Bis zur Einführung der intravitrealen Anti-VEGF-Therapie im Jahr 2006 war eine langfristige
Visusverbesserung mit den bis dahin bestehenden Behandlungsmethoden nicht erreicht
worden. Dieser Beitrag gibt einen Überblick über die gegenwärtigen Behandlungsmethoden
der frühen und intermediären altersbedingten Makuladegeneration (AMD), der exsudativen
AMD und den therapeutischen Ansätzen bei geografischer Atrophie.
Abstract
Currently, intravitreal anti-VEGF therapy is the only way to maintain function with
continuous monitoring in neovascular AMD. Several robust morphological biomarkers,
such as intraretinal and subretinal fluid, are important to guide treatment decisions
at baseline and during the course of the disease. Higher concentrations of anti-VEGF
agents and the development of bispecific antibodies combining anti-VEGF and anti-angiopoietin-2
antibodies have been shown to prolong the duration of action in pivotal trials. In
particular, a longer duration of action may improve patient adherence by reducing
the treatment burden. Several ranibizumab biosimilars are also approved and available
for the treatment of neovascular AMD. In addition, bevacizumab is now approved in
its originator form for the treatment of neovascular AMD in Europe. For the treatment
of geographic atrophy, the intravitreal complement inhibitors approved in the US are
not approved in Europe. With these drugs, continuous
monthly or bimonthly injections were associated with significantly slower growth of
the atrophic area in registration studies. Visual function after two years of treatment
showed no difference compared to untreated eyes. In a post-hoc analysis of the largest
supplementation studies AREDS and AREDS2, a significantly slower increase in RPE atrophy
from the atrophic edge to the fovea was observed compared to placebo (AREDS [n = 208]:
p = 0.012; AREDS2 [n = 392]: p = 0.011). This effect needs to be confirmed in controlled
randomised trials.
Schlüsselwörter
Neovaskuläre AMD - Anti-VEGF-Therapie - morphologische Biomarker - geographische Atrophie
- Komplementinhibitoren
