Real-world cost-effectiveness of anti-VEGF monotherapy and combination therapy for the treatment of polypoidal choroidal vasculopathy

Eye ◽  
2021 ◽  
Author(s):  
Junxing Chay ◽  
Beau J. Fenner ◽  
Eric A. Finkelstein ◽  
Kelvin Y. C. Teo ◽  
Chui Ming Gemmy Cheung
Keyword(s):  
Cost Effectiveness ◽  
Combination Therapy ◽  
Real World ◽  
Polypoidal Choroidal Vasculopathy ◽  
Anti Vegf ◽  
Choroidal Vasculopathy

scholarly journals Systematic review with network meta-analysis of antivascular endothelial growth factor use in managing polypoidal choroidal vasculopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sheng-Chu Chi ◽  
Yi-No Kang ◽  
Yi-Ming Huang
Keyword(s):  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Evaluation Methodology ◽  
Combination Group ◽  
Anti Vegf ◽  
Searching Strategy ◽  
Early Combination Therapy ◽  
Choroidal Vasculopathy

AbstractPolypoidal choroidal vasculopathy (PCV) is a vision-threatening disease common in Asian populations. However, the optimal treatment for PCV remains under debate. We searched the databases with optimal searching strategy. The study included randomized clinical trials and prospective studies that recruited patients with active PCV who had received interventions, including PDT, anti-VEGF, or a combination of PDT and anti-VEGF. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used for rating the quality of evidence. Our study included 11 studies involving 1277 patients. The network meta-analysis of RCTs revealed the anti-VEGF group, early combination group, and late combination group had significant BCVA changes compared with the PDT group. Early combination therapy led to a significant decrease in CRT compared with PDT, anti-VEGF, and late combination therapy. Additionally, the early combination group had a significantly higher complete polyp regression rate than the anti-VEGF group. No significant differences were detected in the analysis of the number of anti-VEGF injections and safety profile. This network meta-analysis revealed that early combination therapy exhibited better efficacy related to anatomical outcomes than other therapies. Nonetheless, no significant differences related to BCVA change could be detected between anti-VEGF and late combination therapy.

scholarly journals CHOROIDAL VASCULARITY INDICES AND COEXISTING MORPHOLOGICAL CHANGES IN POLYPOIDAL CHOROIDAL VASCULOPATHY. A COMPARATIVE ANALYSIS BETWEEN TWO TREATMENT STRATEGIES

2021 ◽  
pp. 128-131
Author(s):  
Divya Alex
Keyword(s):  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Choroidal Thickness ◽  
Morphological Changes ◽  
Treatment Strategies ◽  
Enhanced Depth Imaging ◽  
Anti Vegf ◽  
Luminal Area ◽  
Imagej Software ◽  
Choroidal Vasculopathy

Purpose: Compare the effect of Combination therapy (PDT+Anti-VEGF) and Anti-VEGF monotherapy on choroidal vascularity indices and morphological parameters in Polypoidal Choroidal Vasculopathy (PCV). Methods: Retrospective, cohort study involving 33eyes with a diagnosis of PCV and had visible sclerochoroidal boundary on enhanced depth imaging. Cases were treated either with combination (n=17) or Anti-VEGF monotherapy (n=16). Demographic details, visual acuity assessment, OCT analysis was considered from baseline to the 3rd and 6th month follow-up visits. Choroidal vascularity analysis including choroidal thickness, Total Choroidal Surface Area (TCSA), Total Stromal area (TSA), Total Luminal Area (TLA) and Choroidal Vascularity Index (CVI) assessment were done with ImageJ software using the technique of image binarization. Results: Disease activity was significantly higher in the Anti-VEGF monotherapy arm compared to the combination therapy arm both at 3 and 6 months. When compared to baseline values, there was statistically significant decrease in choroidal thickness, Double layer sign (DLS) width, TCSA, TSA and TLA (P<0.05) in the combination therapy arm. Whereas, Anti-VEGF monotherapy arm showed an increase in the mean sub foveal choroidal thickness and DLS width at both visits. Complete collapse of PED, reduction in DLS width which was achieved only in combination therapy arm showed significant positive correlation with the resolution of the disease. CVI did not show a statistically significant reduction in both the arms. Conclusion: In view of better outer retinal and choroidal morphological changes and vascular remodelling, our study strongly supports the superiority of combination therapy over Anti-VEGF monotherapy in PCV

scholarly journals Five-year visual outcomes after anti-VEGF therapy with or without photodynamic therapy for polypoidal choroidal vasculopathy

