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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 monotherapy vs IVR+PDT for treating wet AMD.Notes: A significant difference was shown between the two groups. Compared to monotherapy, the combination therapy can raise VA by 2.74 letters (WMD =2.74, 95% CI =0.26–5.21, P=0.03).Abbreviations: AMD, age-related macular degeneration; BCVA, best corrected visual acuity; CI, confidence interval; IVR, intravitreal ranibizumab; PDT, photodynamic therapy; WMD, weighted mean difference; VA, visual acuity.
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f4-dddt-9-5397: Forest plot of BCVA of IVR monotherapy vs IVR+PDT for treating wet AMD.Notes: A significant difference was shown between the two groups. Compared to monotherapy, the combination therapy can raise VA by 2.74 letters (WMD =2.74, 95% CI =0.26–5.21, P=0.03).Abbreviations: AMD, age-related macular degeneration; BCVA, best corrected visual acuity; CI, confidence interval; IVR, intravitreal ranibizumab; PDT, photodynamic therapy; WMD, weighted mean difference; VA, visual acuity.

Mentions: Five studies assessed the efficacy of monotherapy and combined therapy.12,13,16,19,20 No heterogeneity in BCVA and LS was observed among the studies (I2=0%, P=0.72; I2=0%, P=0.36). Combined therapy significantly raised VA by 2.74 letters combined with monotherapy (WMD =2.74, 95% CI =0.26–5.21, P=0.03) (Figure 4). No significant difference could be observed in LS (WMD =0.05, 95% CI =−0.05 to 0.14, P=0.35). High heterogeneity in CRT was observed in the included studies (I2=72.8%, P=0.03). A pooled analysis on random effect showed no significant difference among the groups (WMD =4.66, 95% CI =−30.37 to 39.68, P=0.79). Table 2 summarized the overall effect and heterogeneity of the pooled studies. Vallance et al found that the PDT group gained a mean of 2.2 letters and the IVR group gained a mean of 4.4 letters at 1 year (P=0.47).16 The mean CRT was reduced by 138 µm in the PDT group and by 103 µm in the IVR group (P=0.57).


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 monotherapy vs IVR+PDT for treating wet AMD.Notes: A significant difference was shown between the two groups. Compared to monotherapy, the combination therapy can raise VA by 2.74 letters (WMD =2.74, 95% CI =0.26–5.21, P=0.03).Abbreviations: AMD, age-related macular degeneration; BCVA, best corrected visual acuity; CI, confidence interval; IVR, intravitreal ranibizumab; PDT, photodynamic therapy; WMD, weighted mean difference; VA, visual acuity.
© Copyright Policy
Related In: Results  -  Collection

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

f4-dddt-9-5397: Forest plot of BCVA of IVR monotherapy vs IVR+PDT for treating wet AMD.Notes: A significant difference was shown between the two groups. Compared to monotherapy, the combination therapy can raise VA by 2.74 letters (WMD =2.74, 95% CI =0.26–5.21, P=0.03).Abbreviations: AMD, age-related macular degeneration; BCVA, best corrected visual acuity; CI, confidence interval; IVR, intravitreal ranibizumab; PDT, photodynamic therapy; WMD, weighted mean difference; VA, visual acuity.
Mentions: Five studies assessed the efficacy of monotherapy and combined therapy.12,13,16,19,20 No heterogeneity in BCVA and LS was observed among the studies (I2=0%, P=0.72; I2=0%, P=0.36). Combined therapy significantly raised VA by 2.74 letters combined with monotherapy (WMD =2.74, 95% CI =0.26–5.21, P=0.03) (Figure 4). No significant difference could be observed in LS (WMD =0.05, 95% CI =−0.05 to 0.14, P=0.35). High heterogeneity in CRT was observed in the included studies (I2=72.8%, P=0.03). A pooled analysis on random effect showed no significant difference among the groups (WMD =4.66, 95% CI =−30.37 to 39.68, P=0.79). Table 2 summarized the overall effect and heterogeneity of the pooled studies. Vallance et al found that the PDT group gained a mean of 2.2 letters and the IVR group gained a mean of 4.4 letters at 1 year (P=0.47).16 The mean CRT was reduced by 138 µm in the PDT group and by 103 µm in the IVR group (P=0.57).

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