Role of anti-vascular endothelial growth factor in the management of non-proliferative diabetic retinopathy without centre-involving diabetic macular oedema: a meta-analysis of trials
This systematic review and meta-analysis investigated the impact of anti-vascular endothelial growth factor (VEGF) treatment in management of eyes with non-proliferative diabetic retinopathy (NPDR) without centre involving diabetic macular oedema (CI-DMO). We searched multiple databases for all rand...
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| Veröffentlicht in: | Eye (London) 2023-07, Vol.37 (10), p.1966-1974 |
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| creator | Chaudhary, Varun Sarohia, Gurkaran S. Phillips, Mark R. Park, Daniel Xie, Jim Zeraatkar, Dena Fung, Matthew Thabane, Lehana Loewenstein, Anat Holz, Frank G. Garg, Sunir J. Kaiser, Peter K. Bhandari, Mohit Guymer, Robyn H. Fraser-Bell, Samantha Sivaprasad, Sobha Wykoff, Charles C. |
| description | This systematic review and meta-analysis investigated the impact of anti-vascular endothelial growth factor (VEGF) treatment in management of eyes with non-proliferative diabetic retinopathy (NPDR) without centre involving diabetic macular oedema (CI-DMO). We searched multiple databases for all randomised clinical trials (RCTs) that evaluated anti-VEGF treatment versus observation in eyes with NPDR without CI-DMO. Data was collected for six outcomes (best corrected visual acuity (BCVA) improvement, diabetic retinopathy severity score (DRSS), central subfield thickness, progression to vision threatening complications (VTCs), ocular adverse events and quality of life measures). Risk of bias was assessed using Cochrane risk-of-bias tool for randomised trials (RoB 2) and certainty of evidence was assessed using Grade of Recommendations, Assessment, Development and Evaluation (GRADE). We identified a total of 2 unique RCTs that compared aflibercept and sham to treat a total of 811 eyes. For BCVA change, there was a small, clinically insignificant benefit for aflibercept treatment at year 2 (MD 0.70, 95% CI 0.02–1.38, GRADE rating: MODERATE). DRSS demonstrated a statistically significant improvement with aflibercept use at year 2 (RR 3.76, 95% CI 2.75–5.13, GRADE rating: MODERATE). VTCs were significantly less in aflibercept arm at year 2 (RR 0.30, 95% CI 0.23–0.40, GRADE rating: MODERATE). In conclusion, aflibercept treatment versus observation in eyes with NPDR without CI-DMO can result in reduced risk of development of VTCs and regression of DRSS score over 2 years. Future trials are needed to increase the precision of the treatment effect and to provide data on quality-of-life metrics.
PROSPERO Registration: CRD42021288608. |
| doi_str_mv | 10.1038/s41433-022-02269-y |
| format | Article |
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DRSS demonstrated a statistically significant improvement with aflibercept use at year 2 (RR 3.76, 95% CI 2.75–5.13, GRADE rating: MODERATE). VTCs were significantly less in aflibercept arm at year 2 (RR 0.30, 95% CI 0.23–0.40, GRADE rating: MODERATE). In conclusion, aflibercept treatment versus observation in eyes with NPDR without CI-DMO can result in reduced risk of development of VTCs and regression of DRSS score over 2 years. Future trials are needed to increase the precision of the treatment effect and to provide data on quality-of-life metrics.
