helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2019-12-2-97-105helmholtzeyeinstitute-279Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWSАнти-VEGF терапия неоваскулярной возрастной макулярной дегенерации: от рандомизированных исследований к реальной клинической практикеAnti-VEGF therapy of neovascular age-related macular degeneration: from randomized trials to routine clinical practiceФайзрахмановР. Р.FayzrakhmanovR. R.

д-р мед. наук, профессор Института усовершенствования врачей, зав. Центром офтальмотологии

105203, Москва, ул. Нижняя Первомайская, д. 70

Dr. Med. Sci., Professor at Institute for Advanced Medical Training, Head of Center for ophthalmology

70, Nizhnyaya Pervomayskaya St., 105203, Moscow

rinatrf@gmail.comФГБУ «Национальный медико-хирургический центр им. Н.И. Пирогова» Минздрава РоссииРоссияN.I. Pirogov National Medical and Surgical CenterRussian Federation20191206201912297105Copyright © Файзрахманов Р.Р., 20192019Файзрахманов Р.Р.Fayzrakhmanov R.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/279

Революционным направлением в лечении неоваскулярной возрастной макулярной дегенерации (нВМД) является антиангиогенная терапия, направленная на блокаду факторов роста новообразованных сосудов (VEGF). На данный момент для применения в офтальмологии зарегистрировано два анти-VEGF препарата, а поиск новых молекул лишь набирает обороты. В ходе изучения новых подходов к лечению и разработки инновационных препаратов современная медицина опирается на данные международных рандомизированных клинических исследований (РКИ). Подобный вектор научных интересов обоснован высокой степенью достоверности данных, получаемых в РКИ. Однако при анализе эффективности анти-VEGF терапии у пациентов с нВМД в реальной клинической практике (РКП) многие офтальмологи выявляют несоответствие ожидаемых (на основании РКИ) и получаемых «в жизни» морфофункциональных результатов. Вследствие этого важно отметить, что РКИ определяют должный идеал динамики морфофункциональных параметров, которого можно достичь лишь при правильном построении терапии в РКП. Результаты, получаемые в практике каждого специалиста, напрямую зависят от тщательности следования прописанным протоколам лечения, бремени лечения, а также потенциала самого лекарственного средства. В данном обзоре литературы представлен сравнительный анализ результатов применения анти-VEGF препаратов (ранибизумаба и афлиберцепта), полученных в ключевых РКИ, с исходами их применения в РКП по показанию нВМД.

Antivasoproliferative therapy is a revolutionary trend in the treatment of neovascular age-related macular degeneration (nAMD), as it is aimed at blocking growth factors of the newly formed vessels. Currently, two anti-VEGF drugs are registered for ophthalmological use, and the search for new molecules is only gaining momentum. Studying new approaches to treatment and developing innovative drugs, modern medicine relies on the data from international randomized clinical trials (RCT). The fact that this direction attracts much scientific interest is explained by high reliability of the data obtained with RCTs. However, when analyzing the effectiveness of anti-VEGF therapy in patients with nAMD in routine clinical practice, many ophthalmologists are confronted with discrepancies between the expected morphological and functional results as predicted by RCTs and those obtained in reality. It is thus important to bear in mind that RCTs simply determine how the dynamics of morphofunctional parameters should look like, whilst the ideal result is only achievable through correct implementation of therapeutic strategy in real clinical practice. The results obtained in the practice of any specialist wholly depend on how carefully the prescribed treatment protocols are followed by doctors and patients, how burdensome the treatment is, as well as on the potential of the medication. This literary review offers a comparative analysis of the results achieved by using anti-VEGF drugs (ranibizumab and aflibercept) obtained in key RCTs and in routine clinical treatment of nAMD patients.

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The authors declare that there are no conflicts of interest present.