Anti-vascular endothelial growth factor therapy for age-related macular degeneration: a systematic review and network meta-analysis

Systematic Reviews

Ghayath Janoudi¹  Trevor Richter¹  Arnav Agarwal²  Jemila S. Hamid³  Erin Lillie⁴  Rachel Warren⁴  Jane P. Sharpe⁴  Sonia M. Thomas⁴  Taehoon Lee⁴  Ba’ Pham⁴  Alistair Scott⁴  Ronak Brahmbhatt⁴  Sharon E. Straus⁵  Areti Angeliki Veroniki⁶  Andrea C. Tricco⁷  Erin Macdonald⁸  Carolina L. M. Francisconi⁹  Rajeev H. Muni⁹ 

[1] Canadian Agency for Drugs and Technologies in Health (CADTH), 865 Carling Avenue, K1S 5S8, Ottawa, Ontario, Canada;Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, Ontario, Canada;Department of Medicine, University of Toronto, 1 King’s College Circle, M5S 1A8, Toronto, Ontario, Canada;Department of Mathematics and Statistics, University of Ottawa, 150 Louis-Pasteur Pvt, K1N 6N5, Ottawa, ON, Canada;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, M5B 1T8, Toronto, ON, Canada;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, M5B 1T8, Toronto, ON, Canada;Department of Geriatric Medicine, University of Toronto, 27 King’s College Circle, M5S 1A1, Toronto, Ontario, Canada;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, M5B 1T8, Toronto, ON, Canada;Department of Primary Education, School of Education, University of Ioannina, 455 00, Ioannina, Mpizani, Greece;Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, Exhibition Rd, South Kensington, SW7 2BU, London, UK;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, M5B 1T8, Toronto, ON, Canada;Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, M5T 3M7, Toronto, Ontario, Canada;Queen’s Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen’s University, 99 University Ave, K7L 3N6, Kingston, Ontario, Canada;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, M5B 1T8, Toronto, ON, Canada;Institute of Health Policy, Management and Evaluation, University of Toronto, 6th floor, 155 College Street, M5T 3M7, Toronto, Ontario, Canada;St. Michael’s Hospital/Unity Health Toronto, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;

关键词: Ranibizumab;    Bevacizumab;    Aflibercept;    Conbercept;    Brolucizumab;    Anti-vascular endothelial growth factor;    Age-related macular degeneration;   

DOI  :  10.1186/s13643-021-01864-6

来源: Springer

【 摘 要 】

BackgroundThe comparative safety and efficacy between anti-vascular endothelial growth factor agents (anti-VEGFs) and between combined therapies for patients with neovascular age-related macular degeneration (nAMD) is unclear. We conducted a systematic review to examine the comparative safety and efficacy anti-VEGFs for adults with nAMD.MethodsStudies were identified through MEDLINE, EMBASE, and Cochrane CENTRAL (inception to June 3, 2019), grey literature, and scanning reference lists. Two reviewers independently screened citations and full-text articles to identify randomized controlled trials (RCTs), extracted data, and appraised risk of bias. Pairwise random-effects meta-analysis and Bayesian network meta-analysis (NMA) were conducted. The primary outcomes were the proportion of patients experiencing moderate vision gain (≥ 15 letters on the Early Treatment Diabetic Retinopathy Study chart) and the proportion of patients experiencing moderate vision loss (≤ 15 letters).ResultsAfter screening 3647 citations and 485 potentially relevant full-text articles, 92 RCTs with 24,717 patients were included. NMA (34 RCTs, 8809 patients, 12 treatments) showed small differences among anti-VEGFs in improving the proportion of patients with moderate vision gain, with the largest for conbercept versus broluczumab (OR 0.15, 95% CrI: 0.05–0.56), conbercept versus ranibizumab (OR 0.17, 95% CrI: 0.05–0.59), conbercept versus aflibercept (OR 0.19, 95% CrI: 0.06–0.65), and conbercept versus bevacizumab (OR 0.2, 95% CrI: 0.06–0.69). In NMA (36 RCTs, 9081 patients, 13 treatments) for the proportion of patients with moderate vision loss, small differences were observed among anti-VEGFs, with the largest being for conbercept versus aflibercept (OR 0.24, 95% CrI: 0–4.29), conbercept versus brolucizumab (OR 0.24, 95% CrI: 0–4.71), conbercept versus bevacizumab (OR 0.26, 95% CrI: 0–4.65), and conbercept versus ranibizumab (OR 0.27, 95% CrI: 0–4.67).ConclusionThe only observed differences were that ranibizumab, bevacizumab, aflibercept, and brolucizumab were statistically superior to conbercept in terms of the proportion of patients with nAMD who experienced moderate vision gain. However, this finding is based on indirect evidence through one small trial comparing conbercept with placebo. This does not account for drug-specific differences when assessing anatomic and functional treatment efficacy in variable dosing regimens.Systematic review registrationPROSPERO registration number CRD42015022041.

【 授权许可】

CC BY