Cargando…

Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis

BACKGROUND: To investigate whether treatment as required ‘pro re nata’ (PRN) versus regular monthly treatment regimens lead to differences in outcomes in neovascular age-related macular degeneration (nAMD). Regular monthly administration of vascular endothelial growth factor (VEGF) inhibitors is an...

Descripción completa

Detalles Bibliográficos
Autores principales: Schmucker, Christine M., Rücker, Gerta, Sommer, Harriet, Virgili, Gianni, Loke, Yoon K., Oeller, Patrick, Agostini, Hansjuergen, Ehlken, Christoph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569266/
https://www.ncbi.nlm.nih.gov/pubmed/26368921
http://dx.doi.org/10.1371/journal.pone.0137866
_version_ 1782390009378111488
author Schmucker, Christine M.
Rücker, Gerta
Sommer, Harriet
Virgili, Gianni
Loke, Yoon K.
Oeller, Patrick
Agostini, Hansjuergen
Ehlken, Christoph
author_facet Schmucker, Christine M.
Rücker, Gerta
Sommer, Harriet
Virgili, Gianni
Loke, Yoon K.
Oeller, Patrick
Agostini, Hansjuergen
Ehlken, Christoph
author_sort Schmucker, Christine M.
collection PubMed
description BACKGROUND: To investigate whether treatment as required ‘pro re nata’ (PRN) versus regular monthly treatment regimens lead to differences in outcomes in neovascular age-related macular degeneration (nAMD). Regular monthly administration of vascular endothelial growth factor (VEGF) inhibitors is an established gold standard treatment, but this approach is costly. Replacement of monthly by PRN treatment can only be justified if there is no difference in patient relevant outcomes. METHODS: Systematic review and meta-analysis. The intervention was PRN treatment and the comparator was monthly treatment with VEGF-inhibitors. Four bibliographic databases were searched for randomised controlled trials comparing both treatment regimens directly (head-to-head studies). The last literature search was conducted in December 2014. Risk of bias assessment was performed after the Cochrane Handbook for Systematic Reviews of Interventions. FINDINGS: We included 3 head-to-head studies (6 reports) involving more than 2000 patients. After 2 years, the weighted mean difference in best corrected visual acuity (BCVA) was 1.9 (95% CI 0.5 to 3.3) ETDRS letters in favour of monthly treatment. Systemic adverse events were higher in PRN treated patients, but these differences were not statistically significant. After 2 years, the total number of intravitreal injections required by the patients in the PRN arms were 8.4 (95% CI 7.9 to 8.9) fewer than those having monthly treatment. The studies were considered to have a moderate risk of bias. CONCLUSIONS: PRN treatment resulted in minor but statistically significant decrease in mean BCVA which may not be clinically meaningful. There is a small increase in risk of systemic adverse events for PRN treated patients. Overall, the results indicate that an individualized treatment approach with anti-VEGF using visual acuity and OCT-guided re-treatment criteria may be appropriate for most patients with nAMD.
format Online
Article
Text
id pubmed-4569266
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-45692662015-09-18 Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis Schmucker, Christine M. Rücker, Gerta Sommer, Harriet Virgili, Gianni Loke, Yoon K. Oeller, Patrick Agostini, Hansjuergen Ehlken, Christoph PLoS One Research Article BACKGROUND: To investigate whether treatment as required ‘pro re nata’ (PRN) versus regular monthly treatment regimens lead to differences in outcomes in neovascular age-related macular degeneration (nAMD). Regular monthly administration of vascular endothelial growth factor (VEGF) inhibitors is an established gold standard treatment, but this approach is costly. Replacement of monthly by PRN treatment can only be justified if there is no difference in patient relevant outcomes. METHODS: Systematic review and meta-analysis. The intervention was PRN treatment and the comparator was monthly treatment with VEGF-inhibitors. Four bibliographic databases were searched for randomised controlled trials comparing both treatment regimens directly (head-to-head studies). The last literature search was conducted in December 2014. Risk of bias assessment was performed after the Cochrane Handbook for Systematic Reviews of Interventions. FINDINGS: We included 3 head-to-head studies (6 reports) involving more than 2000 patients. After 2 years, the weighted mean difference in best corrected visual acuity (BCVA) was 1.9 (95% CI 0.5 to 3.3) ETDRS letters in favour of monthly treatment. Systemic adverse events were higher in PRN treated patients, but these differences were not statistically significant. After 2 years, the total number of intravitreal injections required by the patients in the PRN arms were 8.4 (95% CI 7.9 to 8.9) fewer than those having monthly treatment. The studies were considered to have a moderate risk of bias. CONCLUSIONS: PRN treatment resulted in minor but statistically significant decrease in mean BCVA which may not be clinically meaningful. There is a small increase in risk of systemic adverse events for PRN treated patients. Overall, the results indicate that an individualized treatment approach with anti-VEGF using visual acuity and OCT-guided re-treatment criteria may be appropriate for most patients with nAMD. Public Library of Science 2015-09-14 /pmc/articles/PMC4569266/ /pubmed/26368921 http://dx.doi.org/10.1371/journal.pone.0137866 Text en © 2015 Schmucker et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Schmucker, Christine M.
Rücker, Gerta
Sommer, Harriet
Virgili, Gianni
Loke, Yoon K.
Oeller, Patrick
Agostini, Hansjuergen
Ehlken, Christoph
Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis
title Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis
title_full Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis
title_fullStr Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis
title_full_unstemmed Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis
title_short Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis
title_sort treatment as required versus regular monthly treatment in the management of neovascular age-related macular degeneration: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569266/
https://www.ncbi.nlm.nih.gov/pubmed/26368921
http://dx.doi.org/10.1371/journal.pone.0137866
work_keys_str_mv AT schmuckerchristinem treatmentasrequiredversusregularmonthlytreatmentinthemanagementofneovascularagerelatedmaculardegenerationasystematicreviewandmetaanalysis
AT ruckergerta treatmentasrequiredversusregularmonthlytreatmentinthemanagementofneovascularagerelatedmaculardegenerationasystematicreviewandmetaanalysis
AT sommerharriet treatmentasrequiredversusregularmonthlytreatmentinthemanagementofneovascularagerelatedmaculardegenerationasystematicreviewandmetaanalysis
AT virgiligianni treatmentasrequiredversusregularmonthlytreatmentinthemanagementofneovascularagerelatedmaculardegenerationasystematicreviewandmetaanalysis
AT lokeyoonk treatmentasrequiredversusregularmonthlytreatmentinthemanagementofneovascularagerelatedmaculardegenerationasystematicreviewandmetaanalysis
AT oellerpatrick treatmentasrequiredversusregularmonthlytreatmentinthemanagementofneovascularagerelatedmaculardegenerationasystematicreviewandmetaanalysis
AT agostinihansjuergen treatmentasrequiredversusregularmonthlytreatmentinthemanagementofneovascularagerelatedmaculardegenerationasystematicreviewandmetaanalysis
AT ehlkenchristoph treatmentasrequiredversusregularmonthlytreatmentinthemanagementofneovascularagerelatedmaculardegenerationasystematicreviewandmetaanalysis