Comparative effectiveness and harms of intravitreal antivascular endothelial growth factor agents for three retinal conditions: a systematic review and meta-analysis.
Angiogenesis Inhibitors
/ administration & dosage
Bevacizumab
/ administration & dosage
Humans
Intravitreal Injections
Macular Edema
/ diagnosis
Ranibizumab
/ administration & dosage
Receptors, Vascular Endothelial Growth Factor
/ administration & dosage
Recombinant Fusion Proteins
/ administration & dosage
Retinal Vein Occlusion
/ diagnosis
Treatment Outcome
Vascular Endothelial Growth Factor A
/ antagonists & inhibitors
Visual Acuity
Wet Macular Degeneration
/ diagnosis
Anti-VEGF therapy
aflibercept
age-related macular degeneration
bevacizumab
central or branch retinal vein occlusion
diabetic macular edema
ranibizumab
Journal
The British journal of ophthalmology
ISSN: 1468-2079
Titre abrégé: Br J Ophthalmol
Pays: England
ID NLM: 0421041
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
07
06
2018
revised:
27
09
2018
accepted:
23
10
2018
pubmed:
10
11
2018
medline:
20
12
2019
entrez:
10
11
2018
Statut:
ppublish
Résumé
Intravitreal antivascular endothelial growth factor (VEGF) agents are widely used to treat ocular conditions but the benefits and harms of these treatments are uncertain. We conducted a systematic review to compare the effects of aflibercept, bevacizumab and ranibizumab on best-corrected visual acuity (BCVA) changes, quality of life and ocular or systemic adverse events in patients with neovascular age-related macular degeneration (NVAMD), diabetic macular oedema (DME) and central or branch retinal vein occlusion (RVO). We searched published and unpublished literature sources to February 2017 for randomised controlled trials and cohort or modelling studies reporting comparative costs in the USA. Two reviewers extracted data and graded the strength of the evidence using established methods. Of 17 included trials, none reported a clinically important difference (≥ 5 letters) in visual acuity gains between agents. Nine trials provide high-strength evidence of no difference between bevacizumab and ranibizumab for NVAMD. Three trials provide moderate-strength evidence of no difference between bevacizumab and ranibizumab for DME. There was low-strength evidence of similar effects between aflibercept and ranibizumab for NVAMD, aflibercept and bevacizumab for RVO and all three agents for DME. There was insufficient evidence to compare bevacizumab and ranibizumab for RVO. Rates of ocular adverse events were low, and systemic harms were generally similar between groups, although 1 DME trial reported more arterial thrombotic events with ranibizumab versus aflibercept. Overall, no agent had a clear advantage over another for effectiveness or safety. Aflibercept and ranibizumab were significantly less cost-effective than repackaged bevacizumab in two trials. Systematic review registration number: CRD42016034076.
Identifiants
pubmed: 30409915
pii: bjophthalmol-2018-312691
doi: 10.1136/bjophthalmol-2018-312691
doi:
Substances chimiques
Angiogenesis Inhibitors
0
Recombinant Fusion Proteins
0
Vascular Endothelial Growth Factor A
0
aflibercept
15C2VL427D
Bevacizumab
2S9ZZM9Q9V
Receptors, Vascular Endothelial Growth Factor
EC 2.7.10.1
Ranibizumab
ZL1R02VT79
Types de publication
Journal Article
Meta-Analysis
Research Support, U.S. Gov't, Non-P.H.S.
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
442-451Informations de copyright
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.