Real-Life-Evidenz zur Therapie der neovaskulären altersabhängigen Makuladegeneration in Deutschland

Zusammenfassung

Die Therapie der neovaskulären altersabhängigen Makuladegeneration (nvAMD) mit Inhibitoren des vaskulären endothelialen Wachstumsfaktors hat sich seit Einführung in Deutschland deutlich verbessert. In verschiedenen Anwendungsbeobachtungen zum Einsatz von Ranibizumab und Aflibercept in Deutschland hat sich in den letzten Jahren – parallel zur steigenden Behandlungsfrequenz – ein verbesserter Funktionsgewinn am Ende des 1. Behandlungsjahrs gezeigt. Dies spiegelt sich z. T. auch in retrospektiven Fallserien wider. Mit längeren Verlaufszeiträumen, z. B. für eine Nachbeobachtung von mehr als 3 Jahren, stellt sich trotz des initialen Visusgewinns ein zunehmender Funktionsverlust ein, sodass langfristig nur der Ausgangsvisus gehalten werden konnte. Eine Therapieverzögerung ist vor allem im ländlichen Bereich und bei einer Betreuung an verschiedenen Einrichtungen (z. B. mehreren Praxen oder Praxis und Klinik) ein Problem. Erfreulicherweise weisen hier aktuellere Auswertungen auf eine positive Entwicklung hin. Therapieverzögerung wurde reduziert, Therapie- bzw. Injektionsfrequenz erhöht und Therapieergebnisse verbessert. Dieser Trend muss sich fortsetzen, damit optimale, unter Routinebedingungen zu erreichende Therapieergebnisse in Deutschland erzielt werden.

Abstract

Treatment of neovascular age-related macular degeneration (AMD) with anti-vascular endothelial growth factor agents has been improved since its introduction in Germany. Several observational studies have demonstrated an increased frequency of injections in parallel with improved visual outcomes during the first year of treatment over the last 7 years. These results are reflected in several case series. However, studies with a longer follow-up reported that visual function regressed to baseline vision following an initial improvement, e.g. during the first three years of treatment. A delay in treatment initiation has been reported mainly for rural areas and management models involving more than one ophthalmologist or institution. Encouragingly, recent data confirm a positive trend towards reducing treatment delay, increasing injection frequency and improving treatment outcomes. Still, further improvements are needed to attain optimal treatment outcomes achievable under routine clinical conditions in Germany.

Schlüsselwörter

Real-Life-Evidenz - anti-VEGF - altersabhängige Makuladegeneration - Deutschland

Key words

real-life evidence - anti-VEGF - age-related macular degeneration - Germany

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