Detrimental Effect of Delayed Re-treatment of Active Disease on Outcomes in Neovascular Age-Related Macular Degeneration: The RAMPS Study.
Ophthalmol Retina
; 4(9): 871-880, 2020 09.
Article
em En
| MEDLINE
| ID: mdl-32446840
ABSTRACT
PURPOSE:
To assess the impact of delaying anti-vascular endothelial growth factor (VEGF) treatment of active disease at any point during a patient's treatment journey on clinical outcomes in a real-world cohort of patients with neovascular age-related macular degeneration (nAMD).DESIGN:
Longitudinal cohort study.PARTICIPANTS:
Consecutive treatment-naive nAMD eyes commencing anti-VEGF monotherapy (bevacizumab, ranibizumab, or aflibercept) from January 2014 from a tertiary eye center in Singapore.METHODS:
We conducted a real-world study using registry data comparing delayed re-treatment (defined as not receiving treatment at 2 or more monitoring visits when disease was graded as active) versus timely re-treatment (defined as receiving treatment when disease was active). MAIN OUTCOMEMEASURES:
The primary outcome was the change in visual acuity (VA) in the timely and delayed re-treatment groups at 12 months.RESULTS:
Data from 286 eyes were included and categorized into the timely (188 [66%]) or the delayed (98 ([34%]) group. The mean numbers of anti-VEGF injections over 12 months were similar 5.6 (standard deviation [SD], 2.9) versus 4.9 (SD, 3.2; P = 0.11) for the timely and delayed groups, respectively. Timely treated patients showed larger gains in VA (6.4 letters [SD, 8.1 letters] vs. 1.2 letters [SD, 5.3 letters; P = 0.04), a higher proportion with VA of 6/12 or better (30% vs. 8%; P = 0.01), and greater reduction in OCT-measured central subfield thickness (135 µm [SD, 154 µm] vs. 87.8 µm [SD, 129 µm]; P = 0.04) at 12 months. A longer delay between detection of active disease and re-treatment was associated with poorer vision outcomes (0.02-letter decrease/day; P = 0.03; R2 = 0.29).CONCLUSIONS:
Although it has been established that adequate numbers of injections are required for favorable outcomes, timely re-treatment of active disease also is important. This should be emphasized to patients to ensure optimal outcomes in real-world clinical settings.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Acuidade Visual
/
Sistema de Registros
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Inibidores da Angiogênese
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Degeneração Macular Exsudativa
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
Idioma:
En
Revista:
Ophthalmol Retina
Ano de publicação:
2020
Tipo de documento:
Article