Anti‐vascular endothelial growth factors treatment of wet age‐related macular degeneration: from neurophysiology to cost‐effectiveness

Vottonen, Pasi

doi:10.1111/aos.13706

Cited by 5 publications

(8 citation statements)

References 273 publications

(328 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Per-dose cost is approximately US $772.94 per syringe, per pill, or unit, for pegaptanib; US $1216.65 per syringe, per pill, or unit for ranibizumab; US $1920.04 per vial, per pill, or unit, for aflibercept; and US $50 for bevacizumab. 60 – 62 According to the model developed by Kuopio University Hospital, 63 the direct medical costs include: (a) the costs of diagnosis including medical visit, FA, and OCT; (b) the cost of intravitreal injection of the medication; (c) the costs of follow up, including a medical visit and OCT; and (d) rehabilitation of legally blind persons. For one patient, a 6-week regimen with pegaptanib costs US $7729.40 per year, while bevacizumab PRN costs US $1610.40, ranibizumab PRN costs US $16,687.70, bevacizumab monthly costs US $2924.60, ranibizumab monthly US $25,759.20, aflibercept monthly costs US $13,954.70, aflibercept bimonthly costs US $6977.3, bevacizumab treat-and-extend regimen costs US $2167.9, ranibizumab treat-and-extend regimen costs US $18,678.9, and afliber-cept treat-and-extend regimen costs US $11,280.1.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis

Zhao

Wang

et al. 2020

Therapeutic Advances in Chronic Disease

View full text Add to dashboard Cite

Background: As a debilitating neurodegenerative disease, neovascular age-related macular degeneration (nAMD) accounts for more than 90% of severe visual loss or legal blindness among AMD patients. Anti-vascular endothelial growth factor (VEGF) had been applied widely in nAMD treatment. To date, debate regarding efficacy and safety still exists among different anti-VEGF regimens as management of nAMD. To provide substantial evidence for clinical nAMD treatment, this study ranks the priority of anti-VEGF regimens via Bayesian network meta-analysis (NMA), comparing data collected from randomized controlled trials (RCTs). Methods: We searched PubMed Central, MEDLINE Ovid, Embase Ovid, ISRCTN, ICTRP and ClinicalTrials. gov from a database established until 1 April 2019 systematically for anti-VEGF regimens. Bayesian NMA with random-effect was conducted to compare efficacy and safety and rank priority of anti-VEGF regimens. The primary efficacy and safety outcomes were the proportion of patients gaining 15 or more letters, and the incidence of arterial thromboembolic (ATC) events. The effect measure is the standard mean difference (SMD), or the odds ratio (OR) with their 95% confidence interval (CI). The study protocol is registered with PROSPERO, number CRD42019132243. Results: We obtained 6467 citations and identified 29 RCTs including 13,596 participants; 86% of these trials were low risk or of uncertain risk bias. In NMA, ORs compared with sham injection for the proportion of patients gaining 15 or more letters (12,699 participants from 23 trials) ranged from 4.05 [95% Bayesian credible interval (CrI) 1.62–10.11] for ranibizumab quarterly regimen to 8.57 (95% CrI 4.66–15.73) for a ranibizumab treat-and-extend regimen. No difference was found between sham injection and anti-VEGF regimens for ATC events (11,500 participants from 18 trials). Results for the primary outcome did not substantially change in sensitivity analyses after removing studies at high risk of bias and small sample size ( n < 100), respectively. Conclusion: The treat-and-extend regimen of ranibizumab and aflibercept are the preferred anti-VEGF regimens for nAMD. Bevacizumab treat-and-extend regimens need more head-to-head comparisons with other regimens or sham injection for advanced application. The treat-and-extend regimen proved to be the most effective regimen for each anti-VEGF drug in the NMA. Pegaptanib every 6 weeks and Conbercept quarterly are unable to satisfy the best corrected visual acuity (BCVA) improvement requirement of nAMD patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis

Zhao

Wang

et al. 2020

Therapeutic Advances in Chronic Disease

View full text Add to dashboard Cite

show abstract

“…A degeneração macular relacionada à idade (DMRI) é uma doença degenerativa que acomete a região central da retina (mácula), responsável pela visão de cores e detalhes, cuja progressão leva à perda de visão central. 1 Pode ser classificada como seca, responsável pela maior parte dos casos (85%-90%), ou exsudativa, também denominada neovascular ou úmida, correspondendo a 10%-15% do total de casos. 2 A DMRI exsudativa caracteriza-se pelo crescimento de novos vasos sanguíneos a partir de vasos preexistentes, em um processo denominado angiogênese ou neovascularização.…”

