Karesvuo Petteri, Hakkala Laura, Kaarniranta Kai, Uusitalo Hannu, Ojamo Matti, Tuuminen Raimo
Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.
Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland.
Acta Ophthalmol. 2020 Aug;98(5):472-476. doi: 10.1111/aos.14376. Epub 2020 Feb 24.
To correlate the rate of intravitreal anti-VEGF injections and the use of aflibercept as a second-line treatment with visual impairment throughout Finland.
Information related to anti-VEGF treatment, proportions of bevacizumab and aflibercept and new visual impairments due to wet age-related macular degeneration (AMD) was gathered from 5 university hospitals and 14 central hospital districts between 2015 and 2017 covering 232 568 injections and 1172 visual impairments.
Between 2015 and 2017, the number of annual total anti-VEGF injections increased from 60 412 to 93 589 (+24.5% annual change) and of aflibercept injections from 8299 to 20 833 (+58.7% annual change). The 3-year average for total anti-VEGF injections ranged from 9.6 to 21.1 (median 13.3) per 1000 citizens between hospital districts and for aflibercept injections from 0.8 to 4.0 (median 1.9). According to the primary protocol for wet AMD, during 2015-2017, the number of total anti-VEGF injections increased from 10.9 to 15.2 per 1000 citizens with the pro re nata (PRN) protocol and from 11.3 to 18.9 with the treat-and-extend regimen (TER). The 3-year average of aflibercept injections as a second-line treatment, but not the total number of anti-VEGF or bevacizumab injections, inversely correlated with new onset visual impairments (R = -0.505, P = 0.027) in the hospital districts. The number of visual impairments did not differ between the hospital districts according to the PRN and TER protocols (1.23 ± 0.41 and 1.14 ± 0.67, respectively, per 1000 citizens aged ≥64 years, P = 0.713).
These results emphasize that the use of aflibercept injections as a second-line treatment may decrease new onset visual impairments.
在芬兰全国范围内，将玻璃体内抗血管内皮生长因子（VEGF）注射率以及阿柏西普作为二线治疗药物的使用情况与视力损害相关联。
收集了2015年至2017年间5所大学医院和14个中心医院地区与抗VEGF治疗、贝伐单抗和阿柏西普的使用比例以及湿性年龄相关性黄斑变性（AMD）导致的新视力损害相关的信息，涵盖232568次注射和1172例视力损害。
2015年至2017年间，每年抗VEGF注射的总数从60412次增加到93589次（年变化率为+24.5%），阿柏西普注射次数从8299次增加到20833次（年变化率为+58.7%）。各医院地区每1000名居民中抗VEGF注射的3年平均次数在9.6至21.1次之间（中位数为13.3次），阿柏西普注射次数在0.8至4.0次之间（中位数为1.9次）。根据湿性AMD的主要治疗方案，在2015 - 2017年期间，每1000名居民中抗VEGF注射的总数在按需（PRN）治疗方案下从10.9次增加到15.2次，在治疗并延长方案（TER）下从11.3次增加到18.9次。各医院地区作为二线治疗的阿柏西普注射的3年平均次数与新发性视力损害呈负相关（R = -0.505，P = 0.027），但抗VEGF或贝伐单抗注射的总数与之无关。根据PRN和TER方案，各医院地区每1000名年龄≥64岁居民中的视力损害次数无差异（分别为1.23±0.41次和1.14±0.67次，P = 0.713）。
这些结果强调，将阿柏西普注射作为二线治疗药物的使用可能会减少新发性视力损害。
