系统药物治疗与年龄相关性黄斑变性治疗试验中地理萎缩发生率和进展的比较。
SYSTEMIC MEDICATION USE AND THE INCIDENCE AND GROWTH OF GEOGRAPHIC ATROPHY IN THE COMPARISON OF AGE-RELATED MACULAR DEGENERATION TREATMENTS TRIALS.
机构信息
Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and.
Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
出版信息
Retina. 2021 Jul 1;41(7):1455-1462. doi: 10.1097/IAE.0000000000003075.
PURPOSE
To determine associations of systemic medications with the incidence and growth of geographic atrophy (GA) in participants of the comparison of age-related macular degeneration treatments trials.
METHODS
Participants of comparison of age-related macular degeneration treatments trials with new untreated choroidal neovascularization in the study eye (one study eye per participant) were randomized to receive treatment with bevacizumab or ranibizumab. Participants were released from clinical trial treatment at 2 years and examined at approximately 5 years. Color fundus photographs and fluorescein angiograms taken at baseline, Years 1, 2, and 5 were assessed for the presence and size of GA by two masked graders. Participants were interviewed about systemic medication use at baseline. Systemic medications previously reported to be associated with age-related macular degeneration were evaluated for associations with GA incidence in study eye using univariable and multivariable Cox models and for association with the GA growth using linear mixed effects models.
RESULTS
In multivariable analysis of 1,011 study eyes without baseline GA, systemic medications, including cholinesterase inhibitors, angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers, diuretics, aspirin, steroids, statins, hormone replacement therapy, antacids, and drugs targeting G protein-coupled receptors, were not associated with GA incidence in the study eye (all adjusted hazard ratios ≤1.86, P ≥ 0.18). In multivariable analysis of 214 study eyes with longitudinal GA size measurements, calcium channel blockers were associated with a higher GA growth rate (0.40 vs. 0.30 mm/year, P = 0.02).
CONCLUSION
None of the systemic medications analyzed were associated with GA incidence. However, calcium channel blockers were associated with a higher growth rate of GA in the study eye.
目的
在比较年龄相关性黄斑变性治疗试验的参与者中，确定全身药物与地理萎缩（GA）的发生和发展之间的关联。
方法
在比较年龄相关性黄斑变性治疗试验的参与者中，每只研究眼（每位参与者一只眼）均有新的未经治疗的脉络膜新生血管，将其随机分配接受贝伐单抗或雷珠单抗治疗。参与者在 2 年时停止临床试验治疗，并在大约 5 年时进行检查。通过两名盲法分级员，根据眼底彩色照片和荧光素血管造影，评估基线、第 1 年、第 2 年和第 5 年 GA 的存在和大小。在基线时对参与者进行了全身药物使用情况的访谈。根据单变量和多变量 Cox 模型评估先前报道与年龄相关性黄斑变性相关的全身药物与研究眼 GA 发生率的相关性，并使用线性混合效应模型评估与 GA 生长的相关性。
结果
在没有基线 GA 的 1011 只研究眼中的多变量分析中，全身药物，包括胆碱酯酶抑制剂、血管紧张素转换酶抑制剂、钙通道阻滞剂、β受体阻滞剂、利尿剂、阿司匹林、皮质类固醇、他汀类药物、激素替代疗法、抗酸剂和靶向 G 蛋白偶联受体的药物，与研究眼中 GA 的发生率无关（所有调整后的危险比≤1.86，P≥0.18）。在 214 只具有纵向 GA 大小测量值的研究眼中的多变量分析中，钙通道阻滞剂与更高的 GA 生长速率相关（0.40 与 0.30mm/年，P=0.02）。
结论
分析的全身药物均与 GA 的发生率无关。然而，钙通道阻滞剂与研究眼中 GA 的生长速率较高有关。
Zotero 插件