Elwes Flora, Borooah Shyamanga, Aspinall Peter, Sim Peng Yong, Loo Cheng Yi, Armbrecht Ana-Maria, Dhillon Baljean, Cackett Peter
Royal Infirmary of Edinburgh, Edinburgh, UK.
The Princess Alexandra Eye Pavilion, Edinburgh, UK.
BMC Ophthalmol. 2018 Jan 30;18(1):20. doi: 10.1186/s12886-018-0688-3.
To assess the effect of switching patients previously incompletely treated with ranibizumab (RBZ) to aflibercept (AFL) using a pro re nata (PRN) treatment strategy in neovascular age-related macular degeneration (nvAMD).
A retrospective case series was conducted on patients who had persistent or recurrent intra- and/or sub-retinal fluid treated initially with RBZ and subsequently switched to AFL. The main outcome measures were best corrected visual acuity (BCVA) and central retinal thickness (CRT) measured at different stages of the study. Friedman analysis of variance and Wilcoxon test were used to examine differences in BCVA and CRT.
Two hundred and seven eyes from 182 patients were included. BCVA and CRT improved significantly initially following 3 RBZ injections with a mean gain of 3.7 letters (p < 0.001) and a mean loss of 69 μm (p < 0.001) respectively. Following PRN RBZ therapy and immediately prior to switching to AFL (mean 129 weeks), there was a mean loss of 6.7 letters (p < 0.001) BCVA and a mean gain of 24 μm (p < 0.001) CRT. AFL loading resulted in a mean improvement of 0.7 letters (p = 0.28) BCVA and 55 μm (p < 0.001) CRT. At final follow-up following AFL PRN therapy (mean 85 weeks), there was a mean loss of 8.9 letters (p < 0.001) BCVA and a mean gain of 12 μm (p < 0.05) CRT.
AFL loading resulted in a significant anatomical improvement but no significant change in visual acuity. However, the benefits of switching were gradually lost over time with AFL PRN dosing despite an increased injection rate when compared with RBZ PRN treatment.
Not applicable.
评估采用按需（PRN）治疗策略，将先前接受雷珠单抗（RBZ）不完全治疗的新生血管性年龄相关性黄斑变性（nvAMD）患者转换为阿柏西普（AFL）治疗的效果。
对最初接受RBZ治疗，随后转换为AFL治疗的持续性或复发性视网膜内和/或视网膜下液患者进行回顾性病例系列研究。主要观察指标为在研究不同阶段测量的最佳矫正视力（BCVA）和中心视网膜厚度（CRT）。采用Friedman方差分析和Wilcoxon检验来检查BCVA和CRT的差异。
纳入了182例患者的207只眼。在最初3次RBZ注射后，BCVA和CRT显著改善，平均提高3.7个字母（p < 0.001），平均降低69μm（p < 0.001）。在PRN RBZ治疗后且即将转换为AFL治疗前（平均129周），BCVA平均降低6.7个字母（p < 0.001），CRT平均增加24μm（p < 0.001）。AFL负荷剂量导致BCVA平均提高0.7个字母（p = 0.28），CRT降低55μm（p < 0.001）。在AFL PRN治疗后的最终随访（平均85周）时，BCVA平均降低8.9个字母（p < 0.001），CRT平均增加12μm（p < 0.05）。
AFL负荷剂量导致了显著的解剖学改善，但视力无显著变化。然而，与RBZ PRN治疗相比，尽管AFL PRN给药时注射频率增加，但随着时间推移，转换治疗的益处逐渐丧失。
不适用。
