Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-Analysis
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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/7/1834 |
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| author | Frédéric Matonti Jean-François Korobelnik Corinne Dot Vincent Gualino Vincent Soler Sarah Mrejen Marie-Noëlle Delyfer Stéphanie Baillif Maté Streho Pierre Gascon Catherine Creuzot-Garcher Laurent Kodjikian |
| author_facet | Frédéric Matonti Jean-François Korobelnik Corinne Dot Vincent Gualino Vincent Soler Sarah Mrejen Marie-Noëlle Delyfer Stéphanie Baillif Maté Streho Pierre Gascon Catherine Creuzot-Garcher Laurent Kodjikian |
| author_sort | Frédéric Matonti |
| collection | DOAJ |
| description | 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 (<i>p</i> < 0.0001) and Year 2 (<i>p</i> = 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. |
| first_indexed | 2024-03-09T11:43:55Z |
| format | Article |
| id | doaj.art-d8f82129e9974bedb78c1443f635102b |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T11:43:55Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d8f82129e9974bedb78c1443f635102b2023-11-30T23:27:31ZengMDPI AGJournal of Clinical Medicine2077-03832022-03-01117183410.3390/jcm11071834Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-AnalysisFrédéric Matonti0Jean-François Korobelnik1Corinne Dot2Vincent Gualino3Vincent Soler4Sarah Mrejen5Marie-Noëlle Delyfer6Stéphanie Baillif7Maté Streho8Pierre Gascon9Catherine Creuzot-Garcher10Laurent Kodjikian11Centre Monticelli Paradis, 433 Bis Rue Paradis, 13008 Marseille, FranceDepartment of Ophthalmology, Bordeaux University Hospital, 33000 Bordeaux, FranceDepartment of Ophthalmology, Desgenettes Military Hospital, 69003 Lyon, FranceClinique Honoré Cave, Department of Ophthalmology, 82000 Montauban, FranceUnité de Rétine, Ophthalmology Department, Hôpital Pierre-Paul Riquet, Toulouse University Hospital, 31300 Toulouse, FranceCentre d’Imagerie et de Laser, 75015 Paris, FranceDepartment of Ophthalmology, Bordeaux University Hospital, 33000 Bordeaux, FranceDepartment of Ophthalmology, Pasteur 2 University Hospital, Côte d’Azur University, 06108 Nice, FranceExplore Vision Centre, 75001 Paris, FranceCentre Monticelli Paradis, 433 Bis Rue Paradis, 13008 Marseille, FranceDepartment of Ophthalmology, University Hospital, CHU Dijon, 21000 Dijon, FranceDepartment of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69002 Lyon, FranceIntravitreal 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 (<i>p</i> < 0.0001) and Year 2 (<i>p</i> = 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.https://www.mdpi.com/2077-0383/11/7/1834age-related macular degeneration (AMD)afliberceptcomparative therapieseffectivenessintravitreal anti-vascular endothelial growth factormeta-analysis |
| spellingShingle | Frédéric Matonti Jean-François Korobelnik Corinne Dot Vincent Gualino Vincent Soler Sarah Mrejen Marie-Noëlle Delyfer Stéphanie Baillif Maté Streho Pierre Gascon Catherine Creuzot-Garcher Laurent Kodjikian Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-Analysis Journal of Clinical Medicine age-related macular degeneration (AMD) aflibercept comparative therapies effectiveness intravitreal anti-vascular endothelial growth factor meta-analysis |
| title | Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-Analysis |
| title_full | Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-Analysis |
| title_fullStr | Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-Analysis |
| title_full_unstemmed | Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-Analysis |
| title_short | Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-Analysis |
| title_sort | comparative effectiveness of intravitreal anti vascular endothelial growth factor therapies for managing neovascular age related macular degeneration a meta analysis |
| topic | age-related macular degeneration (AMD) aflibercept comparative therapies effectiveness intravitreal anti-vascular endothelial growth factor meta-analysis |
| url | https://www.mdpi.com/2077-0383/11/7/1834 |
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