple cytokine concentrations in the anterior chamber during the induction phase of ranibizumab treatment in patients with neovascular age-related macular degeneration (AMD). Methods This prospective study included 48 treatment-naïve neovascular AMD eyes of 48 patients who received three consecutive monthly injections of ranibizumab at the Japan Community Health Care Organization Tokyo Shinjuku Medical Center between November 2010 and August 2012. We collected ~0.2 mL aqueous humour before the first and third (2 months later) injections. Controls were 80 eyes with cataracts without retinal disease. The cytokines C-X-C motif chemokine ligand 1 (CXCL1), interferon-γ-induced protein 10 (IP-10), C-X-C motif chemokine ligand 12 (CXCL12), C-X-C motif chemokine ligand 13 (CXCL13), monocyte chemoattractant protein 1 (MCP-1), CCL11, C-C motif chemokine ligand 11 (CCL11), interleukin-6 (IL-6), interleukin-10 (IL-10) and matrix metalloproteinase 9 (MMP-9) were analysed using multiplex cytokine assays. Results Mean ages of the patients with AMD and controls were 73 and 75 years, respectively, and 31 (65%) and 37 (46%) subjects were men, respectively. Polypoidal choroidal vasculopathy was found in 27 eyes (56%). Mean concentrations of cytokines in aqueous humour in patients with neovascular AMD before the first and third ranibizumab injections were as follows (in pg/mL): CXCL1, 8.4 and 3.3; IP-10, 110 and 55; CXCL12, 480 and 240; CXCL13, 9.2 and 2.6; MCP-1, 620 and 220; CCL11, 7.1 and 2.8; IL-6, 5.9 and 1.6; IL-10, 0.15 and 0.015 (all p<0.0001), and MMP-9, 0.92 and 1.5 (p=0.0216), respectively. Concentrations of all cytokines decreased significantly after two consecutive ranibizumab injections, except for MMP-9, which increased significantly. Conclusions After two monthly consecutive antivascular endothelial growth factor injections, inflammatory cytokine levels in the aqueous humour of the eyes with AMD were strongly suppressed, while MMP-9 levels increased.
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Affiliation(s)
- Shinichi Sakamoto
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hidenori Takahashi
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan.,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Xue Tan
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yuji Inoue
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan.,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yoko Nomura
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Arai
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yasuo Yanagi
- Department of Medical Retina, Singapore National Eye Centre, Singapore, Singapore.,Department of Medical Retina, Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS, Medical School, National University of Singapore, Singapore, Singapore
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Lu Y, Huang J, Zhao J, Yu X, Long L, Dai H. Effects of Intravitreal Ranibizumab Injection on Chinese Patients with Wet Age-Related Macular Degeneration: 5-Year Follow-Up Results. J Ophthalmol 2016; 2016:6538192. [PMID: 27885338 DOI: 10.1155/2016/6538192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose. To observe the effect of intravitreal ranibizumab injection on wet age-related macular degeneration (wAMD) over 5 years in Chinese patients. Methods. Thirty-seven patients who were diagnosed with wAMD in our hospital from June 2007 to June 2014 were retrospectively reviewed. The PRN regimen and the treatment and extend regimen were applied. Best corrected visual acuity (BCVA), number of ranibizumab injections, and changes in the choroidal neovascularization (CNV) lesion over 5 years were analyzed. Results. The mean BCVA measured by the ETDRS chart at baseline was 47.4 and 5 years after the treatment it was 34.89 letters, which was significantly different (p = 0.013). Fourteen eyes (37.8%) had improved visual acuity after 5 years. The number of injections in 5 years was 11.53, and most of the injections were in the first two years. Seventeen (45.9%) cases developed fibrous lesions, and 2 (5.4%) cases had atrophic lesions after 5 years. The fibrosis/atrophy was significantly correlated with the injection numbers (Pearson, r = 0.663, and p = 0.000). Conclusion. Most of the patients can maintain visual acuity treated by ranibizumab in the first 3 years. After 5 years, some patients can still improve or maintain visual acuity. Fibrous scarring of the lesion is the main reason for a decrease in vision of wAMD patients.
