Bevacizumab for ocular neovascular diseases: a systematic review

Abstract

CONTEXT AND OBJECTIVE: Many eye diseases involve increased local levels of vascular endothelial growth factor (VEGF), and there are several therapeutic strategies for them. Thus, the aim of this study was to evaluate the effectiveness and safety of bevacizumab for treating eye diseases involving increased local levels of VEGF, as the assumed pathophysiological mechanism. DATA SOURCES:The following databases were systematically searched for evidence: PubMed, CENTRAL (Cochrane Library), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and reference lists, without language restrictions. Only randomized controlled trials were included. The primary outcome of interest was visual acuity, irrespective of the evaluation method.DATA SYNTHESIS: A total of 667 eyes in nine randomized trials were included. Meta-analysis showed that the proportion of patients with age-related macular degeneration who presented improvements from baseline regarding best-corrected visual acuity was higher among those treated with bevacizumab than among those in the photodynamic therapy group (risk ratio, RR, 0.49; 95% confidence interval, CI, 0.31 to 0.78; P = 0.01). CONCLUSIONS:The evidence available demonstrates that bevacizumab alone or combined with other treatments is more effective than other options, including photodynamic therapy, focal photocoagulation and triamcinolone. The use of bevacizumab instead of photodynamic therapy could reduce treatment costs by more than 99% and could significantly increase access to treatment. However, long-term studies are still needed in order to reduce uncertainty concerning the safety of this medication for all ocular neovascular diseases in which bevacizumab has the potential to improve visual acuity. CONCLUSÕES: A evidência disponível demonstra que bevacizumabe isolado ou combinado com outras terapias é mais eficaz que terapia fotodinâmica, fotocoagulação focal e triancinolona. O uso de bevacizumabe em vez da terapia fotodinâmica poderia reduzir os custos do tratamento em mais de 99% e aumentar significativamente o acesso ao tratamento. Entretanto, o aspecto de segurança do fármaco ainda necessita ser avaliado por estudos em longo prazo com todas as doenças neovasculares em que bevacizumabe tenha o potencial de melhorar acuidade visual.

Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration

“…A recent systematic review [49] of bevacizumab in the treatment of ocular neovascular diseases identified 474 studies, of which nine were RCTs that employed the minimum methodological rigour necessary to generate robust data. Furthermore, methodological flaws within these trials, including potential performance bias in six of the studies and detection bias in five of the studies, precluded any definitive conclusions regarding the safety of intraocular bevacizumab administration.…”

The methodological quality of systematic reviews comparing intravitreal bevacizumab and alternates for neovascular age related macular degeneration: A systematic review of reviews

“…Review by Ziemssen et al .,[13] found off-label use of bevacizumab superior to PDT, in the short term, however the evidence was of moderate quality (2b level of evidence) primarily from before-after studies, case series and RCT's of bevacizumab for neovascular AMD. Andriolo et al .,[14] in their meta-analysis showed that BCVA was higher among those treated with bevacizumab than those in the PDT group (risk ratio, RR, 0.49; 95% confidence interval (CI), 0.31 to 0.78; P = 0.01). Jyothi et al ., summarized the findings from 5 RCT's and 50 observations studies that met “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) criteria.…”

“…[1234567891011121314] With increasing life expectancy, the worldwide prevalence of AMD is set to increase. Neovascular AMD is characterized by abnormal growth of new blood vessels under the macula, it accounts for only 20% of the cases with AMD, but responsible for 90% of the cases of legal blindness.…”

Ritonavir inhibits HIF-1α-mediated VEGF expression in retinal pigment epithelial cells in vitro

“…All these molecules bind to secreted VEGF and prevent its interaction with VEGF receptors. [13][14][15] Aflibercept is a recombinant fusion protein consisting of portions of VEGF receptors fused to Fc domain of IgG1. It acts as a soluble decoy receptor binding free VEGF.…”