Efficacy and safety of different agents, dosages and strategies of anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration: a network meta-analysis of randomized controlled trials.

Autor: Zhao XY; Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.; Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China., Meng LH; Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.; Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China., Liu SZ; Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA., Chen YX; Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.; Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Jazyk: angličtina
Zdroj: Acta ophthalmologica [Acta Ophthalmol] 2021 Nov; Vol. 99 (7), pp. e1041-e1050. Date of Electronic Publication: 2021 Jan 13.
DOI: 10.1111/aos.14756
Abstrakt: Purpose: To evaluate the efficacy and safety of different agents, dosages and strategies of anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (nAMD) by network meta-analysis.
Methods: Electronic database searches were conducted on PubMed, Embase and Cochrane Central Register of Controlled Trials up to 1 December 2019 to `identify relevant randomized controlled trials (RCTs). The standardized mean difference (SMD), odds ratios (OR), 95% confidence intervals (CI), the surface under the cumulative ranking curves and the mean ranks of each outcome were estimated by Stata 14.0.
Results: Forty-seven RCTs encompassing 17 872 nAMD patients randomly assigned to 36 regimens of anti-VEGF agents or sham treatment were included. T&E strategy shows top-level effect both in BCVA changes and the percentage of patients with a gain of 3 lines or more of BCVA. When taking the same strategy, there is no significant difference of efficacy among ranibizumab, bevacizumab and aflibercept (p > 0.05); The combination of radiation, topical NSAIDs and photodynamic therapy (PDT) might provide additional benefit in central retinal thickness (CRT) reduction; all these therapeutic regimens of different anti-VEGF agents do not significantly increase the risk of severe ocular or cardiocerebral vascular adverse events (ADEs) compared with sham treatment (p > 0.05).
Conclusions: T&E strategy showed a satisfactory effect in visual improvement and there is no significant difference in efficacy or safety among ranibizumab, bevacizumab and aflibercept. All the included regimens have an acceptable risk of ADEs.
(© 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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