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Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review

OBJECTIVES: The aim of this study is to systematically review the evidence for anti-vascular endothelial growth factor (VEGF) therapy in choroidal neovascularisation secondary to conditions other than age-related macular degeneration. DATA SOURCES: MEDLINE, MEDLINE in-process, EMBASE and CENTRAL dat...

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Autores principales: Stuart, Arabella, Ford, John A, Duckworth, Susan, Jones, Colin, Pereira, Augustine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420986/
https://www.ncbi.nlm.nih.gov/pubmed/25941188
http://dx.doi.org/10.1136/bmjopen-2015-007746
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author Stuart, Arabella
Ford, John A
Duckworth, Susan
Jones, Colin
Pereira, Augustine
author_facet Stuart, Arabella
Ford, John A
Duckworth, Susan
Jones, Colin
Pereira, Augustine
author_sort Stuart, Arabella
collection PubMed
description OBJECTIVES: The aim of this study is to systematically review the evidence for anti-vascular endothelial growth factor (VEGF) therapy in choroidal neovascularisation secondary to conditions other than age-related macular degeneration. DATA SOURCES: MEDLINE, MEDLINE in-process, EMBASE and CENTRAL databases and conference abstracts were searched (from inception to Jan 2014). STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Randomised and non-randomised comparative studies with follow-up of at least 6 months were included and were used to assess clinical effectiveness. STUDY APPRAISAL AND SYNTHESIS METHOD: Risk of bias was assessed using the Cochrane risk of bias tool and modified Newcastle-Ottawa Scale. Meta-analysis was not possible due to methodological heterogeneity. RESULTS: 16 studies met the inclusion criteria (1091 eyes; 963 pathological myopia, 74 other conditions). There was large variation in risk of bias across studies. An improvement in best-corrected visual acuity in anti-VEGF arms over comparators was reported in all studies. The proportion of patients improving by at least 15 letters in anti-VEGF arms ranged from 27.3% to 70%. There were no significant differences between bevacizumab and ranibizumab. LIMITATIONS: Owing to the rarity of choroidal neovascularisation secondary to conditions other than age-related macular degeneration or pathological myopia, there are unlikely to ever be sufficiently powered trials in these populations. CONCLUSIONS: Bevacizumab and ranibizumab appear to be effective in improving visual acuity for patients with choroidal neovascularisation secondary to conditions other than age-related macular degeneration. The evidence base is strongest for choroidal neovascularisation secondary to pathological myopia, however, based on current evidence and likely pharmacological pathways, clinicians should consider treatment with either bevacizumab or ranibizumab for rarer causes.
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spelling pubmed-44209862015-05-13 Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review Stuart, Arabella Ford, John A Duckworth, Susan Jones, Colin Pereira, Augustine BMJ Open Ophthalmology OBJECTIVES: The aim of this study is to systematically review the evidence for anti-vascular endothelial growth factor (VEGF) therapy in choroidal neovascularisation secondary to conditions other than age-related macular degeneration. DATA SOURCES: MEDLINE, MEDLINE in-process, EMBASE and CENTRAL databases and conference abstracts were searched (from inception to Jan 2014). STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Randomised and non-randomised comparative studies with follow-up of at least 6 months were included and were used to assess clinical effectiveness. STUDY APPRAISAL AND SYNTHESIS METHOD: Risk of bias was assessed using the Cochrane risk of bias tool and modified Newcastle-Ottawa Scale. Meta-analysis was not possible due to methodological heterogeneity. RESULTS: 16 studies met the inclusion criteria (1091 eyes; 963 pathological myopia, 74 other conditions). There was large variation in risk of bias across studies. An improvement in best-corrected visual acuity in anti-VEGF arms over comparators was reported in all studies. The proportion of patients improving by at least 15 letters in anti-VEGF arms ranged from 27.3% to 70%. There were no significant differences between bevacizumab and ranibizumab. LIMITATIONS: Owing to the rarity of choroidal neovascularisation secondary to conditions other than age-related macular degeneration or pathological myopia, there are unlikely to ever be sufficiently powered trials in these populations. CONCLUSIONS: Bevacizumab and ranibizumab appear to be effective in improving visual acuity for patients with choroidal neovascularisation secondary to conditions other than age-related macular degeneration. The evidence base is strongest for choroidal neovascularisation secondary to pathological myopia, however, based on current evidence and likely pharmacological pathways, clinicians should consider treatment with either bevacizumab or ranibizumab for rarer causes. BMJ Publishing Group 2015-05-02 /pmc/articles/PMC4420986/ /pubmed/25941188 http://dx.doi.org/10.1136/bmjopen-2015-007746 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Ophthalmology
Stuart, Arabella
Ford, John A
Duckworth, Susan
Jones, Colin
Pereira, Augustine
Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review
title Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review
title_full Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review
title_fullStr Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review
title_full_unstemmed Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review
title_short Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review
title_sort anti-vegf therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review
topic Ophthalmology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420986/
https://www.ncbi.nlm.nih.gov/pubmed/25941188
http://dx.doi.org/10.1136/bmjopen-2015-007746
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