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要約 目的:維持期加療中にラニビズマブバイオシミラー硝子体内注射(IVRBS)へ切り替えを施行した新生血管型加齢黄斑変性症(nAMD)の12か月治療成績を報告する。
対象と方法:千葉大学医学部附属病院でアフリベルセプト(IVA)およびラニビズマブ(IVR)のtreat and extend加療中のnAMD症例のうち,2022年12月〜2023年4月の間にIVRBSに切り替え,12か月経過を追えた22例24眼(男性18例19眼)を対象として後ろ向きに検討した。切り替え時(BL),6か月後(6M)および12か月後(12M)の視力,中心窩網膜厚(CFT),滲出性変化,投与間隔・回数について検討した。
結果:切り替え時の平均年齢は77.4歳,病型はType 1 MNV 3眼,Type 2 5眼,Type 3 4眼,PCV 12眼であった。視力(logMAR)はBL 0.33±0.44,6M 0.37±0.49,12M 0.31±0.40であり,CRT(μm)はBL 209±65,6M 232±118,12M 203±78でありともに有意差はなかった。12か月時点での平均投与間隔は11.5±3.0週,平均投与回数(1年)は5.4±0.8であり,黄斑ドライは17眼(71%)で得られていた。12か月時点までに他剤へ変更した症例は8眼(33%)認め,変更の理由はすべてで滲出性病変の悪化であった。
結論:IVRBSへの切り替え後12か月において視力および網膜厚の維持が可能であった。
Abstract Purpose:To assess the 12-month(12M)treatment outcomes of patients with neovascular age-related macular degeneration(nAMD)who switched to intravitreal injections of ranibizumab biosimilars(IVRBS)during the maintenance phase.
Subjects and Methods:Twenty-four eyes of 22 patients with nAMD whose treatment protocol was switched from intravitreal injections of aflibercept(IVA)or ranibizumab(IVR)to IVRBS using a treat-and-extend(TAE)regimen at Chiba University Hospital between December 2022 and April 2023 were included in this retrospective study. The best-corrected visual acuity(BCVA), number of injections, treatment intervals, and dry macula rate were recorded during the 12M follow-up period. Optical coherence tomography was performed to measure the central foveal thickness(CFT)and central choroidal thickness(CCT).
Results:The mean age at the time of switching(baseline;BL)was 77.4 years. The nAMD subtypes were as follows:type 1 MNV, three eyes;type 2, five eyes;type 3, four eyes;and polypoidal choroidal vasculopathy, 12 eyes. The BCVA(logMAR)at BL, 6 months(6M), and 12M was 0.33±0.44, 0.37±0.49, and 0.31±0.40, respectively, indicating no significant differences. The CRT(μm)at BL, 6M, and 12M was 209±65, 232±118, and 203±78, respectively, indicating no significant differences. The mean treatment interval and number of injections at 12M were 11.5±3.0 weeks and 5.4±0.8, respectively. Dry maculae were observed in 17 eyes(71%). Eight eyes(33%)were switched to alternative agents within 12 months owing to worsening exudative changes.
Conclusions:Switching to IVRBS facilitated the maintenance of visual acuity and retinal thickness over 12 months.

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