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阿柏西普:其对渗出性年龄相关性黄斑变性治疗效果的综述

Aflibercept: A review of its effect on the treatment of exudative age-related macular degeneration.

作者信息

Papadopoulos Zois

机构信息

Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.

出版信息

Eur J Ophthalmol. 2019 Jul;29(4):368-378. doi: 10.1177/1120672119832432. Epub 2019 Feb 27.

Abstract

Considerable improvement has been achieved in the way in which exudative age-related macular degeneration is conventionally treated and in the associated visual outcomes and prognosis, thanks to the agents with effects against vascular endothelial growth factor (anti-VEGF). By comparison to earlier treatment approaches that involved the use of lasers, the anti-VEGF agents have made it possible to accomplish more positive visual and anatomical outcomes in cases of exudative age-related macular degeneration. Indeed, owing to their positive effects, anti-VEGF agents have quickly come to be considered the gold standard for the treatment of wet age-related macular degeneration. Aflibercept, the most recently approved intravitreally administered anti-VEGF, seems to mark another milestone in the treatment of wet age-related macular degeneration. This anti-VEGF agent presents a series of singular pharmacodynamic and pharmacokinetic attributes that provide it a number of biological benefits in relation to the treatment of choroidal neovascularization compared to other agents. These attributes include high level of affinity for the VEGF-A factor, an intravitreal half-life of great length, as well as the ability to serve as an antagonist for other growth factors besides VEGF. The impact of Aflibercept on the manner in which exudative age-related macular degeneration is managed was demonstrated by thoroughly reviewing the related literature. The present review article highlights the pharmacology, pharmacokinetics, safety and effectiveness of this anti-VEGF agent as well as the landmark clinical studies that have been carried out to establish this drug as a gold standard in the therapy of neovascular age-related macular degeneration. In addition, studies regarding the outcomes and effectiveness of the various dosage regimens, either as monotherapy or in combination with other agents, are also reviewed.

摘要

由于抗血管内皮生长因子(anti-VEGF)药物的应用,渗出性年龄相关性黄斑变性的传统治疗方法以及相关的视觉效果和预后都有了显著改善。与早期使用激光的治疗方法相比,抗VEGF药物使得渗出性年龄相关性黄斑变性患者能够获得更积极的视觉和解剖学效果。事实上,由于其积极作用,抗VEGF药物迅速成为湿性年龄相关性黄斑变性治疗的金标准。阿柏西普是最近获批的玻璃体内注射抗VEGF药物,它似乎标志着湿性年龄相关性黄斑变性治疗的又一个里程碑。与其他药物相比,这种抗VEGF药物具有一系列独特的药效学和药代动力学特性,使其在治疗脉络膜新生血管方面具有许多生物学优势。这些特性包括对VEGF-A因子的高亲和力、极长的玻璃体内半衰期,以及作为除VEGF之外的其他生长因子拮抗剂的能力。通过全面回顾相关文献,证明了阿柏西普对渗出性年龄相关性黄斑变性治疗方式的影响。本综述文章重点介绍了这种抗VEGF药物的药理学、药代动力学、安全性和有效性,以及为确立该药物作为新生血管性年龄相关性黄斑变性治疗金标准而开展的具有里程碑意义的临床研究。此外,还综述了关于各种剂量方案(无论是单药治疗还是与其他药物联合使用)的疗效和有效性的研究。

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