What do Cochrane systematic reviews say about interventions for age-related macular degeneration?

Mozetic, Vânia; Pacheco, Rafael Leite; Latorraca, Carolina de Oliveira Cruz; Lee, Fernanda Chin Yu Ogasawara; Gomes, João Victor Borges; Riera, Rachel

doi:10.1590/1516-3180.2019.010317092019

Cited by 2 publications

(2 citation statements)

References 30 publications

(44 reference statements)

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“…An interesting novelty of the current meta-analysis has been its ability to compare the long-term efficacy data of the various anti-VEGF and regimens. For this same purpose, other authors have already focused their research on the outcome data recorded at Years 1 and 2 [ 11 , 13 , 14 , 50 , 66 ]. According to their research, the PRN and T&E regimens displayed VA with decent stability and good control, as well as CRT improvements for up to two years, a finding that is perfectly in line with the monthly standard of care.…”

Section: Discussionmentioning

confidence: 99%

“…To compare different anti-VEGF agents and regimens, several meta-analyses have been performed [ 11 , 12 , 13 , 14 ] with the goal of better assisting physicians in their therapeutic decision-making process. Indeed, meta-analyses primarily seek to provide more accurate outcomes and comprehensive conclusions than individual studies through the use of a pool of previously published studies that allow for data comparison [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-Analysis

Matonti

Korobelnik

Dot

et al. 2022

JCM

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Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) have become the standard of care for age-related macular degeneration (AMD). Although most pivotal trials have used monthly injections, alternative strategies that enable the injections to be administered on a more flexible schedule, including pro re nata (PRN) and treat-and-extend (T&E) regimens, are being applied more frequently. This review sought to provide further scientific evidence about the visual outcomes and treatment burden among the currently available anti-VEGF agents and regimens, including aflibercept, ranibizumab, abicipar and brolucizumab. To this end, a systematic review of published randomized studies was conducted from the MEDLINE and EMBASE databases and the Cochrane library, and a meta-analysis was applied to the obtained data using single-means modeling to compare the efficacy and maintenance among the different available treatments and regimens at Years 1 and 2. Quality analysis identified the best-informed data for modeling purposes. Overall, 47 relevant publications were retrieved for the analysis. Superior efficacy, meaning that there were observed improvements in visual acuity (VA) and central retinal thickness (CRT), occurred with monthly versus PRN regimens, yet a higher IVI number was also observed. Conversely, the T&E regimens displayed similar efficacy to the monthly regimens, but with a reduced IVI number. Aflibercept T&E exhibited similar efficacy to ranibizumab T&E, but with significantly lower IVI numbers at both Year 1 (p < 0.0001) and Year 2 (p = 0.0011). Though all of the regimens resulted in maintained efficacy between Years 1 and 2, the required IVI number varied. The retrieved data did not enable other regimens or newer anti-VEGF agents such as brolucizumab to be compared. In conclusion, the T&E regimens were shown to be the most efficient, optimizing durable effectiveness whilst minimizing the IVI number in newly diagnosed exudative AMD, with aflibercept requiring the lowest IVI number.

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