Purchase this article with an account.
Stephane A Regnier, William Malcolm, Jonathan Wright; Efficacy comparison of anti-VEGF and laser photocoagulation in the treatment of visual impairment due to diabetic macular edema: a systematic review and network meta-analysis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1772.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Compare the efficacy of approved therapies in the treatment of visual impairment (VI) due to diabetic macular edema (DME).
A systematic review was conducted to identify relevant randomized clinical trials (RCTs). Studies reporting 6- or 12-month results of RCTs evaluating the efficacy of at least two of ranibizumab 0.5 mg pro re nata (PRN), aflibercept 2q8, laser photocoagulation therapy or sham were included. The outcomes of interest were improvement in best-corrected visual acuity (BCVA) measured as the proportion of patients gaining at least 10 letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale and the proportion of patients gaining at least 15 letters. The sensitivity analyses included RETAIN (ranibizumab PRN vs. treat & extend, T&E).<br /> Comparisons of efficacy were made using a Bayesian network meta-analysis with random treatment effects adjusting for baseline BCVA. The relative treatment effects were the odds ratio (OR) for the percentage of patients experiencing an improvement in BCVA of at least 15 letters and those experiencing an improvement of at least 10 letters.
The analysis included 2220 patients from 9 RCTs (VIVD, VISTA, DA VINCI, RESTORE, RESPOND, RESOLVE, READ-2, DRCR-net Protocol I and RETAIN). For the percentage of patients who gained ≥10 letters, ranibizumab was numerically superior to aflibercept (OR, 1.6; 95% credible interval [CrI], 0.6-5.4). The odds of gaining ≥ 15 letters were the same for ranibizumab 0.5 mg PRN and aflibercept 2q8 (OR, 1.0; 95% CrI, 0.3-5.9). The numerical difference between the two results can be explained by ranibizumab PRN’s higher probability of being a better treatment than aflibercept for a 10-14 letter improvement (92% vs. 8% for aflibercept). For both endpoints (i.e. improvement ≥ 10 letters and improvement ≥ 15 letters), the probability that ranibizumab PRN and aflibercept were superior to laser monotherapy was greater than 95%. Ranibizumab T&E was numerically superior to aflibercept (OR ≥ 10 letters: 1.6; 95% CrI, 0.4-8.9 and OR ≥ 15 letters: 1.1; 95% CrI, 0.3-9.7).
When adjusting for BCVA at baseline, ranibizumab PRN and ranibizumab T&E had similar probabilities of gaining ≥ 15 letters as aflibercept 2q8. However, ranibizumab patients had a higher probability of a 10-14 letter improvement than aflibercept patients.
This PDF is available to Subscribers Only