unclassified

“…Nesse processo, os fatores endoteliais de crescimento vascular (VEGF, do inglês vascular endothelial growth factors) são os fatores mais importantes para o estímulo à neovascularização retiniana e coroidiana; os novos vasos, por sua vez, são frágeis e mais permeáveis, levando a edemas, hemorragias e, em estágios avançados, fibrose. 1 Embora a DMRI exsudativa seja menos comum, a evolução para a cegueira é muito mais frequente nesta forma da doença.…”

unclassified

“…7 Os anti-VEGF revolucionaram o tratamento da DMRI exsudativa. 1,8 Antes da terapia anti-VEGF, a fotocoagulação retiniana e a terapia fotodinâmica eram as únicas opções de tratamento. A fotocoagulação, porém, era aplicável apenas a uma pequena parcela dos pacientes e tinha alto risco de formação de cicatriz com dano permanente na camada de fotorreceptores, 9 enquanto a terapia fotodinâmica não proporcionava ganho de acuidade visual; ambas as terapias foram praticamente abandonadas no manejo da DMRI exsudativa, sendo substituídas pela terapia anti-VEGF como modalidade terapêutica de primeira linha da DMRI exsudativa em todas as diretrizes de tratamento.…”

unclassified

“…O ranibizumabe é um fragmento de anticorpo monoclonal recombinante humanizado anti-VEGF-A e o aflibercepte é uma proteína de fusão recombinante que consiste de porções de domínios extracelulares dos receptores 1 e 2 do VEGF humano, ligados à porção do fragmento cristalizável (Fc) da imunoglobulina humana IgG1, e apresenta alta afinidade por uma ampla gama de VEGF, incluindo todas as isoformas de VEGF-A, o VEGF-B e pelo fator de crescimento placentário (PlGF). 1 A terapia anti-VEGF é aplicada por meio de injeções intravítreas no olho acometido. Os principais desfechos obtidos com o tratamento anti-VEGF são o ganho de acuidade visual, sua manutenção a longo prazo e a diminuição de fluido no exame de tomografia de coerência óptica (OCT).…”

unclassified

See 2 more Smart Citations

Opinião: Vantagens do tratar e estender como regime de utilização dos anti-VEGF para DMRI

Ramalho¹,

Medina²

2022

JAFF

View full text Add to dashboard Cite

O objetivo deste artigo é auxiliar médicos e gestores nas tomadas de decisão em relação ao tratamento da degeneração macular relacionada à idade (DMRI) com anti-VEGF. A complexidade das decisões decorre do alto custo do tratamento, do fato de se tratar de uma doença que pode evoluir para a cegueira e das dificuldades trazidas pelos esquemas de tratamento. Buscamos mostrar aspectos práticos importantes do tratamento, levando em conta os desfechos clínicos, a utilização de recursos e a carga para os pacientes, com base nas melhores evidências.

show abstract

AMD-SD: An Optical Coherence Tomography Image Dataset for wet AMD Lesions Segmentation

Hu,

Gao,

Gao

et al. 2024

Sci Data

View full text Add to dashboard Cite

Wet Age-related Macular Degeneration (wet AMD) is a common ophthalmic disease that significantly impacts patients’ vision. Optical coherence tomography (OCT) examination has been widely utilized for diagnosing, treating, and monitoring wet AMD due to its cost-effectiveness, non-invasiveness, and repeatability, positioning it as the most valuable tool for diagnosis and tracking. OCT can provide clear visualization of retinal layers and precise segmentation of lesion areas, facilitating the identification and quantitative analysis of abnormalities. However, the lack of high-quality datasets for assessing wet AMD has impeded the advancement of related algorithms. To address this issue, we have curated a comprehensive wet AMD OCT Segmentation Dataset (AMD-SD), comprising 3049 B-scan images from 138 patients, each annotated with five segmentation labels: subretinal fluid, intraretinal fluid, ellipsoid zone continuity, subretinal hyperreflective material, and pigment epithelial detachment. This dataset presents a valuable opportunity to investigate the accuracy and reliability of various segmentation algorithms for wet AMD, offering essential data support for developing AI-assisted clinical applications targeting wet AMD.

show abstract

Anti‐vascular endothelial growth factors treatment of wet age‐related macular degeneration: from neurophysiology to cost‐effectiveness

Cited by 5 publications

References 273 publications

Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis

Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis

Opinião: Vantagens do tratar e estender como regime de utilização dos anti-VEGF para DMRI

AMD-SD: An Optical Coherence Tomography Image Dataset for wet AMD Lesions Segmentation

Contact Info

Product

Resources

About