Rush Ryan B
Department of Ophthalmology, Panhandle Eye Group, Amarillo, TX, USA.
Department of Ophthalmology, Southwest Retina Specialists, Amarillo, TX, USA.
Clin Ophthalmol. 2023 Aug 1;17:2201-2208. doi: 10.2147/OPTH.S424315. eCollection 2023.
To assess the 12-month outcomes of intravitreal faricimab (IVF) in treatment-resistant neovascular age-related macular degeneration (nAMD) subjects recalcitrant to intravitreal aflibercept (IVA).
This study was conducted as a retrospective interventional case series of nAMD patients receiving treatment at a single private practice institution. All included patients at baseline had undergone six or more IVA injections over the previous 12 months, four or more IVA injections over the previous 6 months, had a central macular thickness (CMT) ≥320 µm on optical coherence tomography (OCT), and were observed to have intraretinal and/or subretinal fluid on OCT assessment. The baseline exam for the purpose of this study was considered the visit in which the patient was switched from IVA to IVF. Patients were managed with a real-world treat-and-extend protocol and followed over a 12-month study period.
A total of 54 eyes of 54 subjects were analyzed. Overall, 31.5% (17/54) of subjects attained a treatment interval ≥8 weeks and had a fluid-free macula on OCT at 12 months. The CMT on OCT decreased from 395.4 (383.5-407.3) µm at baseline to 350.0 (335.1-364.8) µm at the end of the 12-month study interval (<0.01). There were 16.7% (9/54) of subjects who gained three or more lines of Snellen visual acuity at the end of the study. Visual acuity improved from 0.72 (0.67-0.77) logMAR (Snellen 20/105) at baseline to 0.59 (0.55-0.64) logMAR (Snellen 20/78) at the end of the study (<0.01).
A clinically significant minority of aflibercept-resistant nAMD subjects may attain longer treatment intervals and improved outcomes at 12 months after switching to IVF when a treat-and-extend treatment protocol is utilized. IVF use may be considered whenever resistance to IVA is encountered in this patient population.
评估玻璃体内注射法西单抗（IVF）治疗对玻璃体内注射阿柏西普（IVA）耐药的新生血管性年龄相关性黄斑变性（nAMD）患者12个月的疗效。
本研究为一项回顾性干预病例系列研究，纳入在一家私立医疗机构接受治疗的nAMD患者。所有纳入患者在基线时，在过去12个月内接受过6次或更多次IVA注射，在过去6个月内接受过4次或更多次IVA注射，光学相干断层扫描（OCT）显示中心黄斑厚度（CMT）≥320 µm，且在OCT评估中观察到视网膜内和/或视网膜下液。本研究的基线检查被认为是患者从IVA转换为IVF的那次就诊。患者采用现实世界中的治疗并延长方案进行管理，并在12个月的研究期内进行随访。
共分析了54例患者的54只眼。总体而言，31.5%（17/54）的患者治疗间隔≥8周，且在12个月时OCT显示黄斑无液。OCT上的CMT从基线时的395.4（383.5 - 407.3）µm降至12个月研究期结束时的350.0（335.1 - 364.8）µm（<0.01）。16.7%（9/54）的患者在研究结束时视力提高了3行或更多行。视力从基线时的0.72（0.67 - 0.77）logMAR（Snellen 20/105）提高到研究结束时的0.59（0.55 - 0.64）logMAR（Snellen 20/78）（<0.01）。
当采用治疗并延长治疗方案时，临床上有显著比例的对阿柏西普耐药的nAMD患者在转换为IVF治疗12个月后可能获得更长的治疗间隔并改善疗效。在该患者群体中，每当遇到对IVA耐药时，可考虑使用IVF。
