Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA.
Am J Ophthalmol. 2012 Jun;153(6):1116-24.e1. doi: 10.1016/j.ajo.2011.11.032. Epub 2012 Feb 8.
To examine trends in the treatment of newly diagnosed neovascular age-related macular degeneration (AMD).
Retrospective cohort study.
Among 284 380 Medicare beneficiaries with a new diagnosis between 2006 and 2008, we used the cumulative incidence function to estimate procedure rates and the mean frequency function to estimate the cumulative mean number of intravitreous injections. We used Cox log-binomial regression to estimate predictors of the use of vascular endothelial growth factor (VEGF) antagonists within 1 year after diagnosis. Discontinuation of anti-VEGF therapy was defined by absence of treatment for 12 months. Discontinuation rates were calculated using the Kaplan-Meier method.
The proportion of patients receiving anti-VEGF therapy increased from 60.3% to 72.7%, photodynamic therapy decreased from 12.8% to 5.3%, and thermal laser treatment decreased from 5.5% to 3.2%. Black patients (hazard ratio, 0.77; 95% confidence interval, 0.75-0.79) and patients of other/unknown race (0.83; 0.81-0.84) were less likely than white patients to receive anti-VEGF therapy. Patients with dementia were less likely to receive anti-VEGF therapy (0.88; 0.88-0.89). Among patients who received anti-VEGF therapy, the mean number of injections within 1 year of the first injection was 4.3 per treated eye. Anti-VEGF therapy was discontinued in 53.6% of eyes within 1 year, and in 61.7% of eyes within 18 months.
Treatment of new neovascular AMD changed significantly between 2006 and 2008, most notably in the increasing use of anti-VEGF therapies. However, few patients treated with anti-VEGF medications received monthly injections, and discontinuation rates were high.
研究新诊断的年龄相关性黄斑变性（AMD）新生血管的治疗趋势。
回顾性队列研究。
在 2006 年至 2008 年间，对 284380 名有新诊断的医疗保险受益人的数据进行了回顾性分析，使用累积发病率函数来估计治疗率，使用平均频率函数来估计累积平均玻璃体腔内注射次数。使用 Cox 对数二项式回归来估计诊断后 1 年内使用血管内皮生长因子（VEGF）拮抗剂的预测因素。抗 VEGF 治疗的停药定义为 12 个月内无治疗。使用 Kaplan-Meier 法计算停药率。
接受抗 VEGF 治疗的患者比例从 60.3%增加到 72.7%，光动力疗法从 12.8%下降到 5.3%，热激光治疗从 5.5%下降到 3.2%。黑人患者（危险比，0.77；95%置信区间，0.75-0.79）和其他/未知种族的患者（0.83；0.81-0.84）接受抗 VEGF 治疗的可能性低于白人患者。痴呆患者接受抗 VEGF 治疗的可能性较小（0.88；0.88-0.89）。在接受抗 VEGF 治疗的患者中，在第一次注射后 1 年内，每只治疗眼的平均注射次数为 4.3 次。在 1 年内，53.6%的眼停止了抗 VEGF 治疗，在 18 个月内，61.7%的眼停止了抗 VEGF 治疗。
2006 年至 2008 年间，新的新生血管性 AMD 的治疗方法发生了显著变化，最显著的是抗 VEGF 治疗的应用增加。然而，接受抗 VEGF 药物治疗的患者很少接受每月注射，停药率很高。
