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Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis
OBJECTIVES: To evaluate the comparative effectiveness and safety of intravitreal bevacizumab, ranibizumab and aflibercept for patients with choroidal neovascular age-related macular degeneration (cn-AMD), diabetic macular oedema (DMO), macular oedema due to retinal vein occlusion (RVO-MO) and myopic...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549720/ https://www.ncbi.nlm.nih.gov/pubmed/31142516 http://dx.doi.org/10.1136/bmjopen-2018-022031 |
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author | Pham, Ba' Thomas, Sonia M Lillie, Erin Lee, Taehoon Hamid, Jemila Richter, Trevor Janoudi, Ghayath Agarwal, Arnav Sharpe, Jane P Scott, Alistair Warren, Rachel Brahmbhatt, Ronak Macdonald, Erin Straus, Sharon E Tricco, Andrea C |
author_facet | Pham, Ba' Thomas, Sonia M Lillie, Erin Lee, Taehoon Hamid, Jemila Richter, Trevor Janoudi, Ghayath Agarwal, Arnav Sharpe, Jane P Scott, Alistair Warren, Rachel Brahmbhatt, Ronak Macdonald, Erin Straus, Sharon E Tricco, Andrea C |
author_sort | Pham, Ba' |
collection | PubMed |
description | OBJECTIVES: To evaluate the comparative effectiveness and safety of intravitreal bevacizumab, ranibizumab and aflibercept for patients with choroidal neovascular age-related macular degeneration (cn-AMD), diabetic macular oedema (DMO), macular oedema due to retinal vein occlusion (RVO-MO) and myopic choroidal neovascularisation (m-CNV). DESIGN: Systematic review and random-effects meta-analysis. METHODS: Multiple databases were searched from inception to 17 August 2017. Eligible head-to-head randomised controlled trials (RCTs) comparing the (anti-VEGF) drugs in adult patients aged ≥18 years with the retinal conditions of interest. Two reviewers independently screened studies, extracted data and assessed risk of bias. RESULTS: 19 RCTs involving 7459 patients with cn-AMD (n=12), DMO (n=3), RVO-MO (n=2) and m-CNV (n=2) were included. Vision gain was not significantly different in patients with cn-AMD, DMO, RVO-MO and m-CNV treated with bevacizumab versus ranibizumab. Similarly, vision gain was not significantly different between cn-AMD patients treated with aflibercept versus ranibizumab. Patients with DMO treated with aflibercept experienced significantly higher vision gain at 12 months than patients receiving ranibizumab or bevacizumab; however, this difference was not significant at 24 months. Rates of systemic serious harms were similar across anti-VEGF agents. Posthoc analyses revealed that an as-needed treatment regimen (6–9 injections per year) was associated with a mortality increase of 1.8% (risk ratio: 2.0 [1.2 to 3.5], 2 RCTs, 1795 patients) compared with monthly treatment in cn-AMD patients. CONCLUSIONS: Intravitreal bevacizumab was a reasonable alternative to ranibizumab and aflibercept in patients with cn-AMD, DMO, RVO-MO and m-CNV. The only exception was for patients with DME and low visual acuity (<69 early treatment diabetic retinopathy study [ETDRS] letters), where treatment with aflibercept was associated with significantly higher vision gain (≥15 ETDRS letters) than bevacizumab or ranibizumab at 12 months; but the significant effects were not maintained at 24 months. The choice of anti-VEGF drugs may depend on the specific retinal condition, baseline visual acuity and treatment regimen. PROSPERO REGISTRATION NUMBER: CRD42015022041. |
format | Online Article Text |
id | pubmed-6549720 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65497202019-06-21 Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis Pham, Ba' Thomas, Sonia M Lillie, Erin Lee, Taehoon Hamid, Jemila Richter, Trevor Janoudi, Ghayath Agarwal, Arnav Sharpe, Jane P Scott, Alistair Warren, Rachel Brahmbhatt, Ronak Macdonald, Erin Straus, Sharon E Tricco, Andrea C BMJ Open Ophthalmology OBJECTIVES: To evaluate the comparative effectiveness and safety of intravitreal bevacizumab, ranibizumab and aflibercept for patients with choroidal neovascular age-related macular degeneration (cn-AMD), diabetic macular oedema (DMO), macular oedema due to retinal vein occlusion (RVO-MO) and myopic choroidal neovascularisation (m-CNV). DESIGN: Systematic review and random-effects meta-analysis. METHODS: Multiple databases were searched from inception to 17 August 2017. Eligible head-to-head randomised controlled trials (RCTs) comparing the (anti-VEGF) drugs in adult patients aged ≥18 years with the retinal conditions of interest. Two reviewers independently screened studies, extracted data and assessed risk of bias. RESULTS: 19 RCTs involving 7459 patients with cn-AMD (n=12), DMO (n=3), RVO-MO (n=2) and m-CNV (n=2) were included. Vision gain was not significantly different in patients with cn-AMD, DMO, RVO-MO and m-CNV treated with bevacizumab versus ranibizumab. Similarly, vision gain was not significantly different between cn-AMD patients treated with aflibercept versus ranibizumab. Patients with DMO treated with aflibercept experienced significantly higher vision gain at 12 months than patients receiving ranibizumab or bevacizumab; however, this difference was not significant at 24 months. Rates of systemic serious harms were similar across anti-VEGF agents. Posthoc analyses revealed that an as-needed treatment regimen (6–9 injections per year) was associated with a mortality increase of 1.8% (risk ratio: 2.0 [1.2 to 3.5], 2 RCTs, 1795 patients) compared with monthly treatment in cn-AMD patients. CONCLUSIONS: Intravitreal bevacizumab was a reasonable alternative to ranibizumab and aflibercept in patients with cn-AMD, DMO, RVO-MO and m-CNV. The only exception was for patients with DME and low visual acuity (<69 early treatment diabetic retinopathy study [ETDRS] letters), where treatment with aflibercept was associated with significantly higher vision gain (≥15 ETDRS letters) than bevacizumab or ranibizumab at 12 months; but the significant effects were not maintained at 24 months. The choice of anti-VEGF drugs may depend on the specific retinal condition, baseline visual acuity and treatment regimen. PROSPERO REGISTRATION NUMBER: CRD42015022041. BMJ Publishing Group 2019-05-28 /pmc/articles/PMC6549720/ /pubmed/31142516 http://dx.doi.org/10.1136/bmjopen-2018-022031 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Ophthalmology Pham, Ba' Thomas, Sonia M Lillie, Erin Lee, Taehoon Hamid, Jemila Richter, Trevor Janoudi, Ghayath Agarwal, Arnav Sharpe, Jane P Scott, Alistair Warren, Rachel Brahmbhatt, Ronak Macdonald, Erin Straus, Sharon E Tricco, Andrea C Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis |
title | Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis |
title_full | Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis |
title_fullStr | Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis |
title_full_unstemmed | Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis |
title_short | Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis |
title_sort | anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis |
topic | Ophthalmology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549720/ https://www.ncbi.nlm.nih.gov/pubmed/31142516 http://dx.doi.org/10.1136/bmjopen-2018-022031 |
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