Wydanie specjalne czerw 2018
str. 16 - 20
Terapia ranibizumabem jako alternatywa u pacjentów objętych Programem Lekowym leczenia wysiękowej postaci zwyrodnienia plamki związanego z wiekiem niereagujących na terapię afliberceptem
Ranibizumab Therapy as an Alternative in Patients Participating in Drug Prescription Program in Neovascular Age-related Macular Degeneration not Responding to Primary Therapy with Aflibercept
Dorota Kaczmarek 1 , Marta Dembowska 1 , Maria Pomorska 2 , Radosław Kaczmarek 1,2
1 Ośrodek Okulistyki Klinicznej Spektrum we Wrocławiu
Kierownik: prof. dr hab. n. med. Maria H. Niżankowska
2 Katedra i Klinika Okulistyki Wrocławskiego Uniwersytetu Medycznego
Kierownik: prof. dr hab. n. med. Marta Misiuk-Hojło
Summary: Purpose: To evaluate efficacy and safety of ranibizumab switch in patients treated for neovascular age-related macular degeneration not responding to primary aflibercept therapy.
Material and Methods: Retrospective study of patients treated according to protocol described in Drug Prescription Programme in neovascular age-related macular degeneration. First line therapy was aflibercept but in subgroup of patients due to unsatisfactory response the treatment was changed to ranibizumab (according to the treatment protocol). Best corrected visual acuity and central retinal thickness were assesed at consecutive time points: at the qualification (T1), after first aflibercept injection (T2), after aflibercept loading dose (T3), at the switch (T3a), after ranibizumab loading dose (T3b), end follow-up (T4). The results were statistically anaysed.
Results: Treatment results of fifty eight patients (sixty five eyes) were analysed. Therapy switch was ordained in thirteen cases (twelve patients). At the initial phase we observed positive results both anatomically and functionally (T2) but in a subgroup of patients the results deteriorated during the course – hence the decision to change therapy to ranibizumab. This decision resulted in statistically significant improvement in central retinal thickness at time-points T3b and T4; in these time-points we observed no statistically significant worsening of best corrected-visual acuity.
Discussion: Most publications analyses switch from ranibizumab to aflibercept or from bevacizumab to ranibizumab/ aflibercept. Here we present results of so called “Lucentis switch” in neovascular age-related macular degeneration cases refractory to aflibercept. After the switch we managed to obtain statistically significant morphological improvement which is concurrent with results from other publications.
Conclusions: Change of treatment (switch) should be individually considered in every patient refractory to first-line therapy after careful analysis of possible reasons for the non-response. Switch to ranibizumab, after initial treatment with aflibercept seems to be a promising option in such cases.
Słowa kluczowe: ranibizumab, aflibercept, zmiana terapii, wysiękowa postać zwyrodnienia plamki związanego z wiekiem (nAMD), brak odpowiedzi na terapię.
Keywords: ranibizumab, aflibercept, switch, neovascular age-related macular degeneration (nAMD), non-responders.