Treat-and-extend dosing of intravitreal anti-VEGF agents in neovascular age-related macular degeneration: a meta-analysis

被引:8
|
作者
Nichani, Prem A. H. [1 ]
Popovic, Marko M. [1 ]
Dhoot, Arjan S. [2 ,3 ]
Pathak, Ananya [4 ]
Muni, Rajeev H. [1 ,5 ,6 ]
Kertes, Peter J. [1 ,6 ,7 ]
机构
[1] Univ Toronto, Dept Ophthalmol & Vis Sci, Toronto, ON, Canada
[2] Univ Toronto, Temerty Fac Med, Toronto, ON, Canada
[3] Univ Toronto, Inst Biomed Engn, Fac Appl Sci & Engn, Toronto, ON, Canada
[4] McMaster Univ, Dept Hlth Res Methods Evidence & Impact HEI, Hamilton, ON, Canada
[5] St Michaels Hosp Unity Hlth Toronto, Dept Ophthalmol, Toronto, ON, Canada
[6] Hosp Sick Children, Dept Ophthalmol & Vis Sci, Toronto, ON, Canada
[7] Sunnybrook Hlth Sci Ctr, John & Liz Tory Eye Ctr, Toronto, ON, Canada
关键词
ENDOTHELIAL GROWTH-FACTOR; FACTOR THERAPY; DIABETIC-RETINOPATHY; GEOGRAPHIC ATROPHY; VISUAL IMPAIRMENT; RANIBIZUMAB; PREVALENCE; REGIMEN; TRIAL; BEVACIZUMAB;
D O I
10.1038/s41433-023-02439-6
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Intravitreal injections of antiangiogenic agents are pivotal in treating neovascular age-related macular degeneration (nAMD). The comparative efficacy and safety of treat-and-extend (T&E) versus bimonthly, monthly, and pro re nata (PRN) dosing remains unclear. A systematic review and meta-analysis of English-language RCTs reporting on efficacy and/or safety outcomes of dosing regimens of anti-VEGF agents in nAMD was performed. Best-corrected visual acuity (BCVA, ETDRS letters) at last follow-up represented the primary endpoint, while central subfield thickness (CSFT, mu m), injection burden, and ocular adverse events were secondary endpoints. A random effects meta-analysis was performed, and 95% confidence intervals were calculated. Across six RCTs, 781 T&E-, 663 monthly-, 130 PRN-, and 123 bimonthly treated eyes were included. Mean changes in BCVA and CSFT at last follow-up were similar between T&E versus monthly (WMD, -0.62 letters; 95% CI, -2.12 to 0.87; P = 0.41; WMD, 5.30 microns; 95% CI, -10.67 to 21.26; P = 0.52, respectively), bimonthly (WMD, 1.68 letters; 95% CI, -3.55 to 6.91; P = 0.53; WMD, -18.91 microns; 95% CI, -46.41 to 8.60; P = 0.18, respectively), and PRN (BCVA WMD, 1.08 letters; 95% CI, -2.95 to 5.11; P = 0.60) regimens. T&E was associated with a reduced injection burden versus monthly (WMD, -4.52 injections; 95% CI, -6.66 to 2.39; P < 0.001) but higher injection burden versus PRN (WMD, 1.81 injections; 95% CI, 1.12 to 2.51; P < 0.001) dosing. There was no significant difference in safety outcomes amongst comparators. There was no significant difference in efficacy and safety between T&E, bimonthly, monthly, and PRN dosing. T&E resulted in fewer injections versus monthly and fewer clinic visits versus PRN.
引用
收藏
页码:2855 / 2863
页数:9
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