- United Kingdom
- Inflammation, Clinical Trials, Diabetic Retinopathy, Optical coherence tomography, Age-related Macular Degeneration, Ophthalmology, and 9 moreMedical Imaging, Oxidative Stress, Nanotechnology, Cataract (Ophthalmology), Retina (Ophthalmology), Glaucoma, Visual Psychophysics, Peripheral Visual Processing, and Perimetryedit
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In Europe, healthcare systems differ between countries and different factors may influence Chronic hepatitis B (CHB) treatment choices in different counties. This analysis from a prospective, longitudinal, non‐interventional study in five... more
In Europe, healthcare systems differ between countries and different factors may influence Chronic hepatitis B (CHB) treatment choices in different counties. This analysis from a prospective, longitudinal, non‐interventional study in five EU countries aimed to explore determinants associated with treatment initiation or switch in patients with CHB. A total of 1267 adult patients with compensated CHB in Germany, France, Poland, Romania and Turkey were prospectively followed for up to 2 years (March 2008–December 2010). Determinants of treatment initiation or switch were analysed using multivariate Cox proportional hazards regression. Median time since CHB diagnosis was 2.6 (0–37.7) years. Among 646 treatment‐naïve patients, the probability of treatment initiation during follow‐up was higher: in Germany (P = 0.0006), Poland (P < 0.0001) and Romania (P = 0.0004) compared with Turkey; in patients with alanine transaminase (ALT) 1–2 × upper limit of normal (ULN) (P = 0.0580) or >2 × ULN (P = 0.0523) compared with ALT ≤1 × ULN; and in patients with hepatitis B virus (HBV) DNA ≥2000 IU/mL (P < 0.0001) compared with HBV DNA <2000 IU/mL or undetectable. Among 567 treated patients, 87 switched treatment during follow‐up. The probability of treatment switch was higher: in France (P = 0.0029), Germany (P = 0.0078) and Poland (P = 0.0329) compared with Turkey; and in patients with HBV DNA <2000 (P < 0.0001) or ≥2000 IU/mL (P < 0.0001), compared with undetectable. Viral load and ALT level were identified as the major drivers of treatment initiation. HBV DNA level was also a significant determinant of treatment switch. Results were statistically different across EU countries.
Research Interests: Geography, Medical Microbiology, Adolescent, Medicine, Prospective studies, and 15 moreHumans, Internal Medicine, Europe, Female, Viral hepatitis, Male, Clinical Sciences, Aged, Middle Aged, Longitudinal Studies, Adult, Hepatitis B virus, Antiviral Agents, Alanine Transaminase, and Chronic hepatitis
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Research Interests: Ophthalmology, Optical coherence tomography, Medicine, Applied Economics, Adhesion, and 15 moreBiological Sciences, Humans, Low vision, Diabetic Retinopathy, Female, Male, Clinical Sciences, Middle Aged, Degeneration, Macular Hole, Medicine and Health Sciences, Neurosciences, Intravitreal Injections, Medical and Health Sciences, and Macula lutea
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ABSTRACT Purpose: To discuss the pathophysiology of metamorphopsia, its characterisation using retinal imaging and methods of assessment of patient symptoms and visual function. Methods: A literature search of electronic databases was... more
ABSTRACT Purpose: To discuss the pathophysiology of metamorphopsia, its characterisation using retinal imaging and methods of assessment of patient symptoms and visual function. Methods: A literature search of electronic databases was performed Results: Metamorphopsia has commonly been associated with vitreomacular interface disorders (such as epiretinal membrane) and has also regularly been noted in diseases of the retina and choroid, particularly age-related macular degeneration and central serous chorioretinopathy. Developments in optical coherence tomography retinal imaging have enabled improved imaging of the foveal microstructure and have led to the localisation of the pathophysiology of metamorphopsia within the retinal layers of the macula. Alteration of alignment of inner and outer retinal layers at various retinal loci has been identified using multimodal imaging in patients with metamorphopsia in a range of conditions. Although the Amsler Grid assessment of metamorphopsia is a useful clinical indicator, new emerging methods of metamorphopsia assessment with psychophysical tests such as M-CHARTS and preferential hyperacuity perimetry, have been developed. Conclusions: It appears that there is a complex relationship between visual acuity and metamorphopsia symptoms that vary between retinal conditions. Although metamorphopsia has traditionally been challenging to measure in the clinic, advances in technology promise more robust, easy-to-use tests. It is possible that home assessment of metamorphopsia, particularly in conditions such as age-related macular degeneration, may help to guide the need for further clinic evaluation and consideration of treatment.
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Introduction: We aimed to quantify patients' and physicians' preferences for therapeutic trade-offs involving the efficacy, side-effect risks, and evidence uncertainty in chronic hepatitis B (CHB) treatments. Materials and... more
Introduction: We aimed to quantify patients' and physicians' preferences for therapeutic trade-offs involving the efficacy, side-effect risks, and evidence uncertainty in chronic hepatitis B (CHB) treatments. Materials and Methods: Physicians who treat CHB patients and adult patients with a self-reported physician diagnosis of CHB completed a web-enabled, discrete-choice experiment survey in Turkey. Both patients and physicians answered 12 treatment-choice questions. Each question required evaluating a pair of hypothetical CHB medication profiles defined by the years the medicine has been studied (weight of evidence), probability that the patient's viral load remains undetectable for five years with possible reversal of disease progression (efficacy), five-year treatment-related risks of a fracture and renal insufficiency, and monthly medication cost. Logit models were used to estimate preference weights for all attribute levels and the profile preference scores for thre...
