Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options
Daniele Veritti,1 Valentina Sarao,1,2 Valentina Soppelsa,1 Paolo Lanzetta1,2 1Department of Medicine - Ophthalmology, University of Udine, Udine, Italy; 2Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, ItalyCorrespondence: Paolo LanzettaDepartment of Medicine - Ophthalmology, University of...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2021-01-01
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| Series: | Clinical Ophthalmology |
| Subjects: | |
| Online Access: | https://www.dovepress.com/managing-diabetic-macular-edema-in-clinical-practice-systematic-review-peer-reviewed-article-OPTH |
| _version_ | 1818842938385367040 |
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| author | Veritti D Sarao V Soppelsa V Lanzetta P |
| author_facet | Veritti D Sarao V Soppelsa V Lanzetta P |
| author_sort | Veritti D |
| collection | DOAJ |
| description | Daniele Veritti,1 Valentina Sarao,1,2 Valentina Soppelsa,1 Paolo Lanzetta1,2 1Department of Medicine - Ophthalmology, University of Udine, Udine, Italy; 2Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, ItalyCorrespondence: Paolo LanzettaDepartment of Medicine - Ophthalmology, University of Udine, P.le Santa Maria della Misericordia 15, Udine, 33100, ItalyTel +39 0432 559907Fax +39 0432 559904Email paolo.lanzetta@uniud.itPurpose: This meta-analysis aims to summarize 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-vascular endothelial growth factor (VEGF) therapy and dexamethasone implant for the treatment of diabetic macular edema (DME) and to identify factors affecting treatment response using evidence generated from meta-regression.Methods: A systematic review of electronic databases was conducted to identify randomized controlled trials (RCTs) and real-life/observational studies that reported 12-month changes in BCVA in patients with DME on anti-VEGF or dexamethasone implant treatment in monotherapy. Study factors that were analyzed are baseline patient characteristics, study type, drug employed, number of injections and 12-month change in BCVA. Data were pooled in a random-effects meta-analysis with BCVA change as the main outcome. Meta-regression was conducted to assess the impact of multiple covariates.Results: One-hundred-five heterogeneous study populations (45,032 eyes) were identified and included in the analysis. The use of anti-VEGFs and dexamethasone implant induced an overall increase of +8.13 ETDRS letters in BCVA at 12 months of follow-up. Meta-regression provided evidence that mean BCVA change using anti-VEGFs was not statistically higher for RCTs (p=0.35) compared to observational studies. Dexamethasone implant showed a trend for better results in observational studies over RCTs. Populations following a fixed aflibercept regimen performed better than those following a reactive treatment regimen. Mean BCVA gain was higher in younger populations (p< 0.001), with lower baseline BCVA (p< 0.0001) and longer diabetes duration (p< 0.0001), receiving a higher number of injections (p< 0.0001).Conclusion: Intravitreal therapy with anti-VEGFs or dexamethasone implant produces a significant improvement in BCVA at 12 months in patients with DME. Meta-regression identified the modifiable covariates that can be targeted in order to maximize functional results.Keywords: aflibercept, anti-VEGF, bevacizumab, dexamethasone, diabetic macular edema, ranibizumab |
| first_indexed | 2024-12-19T04:49:55Z |
| format | Article |
| id | doaj.art-d81567f61d014f609cc36e0b81425949 |
| institution | Directory Open Access Journal |
| issn | 1177-5483 |
| language | English |
| last_indexed | 2024-12-19T04:49:55Z |
| publishDate | 2021-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical Ophthalmology |
| spelling | doaj.art-d81567f61d014f609cc36e0b814259492022-12-21T20:35:23ZengDove Medical PressClinical Ophthalmology1177-54832021-01-01Volume 1537538561595Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment OptionsVeritti DSarao VSoppelsa VLanzetta PDaniele Veritti,1 Valentina Sarao,1,2 Valentina Soppelsa,1 Paolo Lanzetta1,2 1Department of Medicine - Ophthalmology, University of Udine, Udine, Italy; 2Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, ItalyCorrespondence: Paolo LanzettaDepartment of Medicine - Ophthalmology, University of Udine, P.le Santa Maria della Misericordia 15, Udine, 33100, ItalyTel +39 0432 559907Fax +39 0432 559904Email paolo.lanzetta@uniud.itPurpose: This meta-analysis aims to summarize 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-vascular endothelial growth factor (VEGF) therapy and dexamethasone implant for the treatment of diabetic macular edema (DME) and to identify factors affecting treatment response using evidence generated from meta-regression.Methods: A systematic review of electronic databases was conducted to identify randomized controlled trials (RCTs) and real-life/observational studies that reported 12-month changes in BCVA in patients with DME on anti-VEGF or dexamethasone implant treatment in monotherapy. Study factors that were analyzed are baseline patient characteristics, study type, drug employed, number of injections and 12-month change in BCVA. Data were pooled in a random-effects meta-analysis with BCVA change as the main outcome. Meta-regression was conducted to assess the impact of multiple covariates.Results: One-hundred-five heterogeneous study populations (45,032 eyes) were identified and included in the analysis. The use of anti-VEGFs and dexamethasone implant induced an overall increase of +8.13 ETDRS letters in BCVA at 12 months of follow-up. Meta-regression provided evidence that mean BCVA change using anti-VEGFs was not statistically higher for RCTs (p=0.35) compared to observational studies. Dexamethasone implant showed a trend for better results in observational studies over RCTs. Populations following a fixed aflibercept regimen performed better than those following a reactive treatment regimen. Mean BCVA gain was higher in younger populations (p< 0.001), with lower baseline BCVA (p< 0.0001) and longer diabetes duration (p< 0.0001), receiving a higher number of injections (p< 0.0001).Conclusion: Intravitreal therapy with anti-VEGFs or dexamethasone implant produces a significant improvement in BCVA at 12 months in patients with DME. Meta-regression identified the modifiable covariates that can be targeted in order to maximize functional results.Keywords: aflibercept, anti-VEGF, bevacizumab, dexamethasone, diabetic macular edema, ranibizumabhttps://www.dovepress.com/managing-diabetic-macular-edema-in-clinical-practice-systematic-review-peer-reviewed-article-OPTHafliberceptanti-vegfbevacizumabdexamethasonediabetic macular edemaranibizumab |
| spellingShingle | Veritti D Sarao V Soppelsa V Lanzetta P Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options Clinical Ophthalmology aflibercept anti-vegf bevacizumab dexamethasone diabetic macular edema ranibizumab |
| title | Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options |
| title_full | Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options |
| title_fullStr | Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options |
| title_full_unstemmed | Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options |
| title_short | Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options |
| title_sort | managing diabetic macular edema in clinical practice systematic review and meta analysis of current strategies and treatment options |
| topic | aflibercept anti-vegf bevacizumab dexamethasone diabetic macular edema ranibizumab |
| url | https://www.dovepress.com/managing-diabetic-macular-edema-in-clinical-practice-systematic-review-peer-reviewed-article-OPTH |
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