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Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review
OBJECTIVE: To compare the efficacy and safety of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (anti-VEGF) agents in the treatment of macular oedema secondary to retinal vein occlusion (RVO). DESIGN: Systematic review and meta-analysis based on Grading of Recom...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322510/ https://www.ncbi.nlm.nih.gov/pubmed/32595145 http://dx.doi.org/10.1136/bmjopen-2019-032128 |
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author | Ming, Shuai Xie, Kunpeng Yang, Mingzhu He, Huijuan Li, Ya Lei, Bo |
author_facet | Ming, Shuai Xie, Kunpeng Yang, Mingzhu He, Huijuan Li, Ya Lei, Bo |
author_sort | Ming, Shuai |
collection | PubMed |
description | OBJECTIVE: To compare the efficacy and safety of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (anti-VEGF) agents in the treatment of macular oedema secondary to retinal vein occlusion (RVO). DESIGN: Systematic review and meta-analysis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE). DATA SOURCES: PubMed, Cochrane Library and ClinicalTrials.gov registry were searched from inception to 10 December 2019, without language restrictions. ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) and real-world observation studies comparing the efficacy of DEX implant and anti-VEGF agents for the treatment of patients with RVO, naïve or almost naïve to both arms, were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data for mean changes in best-corrected visual acuity (BCVA), central subfield thickness (CST) and product safety. Review Manager V.5.3 and GRADE were used to synthesise the data and validate the evidence, respectively. RESULTS: Four RCTs and 12 real-world studies were included. An average lower letter gain in BCVA was determined for the DEX implant (mean difference (MD) = −6.59; 95% CI −8.87 to −4.22 letters) administered at a retreatment interval of 5–6 months. Results were similar (MD(6 months)=−12.68; 95% CI −21.98 to −3.37 letters; MD(12 months)=−9.69; 95% CI −12.01 to −7.37 letters) at 6 and 12 months. The DEX implant resulted in comparable or marginally less CST reduction at months 6 and 12 but introduced relatively higher risks of elevated intraocular pressure (RR=3.89; 95% CI 2.16 to 7.03) and cataract induction (RR=5.22; 95% CI 1.67 to 16.29). Most real-life studies reported an insignificant numerical gain in letters for anti-VEGF drugs relative to that for DEX implant. However, the latter achieved comparable efficacy with a 4-month dosage interval. CONCLUSION: Compared with anti-VEGF agents, DEX implant required fewer injections but had inferior functional efficacy and safety. Real-life trials supplemented the efficacy data for DEX implant. |
format | Online Article Text |
id | pubmed-7322510 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-73225102020-07-02 Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review Ming, Shuai Xie, Kunpeng Yang, Mingzhu He, Huijuan Li, Ya Lei, Bo BMJ Open Ophthalmology OBJECTIVE: To compare the efficacy and safety of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (anti-VEGF) agents in the treatment of macular oedema secondary to retinal vein occlusion (RVO). DESIGN: Systematic review and meta-analysis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE). DATA SOURCES: PubMed, Cochrane Library and ClinicalTrials.gov registry were searched from inception to 10 December 2019, without language restrictions. ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) and real-world observation studies comparing the efficacy of DEX implant and anti-VEGF agents for the treatment of patients with RVO, naïve or almost naïve to both arms, were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data for mean changes in best-corrected visual acuity (BCVA), central subfield thickness (CST) and product safety. Review Manager V.5.3 and GRADE were used to synthesise the data and validate the evidence, respectively. RESULTS: Four RCTs and 12 real-world studies were included. An average lower letter gain in BCVA was determined for the DEX implant (mean difference (MD) = −6.59; 95% CI −8.87 to −4.22 letters) administered at a retreatment interval of 5–6 months. Results were similar (MD(6 months)=−12.68; 95% CI −21.98 to −3.37 letters; MD(12 months)=−9.69; 95% CI −12.01 to −7.37 letters) at 6 and 12 months. The DEX implant resulted in comparable or marginally less CST reduction at months 6 and 12 but introduced relatively higher risks of elevated intraocular pressure (RR=3.89; 95% CI 2.16 to 7.03) and cataract induction (RR=5.22; 95% CI 1.67 to 16.29). Most real-life studies reported an insignificant numerical gain in letters for anti-VEGF drugs relative to that for DEX implant. However, the latter achieved comparable efficacy with a 4-month dosage interval. CONCLUSION: Compared with anti-VEGF agents, DEX implant required fewer injections but had inferior functional efficacy and safety. Real-life trials supplemented the efficacy data for DEX implant. BMJ Publishing Group 2020-06-28 /pmc/articles/PMC7322510/ /pubmed/32595145 http://dx.doi.org/10.1136/bmjopen-2019-032128 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/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 Ming, Shuai Xie, Kunpeng Yang, Mingzhu He, Huijuan Li, Ya Lei, Bo Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review |
title | Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review |
title_full | Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review |
title_fullStr | Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review |
title_full_unstemmed | Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review |
title_short | Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review |
title_sort | comparison of intravitreal dexamethasone implant and anti-vegf drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review |
topic | Ophthalmology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322510/ https://www.ncbi.nlm.nih.gov/pubmed/32595145 http://dx.doi.org/10.1136/bmjopen-2019-032128 |
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