Department of Opthalmology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.
Clinic of Opthalmology and Ocular Oncology, University Hospital, Cracow, Poland.
J Physiol Pharmacol. 2019 Oct;70(5). doi: 10.26402/jpp.2019.5.13. Epub 2020 Jan 30.
Age-related macular degeneration (AMD) is a leading cause of central visual loss in people aged over 50 years in well developed countries. Although the anti-vascular endothelial growth factor (VEGF) therapy has become a standard treatment for exudative AMD, its effectiveness may be limited in some cases. We aimed to assess the prevalence of non-responsiveness and tachyphylaxis to anti-VEGF drugs in patients with exudative AMD. The study included 63 initially treatment-naive AMD patients who were analyzed for non-responsiveness and tachyphylaxis to intravitreal injections (IVI) of ranibizumab and aflibercept. The participants were enrolled in a National Healthcare Fund (NHF) Therapeutic Program for the Treatment of Exudative AMD. Best-corrected visual acuity (BCVA) and morphological features of a disease activity assessed in optical coherence tomography (OCT) were evaluated during a 12-month follow-up. The percentage of non-responders achieved 22.2% (14 eyes). No significant correlation was found between the type of VEGF inhibitor and a negative response to therapy. Eight patients (12.7%) developed early tachyphylaxis, which was more common in eyes treated with aflibercept (P = 0.04). The presence of serous pigment epithelium detachment (sPED) at baseline was associated with non-responsiveness as determined by both BCVA (OR 18.2, 95% CI 2.86 - 248; P = 0.021) and OCT features (OR 23.0, 95% CI 1.80 - 321; P = 0.030). Eyes treated with aflibercept showed statistically significant greater BCVA improvement (P = 0.0034) and central retinal thickness (CRT) reduction (P = 0.0129) as compared to ranibizumab group during a loading phase of therapy. In a maintain phase of treatment the differences in BCVA and CRT between these two groups were not statistically significant, however eyes treated with aflibercept still showed better functional and anatomical results. Anti-VEGF therapy is an effective method of treatment for exudative AMD, however some patients may show week or no positive reaction or may develop tachyphylaxis. Awareness of these possible negative effects is an important clinical problem in the long-term management of AMD patients with VEGF inhibitors.
年龄相关性黄斑变性（AMD）是发达国家 50 岁以上人群中心视力丧失的主要原因。尽管抗血管内皮生长因子（VEGF）治疗已成为渗出性 AMD 的标准治疗方法，但在某些情况下其效果可能有限。我们旨在评估渗出性 AMD 患者对抗 VEGF 药物无反应和快速耐受的发生率。该研究纳入了 63 名最初未经治疗的 AMD 患者，分析了他们对玻璃体内注射雷珠单抗和阿柏西普的无反应和快速耐受情况。这些参与者被纳入国家医疗保健基金（NHF）渗出性 AMD 治疗计划。在 12 个月的随访期间，评估了最佳矫正视力（BCVA）和光学相干断层扫描（OCT）评估的疾病活动的形态特征。无反应者的百分比达到 22.2%（14 只眼）。VEGF 抑制剂的类型与治疗反应之间没有显著相关性。8 名患者（12.7%）发生早期快速耐受，阿柏西普治疗的眼更常见（P = 0.04）。基线时存在浆液性色素上皮脱离（sPED）与 BCVA（OR 18.2，95%CI 2.86-248；P = 0.021）和 OCT 特征（OR 23.0，95%CI 1.80-321；P = 0.030）确定的无反应相关。与雷珠单抗组相比，在治疗的加载阶段，阿柏西普治疗的眼的 BCVA 改善（P = 0.0034）和中心视网膜厚度（CRT）降低（P = 0.0129）具有统计学意义。在治疗的维持阶段，两组间 BCVA 和 CRT 的差异无统计学意义，但阿柏西普治疗的眼仍显示出更好的功能和解剖结果。抗 VEGF 治疗是渗出性 AMD 的有效治疗方法，但有些患者可能表现出较弱或无阳性反应，或可能发生快速耐受。在 VEGF 抑制剂治疗 AMD 患者的长期管理中，了解这些可能的负面效应是一个重要的临床问题。