2018 ◽  
Vol 103 (5) ◽  
pp. 617-622 ◽  
Author(s):  
Manabu Miyata ◽  
Sotaro Ooto ◽  
Kenji Yamashiro ◽  
Hiroshi Tamura ◽  
Masayuki Hata ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Fundus Photography ◽  
Combination Group ◽  
Macular Atrophy ◽  
Anti Vegf ◽  
Significant Difference ◽  
Treatment Naïve ◽  
Choroidal Vasculopathy

Background/aimsTo evaluate the 5-year visual and anatomical outcomes after anti-vascular endothelial growth factor (VEGF) therapy alone or in combination with photodynamic therapy (PDT), followed by pro re nata (PRN) anti-VEGF therapy with or without PDT, for polypoidal choroidal vasculopathy (PCV).MethodsThis retrospective, observational study included 61 consecutive patients with treatment-naïve symptomatic PCV who were followed for 5 years. Twenty eyes (20 patients) initially received PDT and intravitreal injection of ranibizumab (IVR), followed by a PRN regimen of anti-VEGF therapy with or without PDT (combination group), while 41 eyes (41 patients) initially received only IVR every 3 months, followed by a PRN regimen of anti-VEGF monotherapy (IVR group). Macular atrophy including the fovea was confirmed using colour fundus photography and spectral-domain optical coherence tomography.ResultsIn both groups, the visual acuity (VA) at 1 year was better than the baseline VA, whereas the 3-year, 4-year and 5-year VA values were similar to the baseline VA. There was no significant difference in the 5-year VA, 5-year central retinal thickness and incidence of macular atrophy between the two groups (p=0.63, 0.72 and 0.06, respectively). In the combination group, the 5-year VA was correlated with the 5-year incidence of macular atrophy (p=0.02, r=0.51).ConclusionsA PRN regimen for PCV may have a limited effect for the long-term maintenance of improved VA. Macular atrophy may occur more frequently with combination therapy and is possibly associated with the 5-year VA. Thus, combination therapy should be carefully selected for patients susceptible to macular atrophy.

scholarly journals Six-Year Real-World Outcomes of Antivascular Endothelial Growth Factor Monotherapy and Combination Therapy for Various Subtypes of Polypoidal Choroidal Vasculopathy

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Jingyuan Yang ◽  
Mingzhen Yuan ◽  
Song Xia ◽  
Youxin Chen
Keyword(s):  
Combination Therapy ◽  
Real World ◽  
Imaging Biomarkers ◽  
Visual Outcomes ◽  
Anti Vegf ◽  
Initial Combination Therapy ◽  
The Mean ◽  
Endothelial Growth Factor ◽  
Initial Combination ◽  
Choroidal Vasculopathy

The purpose of this study was to compare 6-year visual outcomes of antivascular endothelial growth factor (anti-VEGF) monotherapy and initial combination therapy of photodynamic therapy (PDT) and anti-VEGF therapy for polypoidal choroidal vasculopathy (PCV) in a Chinese population and to investigate imaging biomarkers associated with visual outcomes. Forty-eight treatment-naive PCV eyes of 46 patients were reviewed retrospectively, which underwent anti-VEGF monotherapy or initial combination therapy. PCV was classified into 2 subtypes. Mean best-corrected visual acuity (BCVA) using logarithm of minimal angle resolution and imaging morphological features was compared. No significant differences of mean BCVA changes were noticed between anti-VEGF monotherapy and combination therapy in either subtype 1 PCV or subtype 2 PCV during 6-year period (all P values >0.05). Compared with BCVA at baseline, the mean BCVA at 72 months deteriorated significantly in eyes with subtype 1 PCV (P<0.001), while the mean BCVA at 72 months remained stable in eyes with subtype 2 PCV (P=0.941). In subtype 2 PCV eyes with continuous retina pigment epithelium, the mean changes of BCVA in eyes treated with anti-VEGF monotherapy were better than those in eyes treated with combination therapy (P=0.020). Anti-VEGF monotherapy and combination therapy for various subtypes of PCV had comparable long-term visual outcomes in most cases in real world. Imaging biomarkers which correlate with visual outcomes and treatment response should be included in the classification of PCV and validated in real world.

scholarly journals Photodynamic and Anti- VEGF Therapy for Polypoidal Choroidal Vasculopathy - ‘Real World’ Outcomes in a Caucasian Population.