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Bertelmann T, Feltgen N, Scheffler M, Hufenbach U, Wiedon A, Wilhelm H, Ziemssen F. Vision-related quality of life in patients receiving intravitreal ranibizumab injections in routine clinical practice: baseline data from the German OCEAN study. Health Qual Life Outcomes 2016; 14:132. [PMID: 27644469 PMCID: PMC5029004 DOI: 10.1186/s12955-016-0536-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/09/2016] [Indexed: 11/19/2022] Open
Abstract
Background Vision-related quality of life (vrQoL) is advancing more and more into the focus of interest in ophthalmological clinical research. However, to date only little information is available about vrQoL from large non-interventional studies in terms of "real-world evidence". The purpose of this investigation was to describe baseline VFQ-25 visual function scores, to evaluate whether they differ from previous phase III clinical trials, to determine which contributing factors (e.g. indication, age, gender) affect VFQ-25 scores and to identify its impact on driving. Methods The non-interventional OCEAN study (Observation of treatment patterns with LuCEntis and real life ophthalmic monitoring, including optional OCT in Approved iNdications) is the largest ophthalmic study conducted in Germany, to evaluate the real world situation of patients treated with ranibizumab (NCT02194803). The NEI-VFQ-25 questionnaire was conducted at baseline, months 4, 12 and 24. Descriptive statistics was used to analyse the baseline data. ANOVA was performed to evaluate the impact of various contributing factors on composite and selected subscale scores. Results Overall, 4844 (84.1 %) of all 5760 OCEAN patients completed the VFQ-25 questionnaire at baseline. Thereof, 3414 treatment-naïve patients were further analysed. Overall, the VFQ subscore general health was most affected by the ocular disease, followed by general vision. No major differences were detected in comparison to corresponding VFQ-25 scores of previous phase III clinical trials, except in DME patients, or with respect to possible contributing factors. A tendency towards a more decreased VFQ-25 composite score was observed for nAMD, for elderly patients ≥75 years of age, for female patients, for patients with low baseline visual acuity (VA; <50 letters) and for those with statutory health insurance. Indication, age, gender, baseline VA (all p <0.01) and the interaction of age and indication, as well as baseline VA and indication (p <0.01 each) had a significant impact on composite, general vision and distance vision scores (ANOVA). About 10 % of patients gave up driving due to eyesight issues. Conclusions The knowledge of a patient’s subjective disease burden is crucial to understanding anxieties and mental anguish. Additionally, the understanding of the impact of various contributing factors on the VFQ-25 scores and the extent to which they can be influenced help to optimize patient care. It demonstrates the need for medical and mental support by all medical staff, to encourage patients’ compliance with a comprehensive anti-VEGF therapy, to increase BCVA and, consecutively, VFQ-25 scores. Trial registration NCT02194803 Electronic supplementary material The online version of this article (doi:10.1186/s12955-016-0536-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany. .,Novartis Pharma GmbH, Nuremberg, Germany.
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | | | | | | | - Helmut Wilhelm
- Centre for Ophthalmology, Eberhard-Karl University, Tuebingen, Germany
| | - Focke Ziemssen
- Centre for Ophthalmology, Eberhard-Karl University, Tuebingen, Germany
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Croft DE, Wykoff CC, Michels S, Chakravarthy U, Cruess AF. Regulatory Factors Influencing Usage of Retinal Pharmaceuticals: A Look Both Home and Abroad. Am J Ophthalmol 2016; 169:xiv-vi. [PMID: 27485923 DOI: 10.1016/j.ajo.2016.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 11/23/2022]
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Kieselbach G, Vavrovsky A, Hochreiter R. IVOM in Österreich 2013 – Eine Auswertung anhand realer Patientenzahlen. Spektrum Augenheilkd 2016; 30:106-110. [DOI: 10.1007/s00717-016-0294-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Enders P, Scholz P, Muether PS, Fauser S. Variability of disease activity in patients treated with ranibizumab for neovascular age-related macular degeneration. Eye (Lond) 2016; 30:1072-6. [PMID: 27197870 DOI: 10.1038/eye.2016.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 02/25/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo analyze choroidal neovasularization (CNV) activity and recurrence patterns in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab, and the correlation with individual intraocular vascular endothelial growth factor (VEGF) suppression time (VST).MethodsPost-hoc analysis of data from a prospective, non-randomized clinical study. Patients with nAMD treated with ranibizumab on a pro re nata regimen. Disease activity was analyzed monthly by spectral-domain optical coherence tomography and correlated with VSTs.ResultsOverall, 73 eyes of 73 patients were included in the study with a mean follow-up of 717 days (range: 412-1239 days). Overall, the mean CNV-activity-free interval was 76.5 days (range: 0-829 days). The individual range of the length of dry intervals was high. A total of 42% of patients had a range of more than 90 days. Overall, 16% of patients showed persistent activity. And 12% stayed dry after the initial ranibizumab treatment. No significant correlation was found between the CNV-recurrence pattern and VST (P=0.12).ConclusionsCNV activity in nAMD is irregular, which is reflected in the range of the duration of dry intervals and late recurrences. The biomarker VST solely seems not to be sufficient to explain recurrence pattern of CNV in all AMD patients.
