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A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity.

Pertl L, Steinwender G, Mayer C, Hausberger S, Pöschl EM, Wackernagel W, Wedrich A, El-Shabrawi Y, Haas A - PLoS ONE (2015)

Bottom Line: This meta-analysis explores the safety of VEGF inhibitors.VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates.Due to the lack of data, the risk of systemic side effects cannot be assessed.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria.

ABSTRACT

Introduction: Laser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors.

Methods: The Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library.

Results: This meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents.

Discussion: VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.

No MeSH data available.


Related in: MedlinePlus

Systemic VEGF suppression after VEGF inhibitors.Research papers investigating systemic levels of VEGF after intravitreal injection of VEGF inhibitors over a defined period of time. *1 = infants with retinopathy of prematurity, unilateral injection of bevacizumab (14); 2 = infants with retinopathy of prematurity, unilateral injection of ranibizumab (105); 3 = patients with age-related macular degeneration (AMD), unilateral injection of bevacizumab (106); 4 = patients with AMD, bilateral injection of bevacizumab (106); 5 = patients with AMD, unilateral injection of ranibizumab (107); 6 = patients with AMD, unilateral injection of bevacizumab (108); 7 = patients with AMD, unilateral injection of ranibizumab (108); 8 = patients with AMD, unilateral injection of aflibercept (109); 9 = patients with AMD, unilateral injection of ranibizumab (109); 10 = patients with AMD, unilateral injection of ranibizumab (110); 11 = patients with AMD, unilateral injection of aflibercept (110); 12 = patients with AMD, unilateral injection of ranibizumab (111). ** y-axis in pg/ml.
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pone.0129383.g002: Systemic VEGF suppression after VEGF inhibitors.Research papers investigating systemic levels of VEGF after intravitreal injection of VEGF inhibitors over a defined period of time. *1 = infants with retinopathy of prematurity, unilateral injection of bevacizumab (14); 2 = infants with retinopathy of prematurity, unilateral injection of ranibizumab (105); 3 = patients with age-related macular degeneration (AMD), unilateral injection of bevacizumab (106); 4 = patients with AMD, bilateral injection of bevacizumab (106); 5 = patients with AMD, unilateral injection of ranibizumab (107); 6 = patients with AMD, unilateral injection of bevacizumab (108); 7 = patients with AMD, unilateral injection of ranibizumab (108); 8 = patients with AMD, unilateral injection of aflibercept (109); 9 = patients with AMD, unilateral injection of ranibizumab (109); 10 = patients with AMD, unilateral injection of ranibizumab (110); 11 = patients with AMD, unilateral injection of aflibercept (110); 12 = patients with AMD, unilateral injection of ranibizumab (111). ** y-axis in pg/ml.

Mentions: In adults, systemic complications of intravitreal VEGF inhibitors are still under debate. Some studies showed an increase in mortality, while others did not (see Table 3). After intravitreal injection, VEGF inhibitors are found in the systemic circulation and systemic VEGF levels decrease [97–103]. Therefore concern remains about systemic toxicity of intravitreal VEGF inhibitors in infants (see Fig 2).


A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity.

Pertl L, Steinwender G, Mayer C, Hausberger S, Pöschl EM, Wackernagel W, Wedrich A, El-Shabrawi Y, Haas A - PLoS ONE (2015)

Systemic VEGF suppression after VEGF inhibitors.Research papers investigating systemic levels of VEGF after intravitreal injection of VEGF inhibitors over a defined period of time. *1 = infants with retinopathy of prematurity, unilateral injection of bevacizumab (14); 2 = infants with retinopathy of prematurity, unilateral injection of ranibizumab (105); 3 = patients with age-related macular degeneration (AMD), unilateral injection of bevacizumab (106); 4 = patients with AMD, bilateral injection of bevacizumab (106); 5 = patients with AMD, unilateral injection of ranibizumab (107); 6 = patients with AMD, unilateral injection of bevacizumab (108); 7 = patients with AMD, unilateral injection of ranibizumab (108); 8 = patients with AMD, unilateral injection of aflibercept (109); 9 = patients with AMD, unilateral injection of ranibizumab (109); 10 = patients with AMD, unilateral injection of ranibizumab (110); 11 = patients with AMD, unilateral injection of aflibercept (110); 12 = patients with AMD, unilateral injection of ranibizumab (111). ** y-axis in pg/ml.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4470662&req=5

pone.0129383.g002: Systemic VEGF suppression after VEGF inhibitors.Research papers investigating systemic levels of VEGF after intravitreal injection of VEGF inhibitors over a defined period of time. *1 = infants with retinopathy of prematurity, unilateral injection of bevacizumab (14); 2 = infants with retinopathy of prematurity, unilateral injection of ranibizumab (105); 3 = patients with age-related macular degeneration (AMD), unilateral injection of bevacizumab (106); 4 = patients with AMD, bilateral injection of bevacizumab (106); 5 = patients with AMD, unilateral injection of ranibizumab (107); 6 = patients with AMD, unilateral injection of bevacizumab (108); 7 = patients with AMD, unilateral injection of ranibizumab (108); 8 = patients with AMD, unilateral injection of aflibercept (109); 9 = patients with AMD, unilateral injection of ranibizumab (109); 10 = patients with AMD, unilateral injection of ranibizumab (110); 11 = patients with AMD, unilateral injection of aflibercept (110); 12 = patients with AMD, unilateral injection of ranibizumab (111). ** y-axis in pg/ml.
Mentions: In adults, systemic complications of intravitreal VEGF inhibitors are still under debate. Some studies showed an increase in mortality, while others did not (see Table 3). After intravitreal injection, VEGF inhibitors are found in the systemic circulation and systemic VEGF levels decrease [97–103]. Therefore concern remains about systemic toxicity of intravitreal VEGF inhibitors in infants (see Fig 2).

Bottom Line: This meta-analysis explores the safety of VEGF inhibitors.VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates.Due to the lack of data, the risk of systemic side effects cannot be assessed.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria.

ABSTRACT

Introduction: Laser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors.

Methods: The Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library.

Results: This meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents.

Discussion: VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.

No MeSH data available.


Related in: MedlinePlus