Un nuovo studio pubblicato sulla prestigiosa rivista Retina conferma l’effetto protettivo dei beta bloccanti usati per via sistemica nella gestione della maculopatia essudativa trattata con iniezioni intravitreali di Avastin. I beta bloccanti sono diffusamente usati in cardiologia per l’ipertensione arteriosa o per le aritmie. I ricercatori hanno dimostrato che i pazienti in terapia sistemica con questi agenti avevano bisogno di un minor numero di iniezioni intravitreali per controllare la malattia (5.2 contro 7.9), rispetto a coloro che facevano uso di altre categorie di farmaci.
Montero, Javier A. MD, PhD*; Ruiz-Moreno, Jose M. MD, PhD†,‡; Sanchis-Merino, Eugenia MD§; Perez-Martin, Santiago MD
March 2013 – Volume 33 – Issue 3 – p 508–512
Purpose: To evaluate the effect of concomitant systemic therapy in patients with choroidal neovascularization secondary to age-related macular degeneration (AMD) treated by intravitreal bevacizumab and to propose a mechanism for different interindividual response.
Methods: Retrospective, nonrandomized, single-center, consecutive interventional case series study. Forty-six eyes from 46 patients with choroidal neovascularization secondary to age-related macular degeneration were treated by monthly intravitreal 1.25 mg bevacizumab injections on a pro re nata regime. Patients’ files were revised and changes in Early Treatment Diabetic Retinopathy Study best-corrected visual acuity, central foveal thickness as determined by spectral domain optical coherence tomography, number of injections performed, occurrence of severe adverse effects, and systemic concomitant medication were recorded. The effect of systemic medication on final best-corrected visual acuity, central foveal thickness, and number of injections performed was evaluated.
Results: The most frequent systemic medications recorded were angiotensin-converting-enzyme inhibitors in 19 patients, beta-adrenergic blocking agents (n = 18), nonsteroidal antiinflammatory drugs (n = 17), diuretics (n = 16), calcium channel blockers (n = 14), benzodiazepines (n = 11), proton-pump inhibitors (n = 9), and statins (n = 8). Thirty-two patients had arterial hypertension. Average follow-up was 25.1 months (standard deviation [SD] = 8.9). Average gain in best-corrected visual acuity was 0.9 (SD = 13.6) and −2.1 letters (SD = 15.9) at 12 months and 24 months, respectively. The average reduction in central foveal thickness was 111 μm (SD = 54) and 105 μm (SD = 71) at 12 months and 24 months, respectively. The average number of intravitreal injections required was 6.7 (SD = 3.2). Patients on treatment with systemic beta-adrenergic blocking agents required less intravitreal injections (5.2, SD = 2.4 vs. 7.9, SD = 3.4) and this difference was statistically significant (P = 0.0068, multiple linear regression).
Conclusion: Concomitant systemic beta-adrenergic blocking agents treatment may reduce the need for repeated intravitreal injections of bevacizumab in patients with choroidal neovascularization associated with age-related macular degeneration.