The Efficacy and Safety of Current Treatments in Diabetic Macular Edema: A Systematic Review and Network Meta-Analysis

Abstract

PurposeTo compare the efficacy and safety of current treatments in diabetic macular edema (DME).MethodsPubMed, Embase and CENTRAL were systematically reviewed for randomized controlled trials of current treatments in DME through August 2015. Data on the mean change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) were extracted, and adverse events (AEs) were collected.ResultsA total of 21 trials were included in our network meta-analysis. Intravitreal ranibizumab improved BCVA most significantly (OR: +7.01 95%CI (2.56 to 11.39)) in 6 months and intravitreal aflibercept (+8.19 (5.07 to 11.96)) in 12 months. Intravitreal triamcinolone combined with LASER decreased CMT most significantly (-111.34 (-254.61 to 37.93)) in 6 months and intravitreal aflibercept (-110.83 (-190.25 to -35.27)) in 12 months. Compared with the relatively high rate of ocular AEs in the groups with administration of steroids, systematic AEs occurred more frequently in the groups with vascular endothelial growth factor inhibitors involved.ConclusionsOur analysis confirms that intravitreal aflibercept is most favorable with both BCVA improvement and CMT decrease than other current therapies in the management of DME within 12 months. Vascular endothelial growth factor inhibitors for DME should be used with caution due to systematic AEs. Combined intravitreal triamcinolone with LASER has a stronger efficacy in decreasing CMT than the other interventions in the early stage after injection. More high-quality randomized controlled trials will be necessary.

Α-Melanocyte-Stimulating Hormone Protects Early Diabetic Retina from Blood-Retinal Barrier Breakdown and Vascular Leakage via MC4R

“…The currently available therapeutic modalities to DME include laser photocoagulation, intravitreal injections of glucocorticoid hormone or anti-VEGF drugs [7]. These modalities demonstrate certain efficacies, however, the potential side effects such as retinal damage and elevated intraocular pressure, and the considerable portion of unresponsiveness in patients as well as the prohibitive cost are of major concerns [8]. Therefore, the search for a novel and effective interventional modality to the BRB breakdown and vascular leakage during early DR is of primary clinical importance.…”

Baseline SD-OCT characteristics of diabetic macular oedema patterns can predict morphological features and timing of recurrence in patients treated with dexamethasone intravitreal implants

“…Diabetic macular oedema (DME), a macular thickening secondary to diabetic retinopathy (DR), results from a blood-retinal barrier defect that leads to vascular leakage and fluid accumulation [1]. In patients with diabetes, DME is a leading cause of visual impairment and loss [2] and has been reported in almost 30% of patients with a duration of disease > 20 years [3]. DME has been related to the expression of several inflammatory factors, including vascular endothelial growth factor (VEGF), intercellular adhesion molecule-1 (ICAM-1), interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), and leukostasis [4,5].…”

“…Chiara M. Eandi and Daniele De Geronimo have contributed equally to this work. several treatment options for patients with DME are also in widespread use [2,6]. Indeed, in the past decade, advances in the understanding of the pathogenesis of DME have led to the development of new therapies with anti-inflammatory action, especially steroids and VEGF inhibitors, which have resulted in several novel therapeutic applications [2,7].…”

“…several treatment options for patients with DME are also in widespread use [2,6]. Indeed, in the past decade, advances in the understanding of the pathogenesis of DME have led to the development of new therapies with anti-inflammatory action, especially steroids and VEGF inhibitors, which have resulted in several novel therapeutic applications [2,7]. While intravitreal anti-VEGF agents have been shown to be effective in improving best-corrected visual acuity (BCVA) and decreasing central retinal thickness (CRT), it has been suggested that they should be used with caution due to possible systemic adverse events [2].…”

Effect of Leaking Foveal Microaneurysms on the Treatment of Center-Involving Diabetic Macular Edema: A Pilot Study

“…Anti-VEGF agents have been well demonstrated to provide superior vision recovery over other treatments, such as focal/grid laser by the Early Treatment Diabetic Retinopathy Study (ETDRS) group [3, 7, 8] or steroids [3, 9]. Consequently, we have been developing an adjunct therapy to minimize the required numbers of injections and maximize the adherence and benefit of anti-VEGF treatment in DME patients.…”