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Affiliation(s)
- P Enders
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - P Scholz
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - P S Muether
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - S Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
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Holz FG, Tadayoni R, Beatty S, Berger A, Cereda MG, Hykin P, Staurenghi G, Wittrup-Jensen K, Altemark A, Nilsson J, Kim K, Sivaprasad S. Key drivers of visual acuity gains in neovascular age-related macular degeneration in real life: findings from the AURA study. Br J Ophthalmol 2016; 100:1623-1628. [PMID: 27030279 PMCID: PMC5256408 DOI: 10.1136/bjophthalmol-2015-308166] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/04/2016] [Accepted: 02/28/2016] [Indexed: 11/07/2022]
Abstract
Background/aims To identify predictive markers for the outcomes of anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration (nAMD). Methods AURA was a retrospective, observational, multicentre study that monitored the 2-year outcomes following intravitreal ranibizumab treatment in patients with nAMD. Using stepwise regression analysis, we evaluated the association between visual acuity outcomes, baseline characteristics and resource utilisation in order to determine which variables are significantly linked to outcomes in AURA. We also examined the relationship between visual acuity outcomes and number of injections received. Results Analyses were performed using data from year 1 (n=1695) and year 2 completers (n=1184). Logistic analysis showed that baseline visual acuity score, age at start of therapy, number of ophthalmoscopies and optical coherence tomography (OCT) (combined) and number of injections (ranibizumab) were significant (p<0.05) prognostic factors for vision maintenance (loss <15 letters) or vision gain (≥15 letters). Patients who received >7 injections (in 1 year) or >14 injections (over 2 years) gained more letters and demonstrated greater vision maintenance (loss of <15 letters) than patients who received fewer injections. There was a significant (p<0.05) association between number of injections and national reimbursement schemes and OCT. Conclusions A number of factors that are predictive of treatment outcomes in a real-life setting were identified. Notably, the decline of treatment benefits may be linked to number of injections and a failure to visit clinicians and receive OCT as required. These findings may be helpful in guiding ophthalmologist treatment decisions under limited time and financial constraints. Trial registration number NCT01447043.
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Affiliation(s)
- Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Ramin Tadayoni
- Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7-Sorbonne Paris Cité, Paris, France
| | - Stephen Beatty
- Department of Ophthalmology, Institute of Eye Surgery, Waterford, Ireland
| | - Alan Berger
- Department of Ophthalmology and Vision Sciences, University of Toronto, and St Michael's Hospital, Toronto, Ontario, Canada
| | - Matteo Giuseppe Cereda
- Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Philip Hykin
- NIHR Biomedical Centre for Research in Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | | | - Jonas Nilsson
- Mapi Group, Real World Strategy and Analytics, Stockholm, Sweden
| | - Kun Kim
- Mapi Group, Real World Strategy and Analytics, Stockholm, Sweden
| | - Sobha Sivaprasad
- NIHR Biomedical Centre for Research in Ophthalmology, Moorfields Eye Hospital, London, UK.,Department of Ophthalmology, King's College Hospital, London, UK
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42
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Mueller S, Agostini H, Ehlken C, Bauer-Steinhusen U, Hasanbasic Z, Wilke T. Patient Preferences in the Treatment of Neovascular Age-Related Macular Degeneration: A Discrete Choice Experiment. Ophthalmology 2016; 123:876-83. [PMID: 26778346 DOI: 10.1016/j.ophtha.2015.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The objective of our study was to investigate preferences of patients with neovascular age-related macular degeneration (nAMD) for different anti-vascular endothelial growth factor (VEGF) treatment schemes. DESIGN We used a discrete choice experiment (DCE) design as part of a telephone interview. PARTICIPANTS Patients with nAMD aged at least 50 years were included in the study. METHODS Telephone interviews were done between November 2012 and October 2013. MAIN OUTCOME MEASURES In our DCE survey, we measured patient preferences toward specific levels of attributes that describe different options in the everyday intravitreal injection treatment setting: (1) treatment scheme; (2) change of visual acuity (VA); and (3) time the patient needs for each visit to the eye specialist. RESULTS A total of 284 patients with nAMD with a mean age of 77.4±7.1 years (women: 59.9%) completed the DCE interviews. Of them, 22.9% had poor VA at study inclusion, 54.9% had moderate VA, and 14.1% had good VA; VA was not available for 8.1% of the patients. Generally, patients preferred the attribute levels "improvement in VA" and "short time per specialist visit." The results for the attribute "treatment scheme" were inconclusive because none of the attribute levels (injections every 4 weeks, every 8 weeks, and pro re nata) were associated with statistically significant utility differences. This also mirrors the relative importance of the different attributes in patient decisions: "Change of VA" influenced decision making for a treatment option in 73.6% of cases; "waiting, treatment, and travel time" influenced decision making in 21.0% of cases; and "treatment scheme" influenced decision making for a treatment option in 5.4% of cases. To obtain improved VA instead of a worsening VA, patients in our study stated to be willing to accept a very long time needed per physician visit of 21.2 hours (8.5 hours for improved rather than stable VA and 12.7 hours for stable VA rather than worsening VA). CONCLUSIONS To prevent deterioration of VA, patients with nAMD seem to be willing to accept a high treatment burden with regular intravitreal injections at short intervals and long periods of waiting, treatment, and traveling for their consultations.
