Effectiveness of Current Treatments for Wet Age-Related Macular Degeneration in Japan: A Systematic Review and Pooled Data Analysis

Abstract

Purpose We conducted a systematic review to investigate the effectiveness of clinical treatments for wet age-related macular degeneration (wAMD) in Japanese patients in the decade since anti-vascular endothelial growth factor (VEGF) therapies were introduced. Methods PubMed was searched for articles published in English between 1 January 2008 and 30 September 2018 using a multistring search strategy. Reviews were scanned for additional relevant studies and select gray literature was evaluated. Mean and/or median for the logarithm of the minimum angle of resolution (logMAR) visual acuity (VA), central retinal thickness (CRT), and the number of injections after 12 months of treatment were calculated using extracted data. Data were stratified by disease type and treatment modality. Results Of 335 studies identified, 94 were selected for data extraction (147 treatment arms; typical AMD, n = 25; polypoidal choroidal vasculopathy [PCV], n = 85). Mean (median) logMAR VA was 0.44 (0.32) for typical AMD and 0.34 (0.31) for PCV; the respective mean number of anti-VEGF injections was 5.6 and 4.6. The mean CRT was approximately 220 μm for both groups. For typical AMD, anti-VEGF monotherapy resulted in better VA outcomes than photodynamic therapy (PDT) alone. For PCV, anti-VEGF monotherapy or anti-VEGF plus PDT combination therapy resulted in better VA and CRT outcomes than PDT monotherapy. Combination therapy required fewer injections than anti-VEGF monotherapy (PCV, 3.2 versus 5.3). Conclusion wAMD treatment has advanced dramatically in the years since anti-VEGF drugs were introduced in Japan. Discrete patient populations may benefit from differing management regimens, including the fewer injections required with combination therapy.

Determination of Vascular Endothelial Growth Factor-B Concentrations in Aqueous Humor and Plasma of Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy Patients Before and After Anti-VEGF Therapy

“…We speculated that it might be limited by the small sample size, and larger sample sizes in further research might amplify statistical differences significantly. In the present study, the decrease in CRT in both groups proved to be effective for the treatment with anti-VEGF drugs, consistent with previous studies [32][33][34]. At the same time, the CRT had significantly statistical difference between the nAMD group and PCV group at baseline, and the CRT in nAMD remained thinner than in PCV after treatment; thus, we hypothesized that CRT might help to distinguish PCV from nAMD.…”

Long-Term Prognosis of Patients with Polypoidal Choroidal Vasculopathy Treated with Photodynamic Therapy

“…IVR injections were administered 5.2 times at 12 months. Takahashi et al [17] systematically reviewed the effectiveness of clinical treatments for NV, that is AMD in Japanese patients, and analyzed various parameters of typical AMD and PCV after one year of treatment. They reported that, in the group treated with anti-VEGF plus PDT, the BCVA changed from 0.51 to 0.32 (logMAR units), the CRT changed from 364 µm to 189 µm, and additional treatments with anti-VEGF was administered 3.2 times.…”

Cost of Ranibizumab Port Delivery System vs Intravitreal Injections for Patients With Neovascular Age-Related Macular Degeneration

“…Sood et al 4 investigate the costs of the ranibizumab PDS and compare them with intravitreal injections of ranibizumab, bevacizumab, and aflibercept for neovascular agerelated macular degeneration (AMD). In their cost analysis, the authors show the ranibizumab PDS with refills every 6 months offers marginal cost savings compared with monthly injec-tions of intravitreal ranibizumab and aflibercept.…”

“…Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in individuals older than 50 years in industrialized countries; by 2040, 288 million people worldwide will have AMD . While neovascular AMD (nAMD) is only responsible for 10% to 15% of AMD cases, it caused 90% of AMD–related visual impairment before the introduction of anti–vascular endothelial growth factor (VEGF) drugs . Late atrophic AMD does not have adequate therapeutic options and is leading to increasing visual impairment comparatively .…”

“…1,2 While neovascular AMD (nAMD) is only responsible for 10% to 15% of AMD cases, it caused 90% of AMD-related visual impairment before the introduction of anti-vascular endothelial growth factor (VEGF) drugs. 3,4 Late atrophic AMD does not have adequate therapeutic options and is leading to increasing visual impairment comparatively. 5 Anti-VEGF drugs have reduced AMDattributed blindness by approximately 50% to 72%.…”