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ABSTRACT Purpose: To discuss the pathophysiology of metamorphopsia, its characterisation using retinal imaging and methods of assessment of patient symptoms and visual function. Methods: A literature search of electronic databases was... more
ABSTRACT Purpose: To discuss the pathophysiology of metamorphopsia, its characterisation using retinal imaging and methods of assessment of patient symptoms and visual function. Methods: A literature search of electronic databases was performed Results: Metamorphopsia has commonly been associated with vitreomacular interface disorders (such as epiretinal membrane) and has also regularly been noted in diseases of the retina and choroid, particularly age-related macular degeneration and central serous chorioretinopathy. Developments in optical coherence tomography retinal imaging have enabled improved imaging of the foveal microstructure and have led to the localisation of the pathophysiology of metamorphopsia within the retinal layers of the macula. Alteration of alignment of inner and outer retinal layers at various retinal loci has been identified using multimodal imaging in patients with metamorphopsia in a range of conditions. Although the Amsler Grid assessment of metamorphopsia is a useful clinical indicator, new emerging methods of metamorphopsia assessment with psychophysical tests such as M-CHARTS and preferential hyperacuity perimetry, have been developed. Conclusions: It appears that there is a complex relationship between visual acuity and metamorphopsia symptoms that vary between retinal conditions. Although metamorphopsia has traditionally been challenging to measure in the clinic, advances in technology promise more robust, easy-to-use tests. It is possible that home assessment of metamorphopsia, particularly in conditions such as age-related macular degeneration, may help to guide the need for further clinic evaluation and consideration of treatment.
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SUMMARY Introduction: We aimed to quantify patients' and physicians' preferences for therapeutic trade-offs involving the efficacy, side-effect risks, and evidence uncertainty in chronic hepatitis B (CHB) treatments. Materials and... more
SUMMARY Introduction: We aimed to quantify patients' and physicians' preferences for therapeutic trade-offs involving the efficacy, side-effect risks, and evidence uncertainty in chronic hepatitis B (CHB) treatments. Materials and Methods: Physicians who treat CHB patients and adult patients with a self-reported physician diagnosis of CHB comp- leted a web-enabled, discrete-choice experiment survey in Turkey. Both patients and physicians answered 12 treatment-choice questi- ons. Each question required evaluating a pair of hypothetical CHB medication profiles defined by the years the medicine has been stu- died (weight of evidence), probability that the patient's viral load remains undetectable for five years with possible reversal of disease progression (efficacy), five-year treatment-related risks of a fracture and renal insufficiency, and monthly medication cost. Logit models were used to estimate preference weights for all attribute levels and the profile preference s...
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Aim: Evaluate the cost–effectiveness of ocriplasmin in symptomatic vitreomacular adhesion (VMA) with or without full-thickness macular hole ≤400 μm versus standard of care. Methods: A state-transition model simulated a cohort through... more
Aim: Evaluate the cost–effectiveness of ocriplasmin in symptomatic vitreomacular adhesion (VMA) with or without full-thickness macular hole ≤400 μm versus standard of care. Methods: A state-transition model simulated a cohort through disease health states; assignment of utilities to health states reflected the distribution of visual acuity. Efficacy of ocriplasmin was derived from logistic regression models using Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole trial data. Model inputs were extracted from Phase III trials and published literature. The analysis was conducted from a US Medicare perspective. Results: Lifetime incremental cost–effectiveness ratio was US$4887 per quality-adjusted life year gained in the total population, US$4255 and US$10,167 in VMA subgroups without and with full-thickness macular hole, respectively. Conclusion: Ocriplasmin was cost effective compared with standard of care in symptomatic VMA.
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To assess the effect of ocriplasmin on visual function response (VFR) measured using visual acuity (VA) and vision-related quality of life, and to quantify the association between release of vitreomacular adhesion (VMA) at day 28 and VFR.... more
To assess the effect of ocriplasmin on visual function response (VFR) measured using visual acuity (VA) and vision-related quality of life, and to quantify the association between release of vitreomacular adhesion (VMA) at day 28 and VFR. Prespecified analysis of secondary endpoints from a randomized controlled trial. Of 220 participants with symptomatic VMA/vitreomacular traction (VMT), including VMT associated with a macular hole up to 400 μm, 146 received a single intravitreal injection of 125 μg ocriplasmin and 74 a sham injection. Based on principal components analysis results, a VFR was defined as either a VA improvement of ≥2 lines or an improvement exceeding the minimal clinically important difference (MCID) in the composite or the mental health subscale scores of the Visual Function Questionnaire (VFQ-25). The MCID was estimated using the standard error of measurement approach. The main outcome measure was the VFR at month 6, with further assessments at months 12 and 24. Th...
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If left untreated, vitreomacular traction (VMT) will infrequently improve through spontaneous resolution of vitreomacular adhesion (VMA), and patients remain at risk of further deterioration in vision. The mainstay of treatment for VMT is... more
If left untreated, vitreomacular traction (VMT) will infrequently improve through spontaneous resolution of vitreomacular adhesion (VMA), and patients remain at risk of further deterioration in vision. The mainstay of treatment for VMT is vitrectomy, an invasive procedure that carries the risk of rare but serious complications and further vision loss. As such, a 'watch and wait' approach is often adopted before this surgical intervention is performed. Ocriplasmin (microplasmin) is a potential alternative treatment for patients with symptomatic VMT that may remove the requirement for vitrectomy. The purpose of this study was to evaluate the cost-effectiveness of ocriplasmin for the treatment of VMT in comparison to standard of care. A cohort-based computer simulation model was developed, capturing three mutually exclusive subgroups: 1) VMT without epiretinal membrane (ERM) or full thickness macular hole (FTMH), 2) VMT with ERM but no FTMH, and 3) VMT with FTMH. Transition pro...