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Affiliation(s)
- Sabrina Mueller
- Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), University of Wismar, Wismar, Germany.
| | - Hansjürgen Agostini
- Eye Center, Medical Center, University of Freiburg, Baden-Württemberg, Germany
| | - Christoph Ehlken
- Eye Center, Medical Center, University of Freiburg, Baden-Württemberg, Germany
| | | | - Zoran Hasanbasic
- Medizinische Abteilung für Ophthalmologie, Bayer HealthCare Germany, Leverkusen, Germany
| | - Thomas Wilke
- Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), University of Wismar, Wismar, Germany
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Wachtlin J, Ringwald A, Maulhardt T, Pohl K, Wiedon A. Cooperation of German ophthalmologists in routine care of patients with neovascular age-related macular degeneration: results of the non-interventional BRIDGE study. Graefes Arch Clin Exp Ophthalmol 2015; 254:1529-1536. [PMID: 26678412 DOI: 10.1007/s00417-015-3242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the non-interventional ophthalmological study 'BRIDGE' the routine care of patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab was observed in Germany. A patient regularly sees the general ophthalmologist (GO) for monitoring and, if needed, the injecting ophthalmologist (IO) for intravitreal injections (IVI). Thus, patients are routinely treated by two ophthalmologists in parallel and patient care depends on their collaboration. This cooperation was evaluated based on network questionnaires. METHODS 'BRIDGE' was a multicenter, national, open-label, prospective, observational study, conducted between July 2010 and December 2012. The network questionnaire for GOs consisted of 51 questions, while the similar questionnaire for IOs consisted of 43 questions, addressing the type and details of the individual collaboration. The statistical analysis was purely descriptive. RESULTS The network questionnaire for GOs was completed by 152 GOs, regularly cooperating with 2.5 ± 1.1 IOs, while the questionnaire for IOs was completed by 43 IOs, regularly cooperating with 23.2 ± 23.6 GOs. Generally, both GOs and IOs stated that they regularly exchange information regarding the patients' situation. Diagnostic standards were only established for 15 % of the GOs' collaborations and for 35 % of the IOs' collaborations. After initial treatment, both GOs and IOs agreed on the medical significance of regular monitoring visits performed by the GOs. Agreements on re-treatment criteria were only established in the case of 16 % of the GOs and 28 % of the IOs. Overall, both GOs and IOs were satisfied with the current situation, with regard to the medical treatment situation for patients and to the cooperation within the networks. CONCLUSIONS The network questionnaires revealed well-established cooperation between IOs and GOs in Germany with an accepted division of responsibilities for the routine care of patients with nAMD. However, the cooperation between two ophthalmologists treating one patient harbors risks. Agreements on diagnostic and re-treatment criteria would help to improve network performance and outcomes.
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Affiliation(s)
- Joachim Wachtlin
- Augenabteilung Sankt-Gertrauden Krankenhaus, Paretzer Strasse 12, 10713, Berlin, Germany.
| | - Andreas Ringwald
- Augenklinik Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Germany
| | - Tobias Maulhardt
- Facharzt für Augenheilkunde, Augentagesklinik, Flemmingstraße 8 / Haus 9, 09116, Chemnitz, Germany
| | - Karin Pohl
- Novartis Pharma GmbH, Roonstr.25, 90429, Nürnberg, Germany
| | - Annette Wiedon
- Novartis Pharma GmbH, Roonstr.25, 90429, Nürnberg, Germany
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