2021 ◽  
Author(s):  
Kenneth M. Gilmour ◽  
David Young ◽  
Aaron Jamison ◽  
Monica Precup ◽  
David F. Gilmour
Keyword(s):  
Clinical Outcomes ◽  
Real World ◽  
Polypoidal Choroidal Vasculopathy ◽  
Visual Outcome ◽  
Clinical Feature ◽  
Anti Vegf ◽  
Good Visual Outcome ◽  
Caucasian Patients ◽  
Pre Treatment ◽  
Choroidal Vasculopathy

Abstract BackgroundThe prevalence of polypoidal choroidal vasculopathy (PCV) is significantly higher amongst Asian populations compared to Caucasian, and evidence regarding the clinical outcomes of Caucasian patients is limited. This retrospective study sought to investigate real-world clinical outcomes of Caucasian PCV patients treated with polypoidal verteporfin photodynamic therapy (PDT) in combination with anti-VEGF therapy up to 36 months post treatment. MethodsConsecutive PCV patients who received PDT between 2011 and 2017 were included. Mean change in visual acuity (VA) measured by ETDRS letter score and mean change in central subfield thickness (CST) were the main outcome measures. Data was collected at baseline, 3, 12, 24 and 36 months. Regression analyses were carried out on pre-treatment clinical features to determine if there were any factors associated with a good visual outcome (better than or equal to 70 ETDRS letters at 12 months). ResultsSeventy six patients (96% Caucasian) were included in the analysis. Mean change in VA was -1, -4, and 0 ETDRS letters at 12, 24, and 36 months respectively. CST was reduced by a mean of -51, -54, and -55 microns at 12, 24, and 36 months. Better pre-treatment VA was the only pre-treatment clinical feature associated with a good visual outcome at 12 months (OR 1.16, p<0.001).ConclusionsPDT in combination with anti-VEGF therapy maintains VA and may reduce anti-VEGF therapy burden in Caucasian patients with PCV. Better pre-treatment VA is associated with a good visual outcome.

Infographic: Everest II study “Which is superior? Combination therapy or monotherapy for polypoidal choroidal vasculopathy (PCV) treatment”

Eye ◽  
2022 ◽  
Author(s):  
Chinmayi Himanshuroy Vyas ◽  
Pooi Wah Lott ◽  
Rubamalar Gunatheesan ◽  
Shaun Sebastian Sim ◽  
Christopher Ziyu Sun ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Choroidal Vasculopathy

A Multicountry Comparison of Real-World Management and Outcomes of Polypoidal Choroidal Vasculopathy

2019 ◽  
Vol 3 (3) ◽  
pp. 220-229 ◽  
Author(s):  
Kelvin Yi Chong Teo ◽  
David M. Squirrell ◽  
Vuong Nguyen ◽  
Gayatri Banerjee ◽  
Amy Cohn ◽  
...  
Keyword(s):  
Real World ◽  
Polypoidal Choroidal Vasculopathy ◽  
Choroidal Vasculopathy

scholarly journals Long-Term Follow-Up of Polypoidal Choroidal Vasculopathy Secondary to Angioid Streaks Treated by Intravitreal Aflibercept and Ranibizumab

2017 ◽  
Vol 8 (1) ◽  
pp. 221-231 ◽  
Author(s):  
James G. Wong ◽  
Katherine Yu Qian
Keyword(s):  
Polypoidal Choroidal Vasculopathy ◽  
Angioid Streaks ◽  
Case Review ◽  
Retrospective Case ◽  
Treat And Extend ◽  
Anti Vegf ◽  
Intravitreal Aflibercept ◽  
Choroidal Vasculopathy

Purpose: Angioid streaks (AS) are dehiscences in Bruch’s membrane that may be idiopathic or associated with numerous systemic illnesses. Polypoidal choroidal vasculopathy (PCV) is an underdiagnosed exudative chorioretinopathy often characterised by serosanguineous detachments of the pigmented epithelium. The use of the anti-VEGF agents ranibizumab and aflibercept in the management of PCV secondary to AS has not been previously documented. We report 3 patients with active PCV secondary to AS, 1 of which had a family history of PCV secondary to AS, not previously reported in the literature. All patients were symptomatic and treated with intravitreal anti-VEGF therapy with and without combination photodynamic therapy (PDT). Methods: This is a long-term retrospective case review of 3 eyes of 3 patients with AS and clinical features of PCV. The patients were examined using fundoscopy, spectral domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All patients were managed with intravitreal anti-VEGF using a treat-and-extend protocol according to specific retreatment criteria. One patient had 1 session of PDT in combination with anti-VEGF injections. Results: The mean follow-up time in all patients was 4 years. In all 3 cases, the treatment resulted in improved visual acuity and regression of active PCV lesions with a longer duration between injections. Conclusion: The treat-and-extend protocol with intravitreal aflibercept or ranibizumab with or without PDT is effective and safe for PCV secondary to AS.

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