抗血管内皮生长因子治疗对新生血管性年龄相关性黄斑变性疾病进展的影响:系统评价和基于模型的荟萃分析。
Effect of Anti-VEGF Therapy on the Disease Progression of Neovascular Age-Related Macular Degeneration: A Systematic Review and Model-Based Meta-Analysis.
机构信息
AbbVie, Irvine, California, USA.
qPharmetra LLC, San Francisco, California, USA.
出版信息
J Clin Pharmacol. 2022 May;62(5):594-608. doi: 10.1002/jcph.2002. Epub 2022 Jan 5.
Anti-vascular endothelial growth factor (VEGF) therapy is used to slow the disease progression of neovascular age-related macular degeneration. Due to the treatment burden of frequent intravitreal injections, anti-VEGFs are often used on treat and extend protocols rather than the labeled frequency. The current goal of anti-VEGF drug development is to minimize treatment burden by reducing the number of intravitreal injections. The purpose of this systemic review and model-based meta-analysis (MBMA) was to (1) perform modeling to describe the disease progression of neovascular age-related macular degeneration in the absence of treatment, as well as in the presence of abicipar, aflibercept, brolucizumab, or ranibizumab intervention; (2) and to simulate virtual head-to-head comparisons among the drugs with an extended dose schedule of once every 12 weeks (Q12). Data sources were PubMed, internal Allergan data, www.clinicaltrials.gov, and www.clinicaltrialsregister.eu. Eligibility assessment was performed by 2 independent review authors. Randomized, controlled trials that had at least 1 arm with an anti-VEGF (aflibercept, abicipar, bevacizumab, brolucizumab, pegaptanib, or ranibizumab), a control arm of placebo or anti-VEGF, a treatment duration of at least 4 months, reported best-corrected visual acuity data, and at least 20 patients were included. A total of 22 trials, consisting of 55 arms, from across 9500+ subjects and 500+ best-corrected visual acuity observations were used to develop the model. Consistent with reported data, results from the model showed that abicipar Q12 underperformed ranibizumab (every 4 weeks), aflibercept (every 4 weeks), and brolucizumab (every 8 weeks/Q12) labeled dosing schedules. However, when all drugs were virtually tested using the extended schedule, abicipar outperformed ranibizumab and aflibercept and produced a similar week 52 change from baseline as brolucizumab. Predicted week 52 changes from baseline were 5.92 ± 1.02, 3.04 ± 1.61, 6.61 ± 0.284, and 3.02 ± 2.35 best-corrected visual acuity letters for abicipar, aflibercept, brolucizumab, and ranibizumab, respectively, using the Q12 schedule. Results demonstrate the feasibility of Q12 dosing with clinically meaningful letter gains for abicipar and brolucizumab. The model developed under this MBMA has utility for exploring different regimens for existing or novel anti-VEGF agents.
抗血管内皮生长因子(VEGF)疗法用于减缓新生血管性年龄相关性黄斑变性的疾病进展。由于频繁玻璃体内注射的治疗负担,抗 VEGF 药物通常用于治疗和延长方案,而不是标签频率。目前,抗 VEGF 药物开发的目标是通过减少玻璃体内注射次数来最大程度地减少治疗负担。本系统评价和基于模型的荟萃分析(MBMA)的目的是:(1)进行建模,以描述在没有治疗的情况下以及在 abicipar、aflibercept、brolucizumab 或 ranibizumab 干预存在的情况下,新生血管性年龄相关性黄斑变性的疾病进展情况;(2)并模拟每 12 周(Q12)一次的扩展剂量方案中药物之间的虚拟头对头比较。数据来源包括 PubMed、Allergan 内部数据、www.clinicaltrials.gov 和 www.clinicaltrialsregister.eu。由两名独立的审查作者进行资格评估。纳入了至少有 1 个抗 VEGF(aflibercept、abicipar、bevacizumab、brolucizumab、pegaptanib 或 ranibizumab)手臂、安慰剂或抗 VEGF 对照臂、治疗持续时间至少 4 个月、报告最佳矫正视力数据且至少有 20 名患者的随机对照试验。共有 22 项试验,来自 9500 多名受试者和 500 多次最佳矫正视力观察的 55 个臂,用于开发该模型。与报告的数据一致,模型结果表明,abicipar Q12 的表现逊于 ranibizumab(每 4 周)、aflibercept(每 4 周)和 brolucizumab(每 8 周/Q12)标签剂量方案。然而,当所有药物都使用扩展方案进行虚拟测试时,abicipar 的表现优于 ranibizumab 和 aflibercept,并产生了与 brolucizumab 相似的第 52 周从基线的变化。使用 Q12 方案,abicipar、aflibercept、brolucizumab 和 ranibizumab 的预测第 52 周从基线的变化分别为 5.92±1.02、3.04±1.61、6.61±0.284 和 3.02±2.35 个最佳矫正视力字母。结果表明,abicipar 和 brolucizumab 的 Q12 给药具有临床意义的字母增益是可行的。本 MBMA 下开发的模型可用于探索现有或新型抗 VEGF 药物的不同方案。