Anti-vascular endothelial growth factor in neovascular age-related macular degeneration - a systematic review of the impact of anti-VEGF on patient outcomes and healthcare systems

Autor: James S Talks, Jean-François Korobelnik, Krystallia Pantiri, Bora Eldem, Taiji Sakamoto, Joao Carrasco, Vincent Daien, Robert Finger, Tien Yin Wong, Paul Mitchell
Přispěvatelé: University of Bonn, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), The University of Sydney, Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Royal Victoria Infirmary, Newcastle upon Tyne, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Kagoshima University Graduate School of Medical and Dental Sciences, National University of Singapore (NUS)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Vascular Endothelial Growth Factor A
Visual Acuity
Angiogenesis Inhibitors
LEHA
Macular Degeneration
0302 clinical medicine
lcsh:Ophthalmology
Quality of life
Epidemiology
Medicine
030212 general & internal medicine
Depression (differential diagnoses)
education.field_of_study
Incidence (epidemiology)
General Medicine
Neovascular
3. Good health
Systematic review
Impact
Intravitreal Injections
medicine.symptom
Research Article
medicine.medical_specialty
Vision-related QoL
Cost
Visual impairment
Population
03 medical and health sciences
Ranibizumab
Internal medicine
Humans
[SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs
education
Aged
business.industry
Age-related macular degeneration
Anti-VEGF
Macular degeneration
medicine.disease
Ophthalmology
Legal blindness
lcsh:RE1-994
Quality of Life
Wet Macular Degeneration
030221 ophthalmology & optometry
[SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
business
Delivery of Health Care
Zdroj: BMC Ophthalmology
BMC Ophthalmology, BioMed Central, 2020, 20, pp.294. ⟨10.1186/s12886-020-01554-2⟩
BMC Ophthalmology, Vol 20, Iss 1, Pp 1-14 (2020)
ISSN: 1471-2415
Popis: Background Systematically review the evidence describing the impact of anti–vascular endothelial growth factor (anti-VEGF) therapy on neovascular age-related macular degeneration (nAMD) patient outcomes and healthcare resource utilization. Methods A systematic literature review was completed using Medline and EMBASE for publications prior to July 2018, and proceedings from major ophthalmology conferences (January 2016 to July 2018). The search strategy combined terms for nAMD with terms for anti-VEGF and study design. The review focused on publications describing the impact of anti-VEGF on blindness, visual impairment, vision-related quality of life (VRQoL), mortality, and costs. The search targeted data collected in epidemiological or observational studies to reflect real-world outcomes but also considered modeling-based approaches. Results The use of anti-VEGF in clinical practice was associated with significant reduction in the incidence of blindness by nAMD. Population-based analyses reported reduction in incidence among the general population of 47% (9.1 cases/100,000 in 2006 to 4.8 cases/100,000 in 2011). Among patients aged ≥50 years, a reduction of 50% was observed (52.2 cases/100,000 in 2000 to 25.7 cases/100,000 in 2010). In some cases, the odds of decreased vision (defined as decline from normal to moderate, moderate to severe, or severe to blindness) fell by 41% following introduction of anti-VEGF. Patients’ VRQoL improved with treatment, with patients reporting a positive impact shortly after treatment was initiated. Change on National Eye Institute 25-Item Visual Function Questionnaire score from baseline to month 12 ranged from 0.7 to 4.4. Although nAMD patients report signs of depression and anxiety, the evidence suggests that there is no association between the use of anti-VEGF and the prevalence or diagnosis of depression. The introduction of anti-VEGF led to increased overall treatment costs due to replacement of existing less frequently administered treatments (e.g. photodynamic therapy) and increased number of patients treated (prior to anti-VEGF, only ~ 20% of patients were eligible for treatment). Conclusions The introduction of anti-VEGF agents has been associated with a positive impact on patient-relevant outcomes, including a significant reduction in incidence of blindness and visual impairment by nAMD. Anti-VEGF agents replaced less-effective treatments, improving patient outcomes and broadening the patient population eligible for treatment.
Databáze: OpenAIRE
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