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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Eye (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chaudhary, Varun</au><au>Sarohia, Gurkaran S.</au><au>Phillips, Mark R.</au><au>Park, Daniel</au><au>Xie, Jim</au><au>Zeraatkar, Dena</au><au>Fung, Matthew</au><au>Thabane, Lehana</au><au>Loewenstein, Anat</au><au>Holz, Frank G.</au><au>Garg, Sunir J.</au><au>Kaiser, Peter K.</au><au>Bhandari, Mohit</au><au>Guymer, Robyn H.</au><au>Fraser-Bell, Samantha</au><au>Sivaprasad, Sobha</au><au>Wykoff, Charles C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of anti-vascular endothelial growth factor in the management of non-proliferative diabetic retinopathy without centre-involving diabetic macular oedema: a meta-analysis of trials</atitle><jtitle>Eye (London)</jtitle><stitle>Eye</stitle><addtitle>Eye (Lond)</addtitle><date>2023-07-01</date><risdate>2023</risdate><volume>37</volume><issue>10</issue><spage>1966</spage><epage>1974</epage><pages>1966-1974</pages><issn>0950-222X</issn><issn>1476-5454</issn><eissn>1476-5454</eissn><abstract>This systematic review and meta-analysis investigated the impact of anti-vascular endothelial growth factor (VEGF) treatment in management of eyes with non-proliferative diabetic retinopathy (NPDR) without centre involving diabetic macular oedema (CI-DMO). We searched multiple databases for all randomised clinical trials (RCTs) that evaluated anti-VEGF treatment versus observation in eyes with NPDR without CI-DMO. Data was collected for six outcomes (best corrected visual acuity (BCVA) improvement, diabetic retinopathy severity score (DRSS), central subfield thickness, progression to vision threatening complications (VTCs), ocular adverse events and quality of life measures). Risk of bias was assessed using Cochrane risk-of-bias tool for randomised trials (RoB 2) and certainty of evidence was assessed using Grade of Recommendations, Assessment, Development and Evaluation (GRADE). We identified a total of 2 unique RCTs that compared aflibercept and sham to treat a total of 811 eyes. For BCVA change, there was a small, clinically insignificant benefit for aflibercept treatment at year 2 (MD 0.70, 95% CI 0.02–1.38, GRADE rating: MODERATE). DRSS demonstrated a statistically significant improvement with aflibercept use at year 2 (RR 3.76, 95% CI 2.75–5.13, GRADE rating: MODERATE). VTCs were significantly less in aflibercept arm at year 2 (RR 0.30, 95% CI 0.23–0.40, GRADE rating: MODERATE). In conclusion, aflibercept treatment versus observation in eyes with NPDR without CI-DMO can result in reduced risk of development of VTCs and regression of DRSS score over 2 years. Future trials are needed to increase the precision of the treatment effect and to provide data on quality-of-life metrics.
PROSPERO Registration: CRD42021288608.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>36369263</pmid><doi>10.1038/s41433-022-02269-y</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0923-261X</orcidid><orcidid>https://orcid.org/0000-0002-9988-4146</orcidid><orcidid>https://orcid.org/0000-0002-9441-4356</orcidid><orcidid>https://orcid.org/0000-0002-7706-1165</orcidid><orcidid>https://orcid.org/0000-0001-8019-9272</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Eye (London), 2023-07, Vol.37 (10), p.1966-1974 |
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| subjects | 692/1807/1447 692/699/3161/3175 Acuity Angiogenesis Inhibitors - therapeutic use Bevacizumab - therapeutic use Clinical trials Diabetes Diabetes Mellitus Diabetic retinopathy Diabetic Retinopathy - complications Diabetic Retinopathy - drug therapy Edema Endothelial Growth Factors - therapeutic use Eye Humans Laboratory Medicine Laser Coagulation - adverse effects Macular Edema - etiology Medicine Medicine & Public Health Meta-analysis Ophthalmology Pharmaceutical Sciences/Technology Quality of life Ranibizumab - therapeutic use Retinopathy Review Review Article Statistical analysis Surgery Surgical Oncology Vascular endothelial growth factor Vascular Endothelial Growth Factor A - therapeutic use |
| title | Role of anti-vascular endothelial growth factor in the management of non-proliferative diabetic retinopathy without centre-involving diabetic macular oedema: a meta-analysis of trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T19%3A16%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Role%20of%20anti-vascular%20endothelial%20growth%20factor%20in%20the%20management%20of%20non-proliferative%20diabetic%20retinopathy%20without%20centre-involving%20diabetic%20macular%20oedema:%20a%20meta-analysis%20of%20trials&rft.jtitle=Eye%20(London)&rft.au=Chaudhary,%20Varun&rft.date=2023-07-01&rft.volume=37&rft.issue=10&rft.spage=1966&rft.epage=1974&rft.pages=1966-1974&rft.issn=0950-222X&rft.eissn=1476-5454&rft_id=info:doi/10.1038/s41433-022-02269-y&rft_dat=%3Cproquest_pubme%3E2835330700%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2835330700&rft_id=info:pmid/36369263&rfr_iscdi=true |