Managing Neovascular Age-Related Macular Degeneration in Clinical Practice: Systematic Review, Meta-Analysis, and Meta-Regression

被引:20
作者
Veritti, Daniele [1 ]
Sarao, Valentina [1 ,2 ]
Soppelsa, Valentina [1 ]
Danese, Carla [1 ]
Chhablani, Jay [3 ]
Lanzetta, Paolo [1 ,2 ]
机构
[1] Univ Udine, Dept Med Ophthalmol, I-33100 Udine, Italy
[2] Ist Europeo Microchirurg Oculare IEMO, I-33100 Udine, Italy
[3] Univ Pittsburgh, Sch Med, Med Retina & Vitreoretinal Surg, Pittsburgh, PA 15261 USA
关键词
aflibercept; age-related macular degeneration; anti-VEGF; bevacizumab; brolucizumab; meta-analysis; meta-regression; ranibizumab; TREAT-AND-EXTEND; ENDOTHELIAL GROWTH-FACTOR; OPTICAL COHERENCE TOMOGRAPHY; VISUAL-ACUITY OUTCOMES; PIGMENT EPITHELIAL DETACHMENTS; PRO-RE-NATA; INTRAVITREAL RANIBIZUMAB TREATMENT; TREATMENT-NAIVE PATIENTS; SUBFOVEAL CHOROIDAL NEOVASCULARIZATION; FLUENCE PHOTODYNAMIC THERAPY;
D O I
10.3390/jcm11020325
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The use of anti-vascular endothelial growth factor (VEGF) agents has profoundly changed the prognosis of neovascular age-related macular degeneration (nAMD). As clinical experiences have accumulated, it has become mandatory to summarize data to give information that can be useful in everyday practice. We conducted a systematic review to identify randomized controlled trials (RCTs) and observational studies that reported 12-month changes in best-corrected visual acuity (BCVA) in patients with nAMD on anti-VEGF monotherapy. Data were analyzed in a random-effects meta-analysis with BCVA change as the primary outcome. Meta-regression was conducted to evaluate the impact of multiple covariates. Four hundred and twelve heterogeneous study populations (109,666 eyes) were included. Anti-VEGFs induced an overall improvement of +5.37 ETDRS letters at 12 months. Meta-regression showed that mean BCVA change was statistically greater for RCTs (p = 0.0032) in comparison with observational studies. Populations following a proactive regimen had better outcomes than those following a reactive treatment regimen. Mean BCVA change was greater in younger populations, with lower baseline BCVA and treated with a higher number of injections (p < 0.001). Our results confirm that anti-VEGFs may produce a significant functional improvement at 12 months in patients with nAMD.
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页数:22
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