Association Between Aspirin Use and Age-Related Macular Degeneration: A Meta-Analysis

Ye, Juan; Xu, Yufeng; He, Jinsong; Lou, Lixia

doi:10.1167/iovs.13-13206

Cited by 19 publications

(15 citation statements)

References 69 publications

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“…Furthermore, systemic immunosuppression (e.g., daclizumab or rapamycin) [166] or topical use of bromfenac can significantly reduce the number of intravitreal anti-VEGF injection in neovascular AMD patients [167, 168]. However, a number of meta-analysis of various clinical trials suggests that the use of aspirin may increase the incidence of neovascular AMD [169, 170]. However, most patients with AMD take only low-dose aspirin (75-100 mg/day) in order to reduce the risk of cardiovascular disease, and such low-doses are likely to have minimal effects on the immune system.…”

Section: Dysregulated Para-inflammation and Age-related Macular Degenmentioning

confidence: 99%

Parainflammation, chronic inflammation, and age-related macular degeneration

Chen

2015

Journal of Leukocyte Biology

292

260

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Inflammation is an adaptive response of the immune system to noxious insults to maintain homeostasis and restore functionality. The retina is considered an immune-privileged tissue as a result of its unique anatomic and physiologic properties. During aging, the retina suffers from a low-grade chronic oxidative insult, which sustains for decades and increases in level with advancing age. As a result, the retinal innate-immune system, particularly microglia and the complement system, undergoes low levels of activation (parainflammation). In many cases, this parainflammatory response can maintain homeostasis in the healthy aging eye. However, in patients with age-related macular degeneration, this parainflammatory response becomes dysregulated and contributes to macular damage. Factors contributing to the dysregulation of age-related retinal parainflammation include genetic predisposition, environmental risk factors, and old age. Dysregulated parainflammation (chronic inflammation) in age-related macular degeneration damages the blood retina barrier, resulting in the breach of retinal-immune privilege, leading to the development of retinal lesions. This review discusses the basic principles of retinal innate-immune responses to endogenous chronic insults in normal aging and in age-related macular degeneration and explores the difference between beneficial parainflammation and the detrimental chronic inflammation in the context of age-related macular degeneration.

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Section: Dysregulated Para-inflammation and Age-related Macular Degenmentioning

confidence: 99%

Parainflammation, chronic inflammation, and age-related macular degeneration

Chen

2015

Journal of Leukocyte Biology

292

260

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“…excluded any effect of aspirin on risk of both early and late AMD. Three recent meta‐analyses have assessed the evidence with different conclusions . Therefore, given the potential public health implications, additional information is clearly needed to evaluate the relationship between aspirin use and the risk of AMD.…”

Section: What Is Known and Objectivesmentioning

confidence: 99%

Is aspirin use associated with age-related macular degeneration? A meta-analysis

Chen

et al. 2014

J Clin Pharm Ther

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SUMMARYWhat is known and objectives: Aspirin is one of the most widely used medications in the world. The evidence on its effect on the risk of age-related macular degeneration (AMD) appears inconsistent across different types of studies. The aim of this metaanalysis was to evaluate the association between aspirin use and the risk of AMD. Methods: Relevant studies were searched using databases including PubMed, EMBASE, Cochrane Library and MEDLINE up to March 2014. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated by random-effects or fixed-effect models. The heterogeneity was assessed by the inconsistency index (I 2 ). The publication bias was evaluated by Begg's funnel plot and Egger's weighted regression. Sensitivity analysis was also performed in different ways. Results: Ten eligible studies including 180 834 individuals based on the inclusion criteria were analysed in this metaanalysis. The pooled RR for the aspirin use on the risk of AMD was 1Á137 (95% CI, 1Á003-1Á289; I 2 , 68Á4%). The pooled RR for the aspirin use on the risk of early and late AMD was 1Á19 (95% CI, 0Á92-1Á53; I 2 , 82Á6%) and 1Á22 (95% CI, 0Á87-1Á72; I 2 , 55Á7%), respectively. In different types of late AMD, the pooled RR was 1Á95 (95% CI, 1Á40-2Á72; I 2 , 27%) for neovascularization and 0Á84 (95% CI, 0Á62-1Á15; I 2 , 0%) for geographic atrophy. The pooled RR in studies with standardized AMD classification was 1Á307 (95% CI, 1Á006-1Á698; I 2 , 79Á2%). What is new and conclusion: This meta-analysis updates similar reviews that included studies with various types of biases. A rigorous analysis shows a weak but statistically significant association between aspirin use and the risk of AMD; a result which is different to that previously reported. WHAT IS KNOWN AND OBJECTIVESAge-related macular degeneration (AMD) is a common disease affecting the posterior segment of the eye, and it represents the leading cause of irreversible blindness and low vision in developed and many developing countries with the longest life expectancies.

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“…The systematic reviews from McCann et al [17] to Ye et al [18] were the studies most compliant with methodological quality. Both studies have only one negative domain, which included, respectively, the presentation of the list of excluded articles and reasons of exclusion (domain 7), and the elaboration and publication of a protocol of the systematic review (domain 2) [17,18]. All systematic reviews included the components of Population, Intervention, Comparator, Outcome in the description of research question and inclusion criteria (domain 1), described the results in detail (domain 8), using tables, and graphics if necessary, and reported any potential sources of conflict of interest (domain 16).…”

Section: Methodological Quality Analysismentioning

confidence: 99%

Methodologic Assessment of the Systematic Reviews of Ophthalmic Adverse Drug Reactions Published in Ophthalmology Journals: A Systematic Review

Penedones

Marques

2018

Ophthalmic Res

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Purpose: This systematic review aims to characterize and review the methodology of the systematic reviews reporting ophthalmic adverse drug reactions. Methods: This systematic review followed the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guide. MEDLINE and EMBASE databases were searched, by all Ophthalmology journals. All systematic reviews reporting ophthalmic adverse drug reactions in the last decade were included. Data on methodology were extracted. Methodological quality was assessed through A MeaSurement Tool to Assess systematic Reviews 2 scale. Descriptive analysis was performed. Results: Twenty-one systematic reviews were identified. Almost 60% of the systematic reviews reported non-ophthalmic drugs. Nine (43%) systematic reviews did not follow any recommendation. A search filter was not applied in 48% systematic reviews. Observational data was the source of information most included. The methodological quality was assessed in 57% systematic reviews. A meta-analysis was performed in 57% systematic reviews. The protocol’s elaboration, the explanation of the sources of information and the list of excluded articles were the domains less performed in the systematic reviews. Conclusion: The systematic reviews reporting ophthalmic adverse drug reactions diverged in some methodological aspects. Such an issue deserves further investigation, since discrepancies may lead to biased conclusions and, consequently, impact clinical and/or regulatory decisions.

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Association Between Aspirin Use and Age-Related Macular Degeneration: A Meta-Analysis

Abstract: The pooled effects from current literature suggest that aspirin use is not associated with AMD, but it increased the risk of the neovascular form of AMD.

Cited by 19 publications

References 69 publications

Parainflammation, chronic inflammation, and age-related macular degeneration

Parainflammation, chronic inflammation, and age-related macular degeneration

Is aspirin use associated with age-related macular degeneration? A meta-analysis

Methodologic Assessment of the Systematic Reviews of Ophthalmic Adverse Drug Reactions Published in Ophthalmology Journals: A Systematic Review

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