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Intravitreal anti-VEGF injections for treating wet age-related macular degeneration: a systematic review and meta-analysis.

Ba J, Peng RS, Xu D, Li YH, Shi H, Wang Q, Yu J - Drug Des Devel Ther (2015)

Bottom Line: The superiority remains unclear between IVR and intravitreal bevacizumab in the treatment of neovascular AMD.IVR PRN could significantly increase VA.Combined with photodynamic therapy, IVR therapy could also increase VA effectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai, People's Republic of China ; Department of Cardiac Surgery, Institute of Cardiovascular Diseases of Fudan University, Affiliated Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China.

ABSTRACT

Aims: Age-related macular degeneration (AMD) is the main cause of blindness. Anti-vascular endothelial growth factor is used to prevent further neovascularization due to wet AMD. The purpose of this systematic review was to investigate the effect and protocol of anti-vascular endothelial growth factor treatment on wet AMD.

Methods: A comprehensive literature search was performed in PubMed, Embase, the Cochrane Library, CNKI, and reference lists. Meta-analysis was performed using Stata12.0 software, best corrected visual acuity (BCVA), retinal thickness, and lesion size were evaluated.

Results: Twelve randomized controlled trials spanning from 2010 to 2014 and involving 5,225 patients were included. A significant difference was observed between the intravitreal ranibizumab (IVR) group and the intravitreal bevacizumab group (standard mean difference = -0.14, 95% confidence interval [CI] = -0.23 to -0.05). No significant differences were observed in best corrected VA, retinal thickness, or lesion size between IVR and the intravitreal aflibercept group. Compared to monthly injection, IVR as-needed injections (PRN) can raise VA by 1.97 letters (weighted mean difference = 1.97, 95% CI = 0.14-3.794). Combination therapy of IVR and photodynamic therapy can significantly raise VA by 2.74 letters when combined with IVR monotherapy (weighted mean difference = 2.74, 95% CI = 0.26-5.21).

Conclusion: The superiority remains unclear between IVR and intravitreal bevacizumab in the treatment of neovascular AMD. Intravitreal aflibercept dosed every 2 months required fewer injection times, but produced similar efficacy as monthly IVR. IVR PRN could significantly increase VA. Combined with photodynamic therapy, IVR therapy could also increase VA effectively.

No MeSH data available.


Related in: MedlinePlus

Forest plot of BCVA of IVR vs IVB for treating wet AMD.Note: No significant difference was observed between the IVR group and the IVB group.Abbreviations: AMD, age-related macular degeneration; BCVA, best corrected visual acuity; IVB, intravitreal bevacizumab; IVR, intravitreal ranibizumab; WMD, weighted mean difference; CI, confidence interval.
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f2-dddt-9-5397: Forest plot of BCVA of IVR vs IVB for treating wet AMD.Note: No significant difference was observed between the IVR group and the IVB group.Abbreviations: AMD, age-related macular degeneration; BCVA, best corrected visual acuity; IVB, intravitreal bevacizumab; IVR, intravitreal ranibizumab; WMD, weighted mean difference; CI, confidence interval.

Mentions: Five studies were included for this meta-analysis.11,14,18,20,22Figure 2 shows the BCVA of the five RCTs. Effect sizes were homogeneous (I2=18.8%, P=0.30). The pooled analysis showed no significant difference between the IVR group and the IVB group (WMD =0.47, 95% CI =−0.79 to 1.72, P=0.47). There was no evidence of heterogeneity (I2=0%, P=0.85) in the total retinal thickness at fovea (TTF). The pooled analysis did not reveal any significant difference between the two groups (WMD =−13.16, 95% CI =−31.52 to 5.21, P=0.16). Four studies provided data on LS.11,14,18,22 The effect sizes were homogeneous (I2=46.6%, P=0.13). A significant difference was observed between the IVR group and the IVB group (SMD =−0.14, 95% CI =−0.23 to −0.05, P=0.002).


