Ehlken C, Jungmann S, Böhringer D, Agostini H T, Junker B, Pielen A
Eye Center, Albert-Ludwigs-University, Freiburg, Germany.
1] Eye Center, Albert-Ludwigs-University, Freiburg, Germany [2] Hannover Medical School, Hannover, Germany.
Eye (Lond). 2014 May;28(5):538-45. doi: 10.1038/eye.2014.64. Epub 2014 Apr 11.
Although anti-VEGF therapy of exudative AMD with bevacizumab and ranibizumab proved efficacious in the majority of patients, CNV activity does not respond to continued treatment after repeated injections in a considerable amount of patients. These are referred to as nonresponders. A change of the drug to bevacizumab or ranibizumab could possibly offer an alternative option for the treatment of nonresponding exudative AMD.
A total of 138 nonresponders who switched therapy from bevacizumab to ranibizumab (n=114) or vice versa (n=24) were included in a retrospective study. Visual acuity (VA) and foveal thickness before and after the switch of therapy were compared. By means of linear regression analysis, we analyzed possible prognostic factors associated with a favorable outcome for visual acuity.
Linear regression analysis revealed a statistically significant benefit for nonresponders when treatment was changed to a different anti-VEGF drug (bevacizumab or ranibizumab). VA at the time of the switch was positively correlated with a beneficial development of VA after changing the drug. There was no significant correlation with age, macular thickness, number of injections before the switch, or the development of VA under treatment before the switch. Both patients switching to Avastin and Lucentis benefitted without statistically significant differences.
An exchange of bevacizumab with ranibizumab or vice versa should be considered in nonresponders in the treatment of exudative AMD. Further prognostic factors may help to identify patients who might benefit from a switch. These factors should be investigated in further studies.
尽管使用贝伐单抗和雷珠单抗对渗出性年龄相关性黄斑变性进行抗血管内皮生长因子（VEGF）治疗在大多数患者中已证明有效，但相当一部分患者在反复注射后，脉络膜新生血管（CNV）活性对持续治疗无反应。这些患者被称为无反应者。更换为贝伐单抗或雷珠单抗可能为治疗无反应的渗出性年龄相关性黄斑变性提供另一种选择。
一项回顾性研究纳入了138例从贝伐单抗转换为雷珠单抗治疗（n = 114）或反之（n = 24）的无反应者。比较了治疗转换前后的视力（VA）和黄斑中心凹厚度。通过线性回归分析，我们分析了与视力良好预后相关的可能预后因素。
线性回归分析显示，当治疗更换为不同的抗VEGF药物（贝伐单抗或雷珠单抗）时，无反应者有统计学上显著的获益。转换时的视力与更换药物后视力的有益改善呈正相关。与年龄、黄斑厚度、转换前的注射次数或转换前治疗期间的视力变化无显著相关性。转换为阿瓦斯汀和雷珠单抗的患者均有获益，且无统计学显著差异。
在渗出性年龄相关性黄斑变性的治疗中，对于无反应者应考虑贝伐单抗与雷珠单抗的互换。进一步的预后因素可能有助于识别可能从转换治疗中获益的患者。这些因素应在进一步研究中进行调查。
