Two Duke University economists looked at Medicare
beneficiaries with so-called "wet" macular degeneration and found
those diagnosed after the introduction of anti-VEGF drugs were less
likely to go blind and less likely to move into long-term care.
"At last we have found a way of managing this horrible and very
common disease among the oldest of the old," said Frank Sloan, who
led the new study.
Age-related macular degeneration (AMD) is the number one cause of
blindness in the U.S. affecting older adults, usually after age 65.
Most AMD patients have the dry form of the disease, but about 10
percent have wet AMD, which progresses more quickly than the dry
Past treatments weren't very effective at managing wet AMD, but
retinal surgeons began using injections of vascular endothelial
growth factor inhibitors, known as anti-VEGF, in the mid 2000s.
Previous clinical research has indicated that anti-VEGF treatments
are effective for wet AMD, but Sloan said those types of studies
don't let you see longer-term outcomes or how well the therapy works
in a real-world setting.
The researchers used Medicare claims information from 1994 to 2011
to examine the vision outcomes and long-term care facility
admissions of wet AMD patients who were treated with older methods
or with the new anti-VEGF drugs.
One such drug, ranibizumab (trade name Lucentis), was approved by
the U.S. Food and Drug Administration in 2006 for treating wet AMD.
A second, less expensive drug, bevacizumab (trade name Avastin), has
also been used for this purpose, but without FDA approval.
The researchers discovered that the use of anti-VEGF therapy reduced
vision loss by 41 percent and the onset of severe vision loss and
blindness by 46 percent, compared to earlier forms of treatment.
They also found that patients who received anti-VEGF were 19 percent
less likely to be admitted to long-term care facilities during a
two-year follow-up period compared to those treated before the drugs
came into use.
The findings were published in JAMA Ophthalmology.
The new treatments may be changing the way some doctors think about
[to top of second column]
"We used to say it was better to have the dry form because it
tended to be milder and slowly progressive as opposed to the wet
AMD, which has a rapid onset and much more severe vision loss," Dr.
Michael Stewart told Reuters Health.
Stewart, who chairs the ophthalmology department at the Mayo Clinic
in Jacksonville, Florida, was not involved in the new study.
Stewart said results like these actually call into question whether
or not that old statement is still true because the anti-VEGF drugs
are so effective.
"By and large, we are maintaining good vision in most people that we
treat," Stewart said.
Stewart also says the new drugs have revolutionized the way retinal
surgeons approach these patients.
He says that early diagnosis with quick initiation of treatment is
the best way of preserving vision. The typical course of treatment
is to give an injection of the drug in to the eye, about one time
per month, but treatment can be tapered to the patients' needs.
"Patients and family — and most of us, actually — think of a needle
in the eye as one of the worst medical procedures we can imagine,"
Stewart said, "but the reality is patients tolerate them very, very
well and very few patients actually forgo the treatment because of
either imagined or real pain, discomfort and anxiety."
Ophthalmology, online Jan. 23, 2014.
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