Подходы к назначению антиангиогенных препаратов при терапии пациентов с неоваскулярной возрастной макулярной дегенерацией

Возрастная макулярная дегенерация (ВМД) — хроническое прогрессирующее заболевание, являющееся основной причиной инвалидности по зрению среди пациентов старшей возрастной группы в индустриально развитых странах. При этом наибольшим риском потери зрения характеризуется неоваскулярная ВМД. Стандартом терапии этого заболевания в настоящее время признано интравитреальное введение ингибиторов ангиогенеза. Показано, что применение ингибиторов ангиогенеза позволяет добиться стабилизации зрительных функций в более чем 90 % случаев и улучшения зрения на 3 строки и более (15 букв по шкале ETDRS) у 30–40 % пациентов. Тем не менее результаты наблюдательных исследований свидетельствуют о существовании барьеров, препятствующих эффективному проведению антиангиогенной терапии в условиях рутинной клинической практики. Одним из возможных путей преодоления данных барьеров является поиск оптимального режима назначения ингибиторов ангиогенеза, позволяющего уменьшить число необходимых инъекций без потери терапевтической эффективности. В обзоре рассмотрена текущая доказательная база, посвященная принципам назначения антиVEGF препаратов при лечении пациентов с неоваскулярной ВМД, проанализированы используемые в практике режимы дозирования с учетом их преимуществ и недостатков.

возрастная макулярная дегенерация, антиангиогенная терапия, ингибиторы ангиогенеза, анти-VEGF, афлиберцепт, ранибизумаб, режимы дозирования, режим «по необходимости», «лечить и увеличивать интервал», «лечи и продлевай»

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