Intravitreal anti-VEGF injections for treating wet age-related macular degeneration: a systematic review and meta-analysis.

Ba J, Peng RS, Xu D, Li YH, Shi H, Wang Q, Yu J - Drug Des Devel Ther (2015)

Forest plot of BCVA of IVR vs IVB for treating wet AMD.Note: No significant difference was observed between the IVR group and the IVB group.Abbreviations: AMD, age-related macular degeneration; BCVA, best corrected visual acuity; IVB, intravitreal bevacizumab; IVR, intravitreal ranibizumab; WMD, weighted mean difference; CI, confidence interval.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592052&req=5

f2-dddt-9-5397: Forest plot of BCVA of IVR vs IVB for treating wet AMD.Note: No significant difference was observed between the IVR group and the IVB group.Abbreviations: AMD, age-related macular degeneration; BCVA, best corrected visual acuity; IVB, intravitreal bevacizumab; IVR, intravitreal ranibizumab; WMD, weighted mean difference; CI, confidence interval.
Mentions: Five studies were included for this meta-analysis.11,14,18,20,22Figure 2 shows the BCVA of the five RCTs. Effect sizes were homogeneous (I2=18.8%, P=0.30). The pooled analysis showed no significant difference between the IVR group and the IVB group (WMD =0.47, 95% CI =−0.79 to 1.72, P=0.47). There was no evidence of heterogeneity (I2=0%, P=0.85) in the total retinal thickness at fovea (TTF). The pooled analysis did not reveal any significant difference between the two groups (WMD =−13.16, 95% CI =−31.52 to 5.21, P=0.16). Four studies provided data on LS.11,14,18,22 The effect sizes were homogeneous (I2=46.6%, P=0.13). A significant difference was observed between the IVR group and the IVB group (SMD =−0.14, 95% CI =−0.23 to −0.05, P=0.002).

Bottom Line: The superiority remains unclear between IVR and intravitreal bevacizumab in the treatment of neovascular AMD.IVR PRN could significantly increase VA.Combined with photodynamic therapy, IVR therapy could also increase VA effectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai, People's Republic of China ; Department of Cardiac Surgery, Institute of Cardiovascular Diseases of Fudan University, Affiliated Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China.

ABSTRACT

Aims: Age-related macular degeneration (AMD) is the main cause of blindness. Anti-vascular endothelial growth factor is used to prevent further neovascularization due to wet AMD. The purpose of this systematic review was to investigate the effect and protocol of anti-vascular endothelial growth factor treatment on wet AMD.

Methods: A comprehensive literature search was performed in PubMed, Embase, the Cochrane Library, CNKI, and reference lists. Meta-analysis was performed using Stata12.0 software, best corrected visual acuity (BCVA), retinal thickness, and lesion size were evaluated.

Results: Twelve randomized controlled trials spanning from 2010 to 2014 and involving 5,225 patients were included. A significant difference was observed between the intravitreal ranibizumab (IVR) group and the intravitreal bevacizumab group (standard mean difference = -0.14, 95% confidence interval [CI] = -0.23 to -0.05). No significant differences were observed in best corrected VA, retinal thickness, or lesion size between IVR and the intravitreal aflibercept group. Compared to monthly injection, IVR as-needed injections (PRN) can raise VA by 1.97 letters (weighted mean difference = 1.97, 95% CI = 0.14-3.794). Combination therapy of IVR and photodynamic therapy can significantly raise VA by 2.74 letters when combined with IVR monotherapy (weighted mean difference = 2.74, 95% CI = 0.26-5.21).

Conclusion: The superiority remains unclear between IVR and intravitreal bevacizumab in the treatment of neovascular AMD. Intravitreal aflibercept dosed every 2 months required fewer injection times, but produced similar efficacy as monthly IVR. IVR PRN could significantly increase VA. Combined with photodynamic therapy, IVR therapy could also increase VA effectively.

No MeSH data available.


Related in: MedlinePlus