Individualized Stabilization Criteria-Driven Ranibizumab versus Laser in Branch Retinal Vein Occlusion: Six-Month Results of BRIGHTER

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• 作者：Ramin Tadayoni ; MD ; PhD¹ ; ^{ramin.tadayoni@aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Sebastian M. Waldstein ; MD² ; Francesco Boscia ; MD³ ; Heinrich Gerding ; MD⁴ ; ⁵ ; Ian Pearce ; FRCOphth⁶ ; Siegfried Priglinger ; MD⁷ ; Andreas Wenzel ; PhD⁸ ; Elizabeth Barnes ; PhD⁸ ; Margarita Gekkieva ; MD⁸ ; Stefan Pilz ; PhD⁹ ; Jordi Moné ; s ; MD ; PhD¹⁰ ; on behalf of the BRIGHTER study group^&lowast ;
• 关键词：AE ; adverse event ; BCVA ; best-corrected visual acuity ; BRAVO ; BRAnch Retinal Vein Occlusion ; Evaluation of Efficacy and Safety ; BRVO ; branch retinal vein occlusion ; CFT ; central foveal thickness ; CI ; confidence interval ; CRC ; central reading center ; CRUISE ; Ranibizumab for the Treatment of Macular Edema after Central Retinal Vein OcclUslon Study ; Evaluation of Efficacy and Safety ; CSFT ; central subfield thickness ; ETDRS ; Early Treatment Diabetic Retinopathy Study ; FAS ; full analysis set ; IRF ; in
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：123
• 期：6
• 页码：1332-1344
• 全文大小：2404 K

文摘

To compare the 6-month efficacy and safety profile of an individualized stabilization criteria–driven pro re nata (PRN) regimen of ranibizumab 0.5 mg with or without laser versus laser alone in patients with visual impairment due to macular edema secondary to branch retinal vein occlusion (BRVO).

Design

A 24-month, prospective, open-label, randomized, active-controlled, multicenter, phase IIIb study.

Participants

A total of 455 patients.

Methods

Eligible patients were randomized 2:2:1 to receive ranibizumab (n = 183), ranibizumab with laser (n = 180), or laser only (n = 92). Patients treated with ranibizumab with or without laser received a minimum of 3 initial monthly ranibizumab injections until visual acuity (VA) stabilization, and VA-based PRN dosing thereafter. In the ranibizumab with laser and laser-only groups, laser was given at the investigator's discretion at a minimum interval of 4 months and if VA was <79 letters.

Main Outcome Measures

Mean change from baseline at month 6 in best-corrected visual acuity (BCVA) (primary end point) and central subfield thickness, and safety over 6 months. Exploratory objectives were to evaluate the influence of baseline BCVA, disease duration, and ischemia on BCVA outcomes at month 6.

Results

Baseline mean BCVA was 57.7 letters, and mean BRVO duration was 9.9 months. Ranibizumab with or without laser was superior to laser only in improving mean BCVA from baseline at month 6 (14.8 and 14.8 vs. 6.0 letters; both P < 0.0001; primary end point met). Patients with a shorter BRVO duration at baseline had a higher mean BCVA gain than those with a longer BRVO duration. Patients with a poor baseline VA had a better BCVA gain than those with a higher baseline VA, although final BCVA was lower in those with poor baseline VA. In the ranibizumab with or without laser groups, the presence of some macular ischemia at baseline did not influence mean BCVA gains. There were no new ocular or nonocular safety events.

Conclusions

Ranibizumab with an individualized VA-based regimen, with or without laser, showed statistically significant superior improvement in BCVA compared with laser alone in patients with BRVO. Overall, there were no new safety events other than those reported in previous studies.