Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Ophthalmology, Isala Clinic, Zwolle, The Netherlands.
Acta Ophthalmol. 2021 Sep;99(6):e884-e892. doi: 10.1111/aos.14712. Epub 2020 Dec 23.
To compare treatment outcomes of treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) with bevacizumab as the first-line treatment, according to the guidelines of the Dutch Ophthalmological Society, with those treated first with either ranibizumab or aflibercept, as used in many other countries, all treated using a treat-and-extend strategy.
Data were obtained from the prospectively designed Fight Retinal Blindness! outcomes registry. The primary outcome was the mean change from baseline in visual acuity of all treated eyes, after 12, 24 and 36 months of treatment. Secondary outcomes were the number of injections, the number of visits and the rate of switching to a second anti-VEGF drug.
The study included 703 treatment-naïve eyes with nAMD with 12 months follow-up, 373 eyes with 24 months follow-up, and 171 eyes with 36 months follow-up in the Netherlands, and 1131, 652, and 303 treatment-naïve eyes with respectively 12, 24, and 36 months of follow-up in all other countries. The change in visual acuity from baseline did not differ between the Netherlands and the other countries at any follow-up time. The median number of injections, visits and the proportion of eyes switching treatment was significantly higher in the Netherlands than in the other countries.
Starting anti-VEGF treatment for nAMD with bevacizumab, as is mandatory in the Netherlands, delivers outcomes similar to those starting treatment with either ranibizumab or aflibercept, but at a cost of more frequent injections, and visits, and more frequent switching treatment to a second drug.
根据荷兰眼科协会的指南，比较贝伐单抗作为一线治疗药物治疗初治性新生血管性年龄相关性黄斑变性（nAMD）患者的治疗结果，并与许多其他国家首选使用雷珠单抗或阿柏西普治疗的患者进行比较，所有患者均采用“按需治疗和延长治疗”策略。
数据来自前瞻性设计的 Fight Retinal Blindness! 结果登记处。主要结局是所有治疗眼从基线开始的视力平均变化，治疗 12、24 和 36 个月后。次要结局是注射次数、就诊次数和转换为第二种抗 VEGF 药物的比例。
本研究纳入了 703 例初治性 nAMD 患者，其中荷兰有 12 个月随访的患者 703 例，24 个月随访的患者 373 例，36 个月随访的患者 171 例，其他所有国家有 12 个月随访的患者 1131 例，24 个月随访的患者 652 例，36 个月随访的患者 303 例。从基线开始，视力变化在任何随访时间点在荷兰和其他国家之间均无差异。在荷兰，注射次数、就诊次数中位数以及转换治疗的眼比例明显高于其他国家。
在荷兰，强制性地使用贝伐单抗开始治疗 nAMD，其治疗结果与使用雷珠单抗或阿柏西普开始治疗相似，但需要更频繁地注射、就诊和更频繁地转换为第二种药物。
