Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis

Abstract

Anti-VEGF drugs are effective at improving vision in people with DMO with three to four in every 10 people likely to experience an improvement of 3 or more lines VA at one year. There is moderate-certainty evidence that aflibercept confers some advantage over ranibizumab and bevacizumab in people with DMO at one year in visual and anatomic terms. Relative effects among anti-VEGF drugs at two years are less well known, since most studies were short term. Evidence from RCTs may not apply to real-world practice, where people in need of antiangiogenic treatment are often under-treated and under-monitored.We found no signals of differences in overall safety between the three antiangiogenic drugs that are currently available to treat DMO, but our estimates are imprecise for cardiovascular events and death.

Intravitreal aflibercept partially reverses severe non-proliferative diabetic retinopathy in treatment-naïve patients

“…19 Indeed, anti-VEGF therapy is now a recognized treatment for diabetic macular edema; it can significantly inhibit the growth of new blood vessels, reduce edema, and eventually improve vision. 16–18 Our results demonstrated improvements in BCVA and CFT after aflibercept treatment, in agreement with the findings of the CLARITY trial that compared aflibercept with pan-retinal photocoagulation; 20,25,26 our results are also consistent with the findings of a phase IV study in which a treat-and-extend regimen of aflibercept was found to improve visual acuity and retinal edema in eyes with Type 3 neovascularization, with good tolerability over 52 weeks. 27 Previous studies showed that when an anti-VEGF treatment was administered to patients with retinal venous obstruction, the anti-VEGF group displayed delayed progression of non-perfusion areas and showed improved reperfusion, compared with the control group.…”

Intravitreal aflibercept partially reverses severe non-proliferative diabetic retinopathy in treatment-naïve patients

“…19 Indeed, anti-VEGF therapy is now a recognized treatment for diabetic macular edema; it can significantly inhibit the growth of new blood vessels, reduce edema, and eventually improve vision. 16–18 Our results demonstrated improvements in BCVA and CFT after aflibercept treatment, in agreement with the findings of the CLARITY trial that compared aflibercept with pan-retinal photocoagulation; 20,25,26 our results are also consistent with the findings of a phase IV study in which a treat-and-extend regimen of aflibercept was found to improve visual acuity and retinal edema in eyes with Type 3 neovascularization, with good tolerability over 52 weeks. 27 Previous studies showed that when an anti-VEGF treatment was administered to patients with retinal venous obstruction, the anti-VEGF group displayed delayed progression of non-perfusion areas and showed improved reperfusion, compared with the control group.…”

An efficacy comparison of anti-vascular growth factor agents and laser photocoagulation in diabetic macular edema: a network meta-analysis incorporating individual patient-level data

“…This outcome is consistent with those in other published NMAs [9, 37]. In an updated Cochrane analysis of 24 trials (6007 patients with DME) [37], DME patients receiving ranibizumab (0.3 mg and 0.5 mg monthly) were less likely to gain ≥3 lines of visual acuity at 1 year compared with IVT-AFL (risk ratio [RR] 0.75, 95% CI 0.60–0.94). At 1 year, the visual acuity and CRT were worse with ranibizumab compared with IVT-AFL (mean difference in visual acuity: 0.08 logMAR, 95% CI 0.05–0.11; mean difference in CRT: 39 μm, 95% CI 2–76).…”

“…The EURETINA guidelines question the extent to which the slower effect of ranibizumab seen in DRCR.net Protocol T compared with IVT-AFL is attributable to the lower dose used [36]. This outcome is consistent with those in other published NMAs [9, 37]. In an updated Cochrane analysis of 24 trials (6007 patients with DME) [37], DME patients receiving ranibizumab (0.3 mg and 0.5 mg monthly) were less likely to gain ≥3 lines of visual acuity at 1 year compared with IVT-AFL (risk ratio [RR] 0.75, 95% CI 0.60–0.94).…”

Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs

“……”

Intravitreal aflibercept partially reverses severe non-proliferative diabetic retinopathy in treatment-naïve patients

