Real-world Study on Anti-VEGF Combination Therapy for wAMD
OBJECTIVE To evaluate the efficacy differences in treating wet age-related macular degeneration(wAMD)using real-world data on anti-VEGF combination therapy regimens.METHODS This study included medical records from 55 patients(62 eyes)with wAMD treated at Xiyuan Hospital,China Academy of Chinese Medical Sciences,from November 2020 to March 2023.The patients were divided into three groups based on the type and pattern of anti-VEGF injections:The monoclonal antibody group(16 eyes,treated with ranibizumab alone),the fusion protein group(24 eyes,treated with aflibercept/conbercept alone),and the combination group(22 eyes,treated with ranibizumab and aflibercept/conbercept).The best-corrected visual acuity(BCVA),intraocular pressure(IOP),and central macular thickness(CMT)were measured before treatment and at 14 days,one,three,six,12,18,and 24 months after treatment,along with the frequency of injections.Data were recorded and statistically analyzed.RESULTS(1)BCVA:In the monoclonal antibody group,fusion protein group,and combination group,BCVA improved significantly at all time points compared to before treatment(monoclonal antibody group:t14 d=4.597,t1 mon=6.464,t3 mon=4.690,t6 mon=4.148,t12 mon=4.291,t18 mon=4.636,t24 mon=5.429,all P=0.000;Fusion protein group:t14 d=4.048,t1 mon=5.132,t3 mon=5.817,t6 mon=6.528,t12 mon=7.700,t18 mon=8.625,t24 mon=8.855,all P=0.000;Combination group:t14 d=4.909,t1 mon=6.887,t3 mon=5.608,t6 mon=6.560,t12 mon=7.219,t18 mon=7.987,t24 mon=8.639,all P=0.000).There were no statistically significant differences in BCVA between the three groups at three,six,and 12 months after treatment(P>0.05).However,the fusion protein group at 18 months(t=2.265,P=0.027)and the combination group at 18 and 24 months(t18 mon=2.378,P=0.020;t24 mon=2.235,P=0.029)had significantly higher BCVA than the monoclonal antibody group.There were no statistically significant differences in BCVA between the fusion protein group and the combination group(P>0.05).(2)IOP:There were no statistically significant differences in IOP within or between the three groups before and after treatment(all P>0.05).(3)CMT:In the monoclonal antibody group,fusion protein group,and combination group,CMT decreased significantly at several time points compared to before treatment(monoclonal antibody group:t14 d=3.590,t1 mon=3.744,both P=0.000;t3 mon=3.497,P=0.001;t12 mon=2.080,P=0.042;t18 mon=3.009,P=0.004;t24 mon=2.948,P=0.005.Fusion protein group:t12 mon=2.331,P=0.023;t18 mon=3.259,P=0.002;t24 mon=3.480,P=0.001;combination group:t14 d=4.034,t1 mon=4.015,t12 mon=4.213,t18 mon=5.014,t24 mon=5.380,all P=0.000;t3 mon=2.874,P=0.006;t6 mon=2.915,P=0.005).There were no statistically significant differences in CMT among the three groups at 14 days,one month,three months,and six months after treatment(P>0.05).However,at 12,18,and 24 months after treatment,the combination group had significantly lower CMT compared to the monoclonal antibody group(t12 mon=2.178,P=0.033;t18 mon=2.235,P=0.029;t24 mon=2.720,P=0.009),while there were no significant differences between the monoclonal antibody group and the fusion protein group(P＞0.05).(4)Anti-VEGF Injection Frequency:There were statistically significant differences in the mean injection frequency among the three groups(H=12.644,P=0.002).The combination group had a significantly lower mean injection frequency than the monoclonal antibody group and the fusion protein group(tMAG=3.410,P=0.001;tFPG=2.488,P=0.007),while there was no significant difference between the monoclonal antibody group and the fusion protein group(P>0.05).CONCLUSIONS The combination of monoclonal antibody and fusion protein anti-VEGF therapies not only provides early and rapid improvement in vision and reduction in macular edema but also offers sustained and stable therapeutic effects in the mid-to-late stages,with the added benefit of reducing the number of injections required.
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