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Efficacy and impact of antiangiogenic therapy for neovascular ARMD

Duquette, J. (2013). Efficacy and impact of antiangiogenic therapy for neovascular age-related macular degeneration : Information monitoring summary. Longueuil : INLB. 15 pages.

Neovascular (wet) AMD is characterized by the abnormal formation of new blood vessels beneath the macula (neovascularization). These fragile vessels allow leakage of fluid or blood, leading to detached retina or hemorrhaging. The macula deteriorates and there may be rapid, severe loss of central vision.

Antiangiogenic drugs immediately reduce these fluids substantially. Eligible patients initially receive at least 3 consecutive monthly intravitreal injections. Therapy then continues on a monthly basis or as needed. Any improvement in visual acuity usually occurs during the first 3 months.

Two-year studies reveal spectacular results. With monthly injections, vision was stabilized or improved in 90 % of cases, one-third of them showing significant improvement in visual acuity (VA). However, some 10 % of patients continued to experience vision loss. On the other hand, very few people who remained untreated showed significant improvement in VA, and nearly half would deteriorate. After 2 years, treated patients had markedly better vision than untreated individuals.

Many people who are treated recover VA of at least 6/12. One study found that this proportion rose from 35 % before therapy to 63 % post therapy, while another study showed it increased from 15 % to 42 %. Moreover, the rate of severe visual impairment remained stable in treated individuals but increased in the untreated group.

Treatment efficacy appears to diminish somewhat over time. One research study covered a 4-year period. Compared to the results of 2-year studies, barely half as many subjects experienced visual gains (17 %), while nearly twice as many experienced a loss in VA (23 %). At the end of the 4th year, for various reasons, 45 % of subjects were no longer being treated.

In patients with better baseline VA, treatment is more likely to be successful. However, many factors may render early treatment or continued therapy difficult (e.g. shortage of trained ophthalmologists; increasingly low ratio of ophthalmologists to population; long distance between patient’s home and medical institution; poor health; the patient’s or family’s lack of knowledge about AMD and its consequences).

Sujets : Dégénérescence maculaire; Thérapeutique; Personne âgée

Type de document : Recension des écrits

Aussi disponible en français sous le titre : L’efficacité et l’impact des traitements antiangiogéniques de la dégénérescence maculaire liée à l’âge de forme humide

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