“…19 Indeed, anti-VEGF therapy is now a recognized treatment for diabetic macular edema; it can significantly inhibit the growth of new blood vessels, reduce edema, and eventually improve vision. 16–18 Our results demonstrated improvements in BCVA and CFT after aflibercept treatment, in agreement with the findings of the CLARITY trial that compared aflibercept with pan-retinal photocoagulation; 20,25,26 our results are also consistent with the findings of a phase IV study in which a treat-and-extend regimen of aflibercept was found to improve visual acuity and retinal edema in eyes with Type 3 neovascularization, with good tolerability over 52 weeks. 27 Previous studies showed that when an anti-VEGF treatment was administered to patients with retinal venous obstruction, the anti-VEGF group displayed delayed progression of non-perfusion areas and showed improved reperfusion, compared with the control group.…”

An efficacy comparison of anti-vascular growth factor agents and laser photocoagulation in diabetic macular edema: a network meta-analysis incorporating individual patient-level data

“…This outcome is consistent with those in other published NMAs [9, 37]. In an updated Cochrane analysis of 24 trials (6007 patients with DME) [37], DME patients receiving ranibizumab (0.3 mg and 0.5 mg monthly) were less likely to gain ≥3 lines of visual acuity at 1 year compared with IVT-AFL (risk ratio [RR] 0.75, 95% CI 0.60–0.94). At 1 year, the visual acuity and CRT were worse with ranibizumab compared with IVT-AFL (mean difference in visual acuity: 0.08 logMAR, 95% CI 0.05–0.11; mean difference in CRT: 39 μm, 95% CI 2–76).…”

“…The EURETINA guidelines question the extent to which the slower effect of ranibizumab seen in DRCR.net Protocol T compared with IVT-AFL is attributable to the lower dose used [36]. This outcome is consistent with those in other published NMAs [9, 37]. In an updated Cochrane analysis of 24 trials (6007 patients with DME) [37], DME patients receiving ranibizumab (0.3 mg and 0.5 mg monthly) were less likely to gain ≥3 lines of visual acuity at 1 year compared with IVT-AFL (risk ratio [RR] 0.75, 95% CI 0.60–0.94).…”

Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs

“……”

Intravitreal aflibercept partially reverses severe non-proliferative diabetic retinopathy in treatment-naïve patients

“…19 Indeed, anti-VEGF therapy is now a recognized treatment for diabetic macular edema; it can significantly inhibit the growth of new blood vessels, reduce edema, and eventually improve vision. 16–18 Our results demonstrated improvements in BCVA and CFT after aflibercept treatment, in agreement with the findings of the CLARITY trial that compared aflibercept with pan-retinal photocoagulation; 20,25,26 our results are also consistent with the findings of a phase IV study in which a treat-and-extend regimen of aflibercept was found to improve visual acuity and retinal edema in eyes with Type 3 neovascularization, with good tolerability over 52 weeks. 27 Previous studies showed that when an anti-VEGF treatment was administered to patients with retinal venous obstruction, the anti-VEGF group displayed delayed progression of non-perfusion areas and showed improved reperfusion, compared with the control group.…”

An efficacy comparison of anti-vascular growth factor agents and laser photocoagulation in diabetic macular edema: a network meta-analysis incorporating individual patient-level data

“…This outcome is consistent with those in other published NMAs [9, 37]. In an updated Cochrane analysis of 24 trials (6007 patients with DME) [37], DME patients receiving ranibizumab (0.3 mg and 0.5 mg monthly) were less likely to gain ≥3 lines of visual acuity at 1 year compared with IVT-AFL (risk ratio [RR] 0.75, 95% CI 0.60–0.94). At 1 year, the visual acuity and CRT were worse with ranibizumab compared with IVT-AFL (mean difference in visual acuity: 0.08 logMAR, 95% CI 0.05–0.11; mean difference in CRT: 39 μm, 95% CI 2–76).…”

“…The EURETINA guidelines question the extent to which the slower effect of ranibizumab seen in DRCR.net Protocol T compared with IVT-AFL is attributable to the lower dose used [36]. This outcome is consistent with those in other published NMAs [9, 37]. In an updated Cochrane analysis of 24 trials (6007 patients with DME) [37], DME patients receiving ranibizumab (0.3 mg and 0.5 mg monthly) were less likely to gain ≥3 lines of visual acuity at 1 year compared with IVT-AFL (risk ratio [RR] 0.75, 95% CI 0.60–0.94).…”

Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs

“……”