International clinical researchers led by the University of Bonn, Germany, have published results of a significant anti-VEGF systematic review and meta-analysis impacting nAMD patient outcomes and healthcare. Anti-VEGF agents (aflibercept, ranibizumab, bevacizumab and pegaptanib) have been associated with a positive impact on patient 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.
Researchers have previously outlined that AMD is responsible for 5% of the blindness cases registered worldwide and the total healthcare expenditure for managing AMD-related visual impairment has surpassed $343 billion. The current systematic review for nAMD treatment was conducted by professional searches in relevant Medline and EMBASE databases, including the European Society of Retina Specialists (EURETINA), which collected a total of 2,735 medical articles. From the research analysis, there was a reduction in incidence of anti-VEGF treatments among the general population of 47% (going from 9.1 cases/100,000 in 2006 to 4.8 cases/100,000 in 2011). Studies for meta-analysis showed the impact of anti-VEGF therapy on vision-related outcomes, including blindness, other vision impairment outcomes, and the ability to drive. Four studies were on patients’ overall quality of life (QoL), six studies on the depression or anxiety, nine studies on the risk for mortality, myocardial infarction, or stroke and thirteen studies on the impact of anti-VEGF therapy on costs. In the results, 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’ vision-related quality of life (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. While nAMD patients report signs of depression and anxiety, the evidence indicated that there is no association between the use of anti-VEGF and the prevalence or diagnosis of depression. Finally, the study also showed that 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).
In summary, the systematic review and analysis provided a clear association between the introduction of anti-VEGF treatment and the reduction in the incidence of blindness by nAMD. Concluding the study, researchers commented that “to our knowledge, this is the first study to investigate the societal impact of anti-VEGF treatment for nAMD and cover visual outcomes, QoL, and economic cost. The principal strength of this SLR is the use of systematic methods to standardize the selection of studies and the extraction of data. Relevant publications referenced in any identified reviews and meta-analyses were also screened to ensure a comprehensive review”.