Jordi Monés1, Rishi P Singh2, Francesco Bandello3, Eric Souied4, Xin Liu5, Richard Gale6,7. 1. Institut de la Màcula and Barcelona Macula Foundation, Barcelona, Spain, jmones@institutmacularetina.com. 2. Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA. 3. Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy. 4. Department of Ophthalmology, Hopital Intercommunal de Creteil, Creteil, France. 5. Novartis Pharma AG, Basel, Switzerland. 6. Department of Ophthalmology, York Teaching Hospital's NHS Foundation Trust and Department of Health Sciences, University of York, York, United Kingdom. 7. York Teaching Hospitals, York, United Kingdom.
Abstract
PURPOSE: To assess the gap between visual acuity (VA) outcomes with anti-vascular endothelial growth factor (anti-VEGF) therapies in clinical trials and real-world practice, and explore the reasons for this gap. METHODS: The literature was searched from January 1, 2013, to June 30, 2018, for studies reporting VA gains and injection frequencies in clinical trials and real-world practice. RESULTS: Clinical trials of anti-VEGF agents and their extension studies demonstrated initial VA gains maintained at 4 years and beyond (up to 7 years) with continuous proactive treatment. Visual outcomes correlated with injection frequency. In real-world practice, patients are usually undertreated, accounting for the VA decline over time. Reasons for undertreatment include the burden of injections and monitoring visits imposed on patients/caregivers. However, another primary reason is the general mindset in the ophthalmological community that sustained benefits with treatment are not possible, leading to poor compliance and creating a vicious circle. CONCLUSIONS: Initial VA gains can be maintained with more intensive/proactive approaches. Promising new treatments requiring less frequent injections/monitoring will help in the near future; meanwhile, better results could be achieved by changing the community mindset that contributes to undertreatment.
PURPOSE: To assess the gap between visual acuity (VA) outcomes with anti-vascular endothelial growth factor (anti-VEGF) therapies in clinical trials and real-world practice, and explore the reasons for this gap. METHODS: The literature was searched from January 1, 2013, to June 30, 2018, for studies reporting VA gains and injection frequencies in clinical trials and real-world practice. RESULTS: Clinical trials of anti-VEGF agents and their extension studies demonstrated initial VA gains maintained at 4 years and beyond (up to 7 years) with continuous proactive treatment. Visual outcomes correlated with injection frequency. In real-world practice, patients are usually undertreated, accounting for the VA decline over time. Reasons for undertreatment include the burden of injections and monitoring visits imposed on patients/caregivers. However, another primary reason is the general mindset in the ophthalmological community that sustained benefits with treatment are not possible, leading to poor compliance and creating a vicious circle. CONCLUSIONS: Initial VA gains can be maintained with more intensive/proactive approaches. Promising new treatments requiring less frequent injections/monitoring will help in the near future; meanwhile, better results could be achieved by changing the community mindset that contributes to undertreatment.
Authors: Szilárd Kiss; Kristina Oresic Bender; Ruslan N Grishanin; Kelly M Hanna; Julio D Nieves; Pallavi Sharma; Aivan T Nguyen; Romeo J Rosario; Judith S Greengard; Claire M Gelfman; Mehdi Gasmi Journal: Transl Vis Sci Technol Date: 2021-01-29 Impact factor: 3.283
Authors: Yuichiro Ogura; Glenn J Jaffe; Chui Ming Gemmy Cheung; Gregg T Kokame; Tomohiro Iida; Kanji Takahashi; Won Ki Lee; Andrew A Chang; Jordi Monés; Divya D'Souza; Georges Weissgerber; Kinfemichael Gedif; Adrian Koh Journal: Br J Ophthalmol Date: 2021-07-22 Impact factor: 5.908