Anti-vascular endothelial growth factor therapy and retinal non-perfusion in diabetic retinopathy : A meta-analysis of randomised trials
© 2023 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation..
PURPOSE: Retinal non-perfusion (RNP) is fundamental to disease onset and progression in diabetic retinopathy (DR). Whether anti-vascular endothelial growth factor (anti-VEGF) therapy can modify RNP progression is unclear. This investigation quantified the impact of anti-VEGF therapy on RNP progression compared with laser or sham at 12 months.
METHODS: A systematic review and meta-analysis of randomised controlled trials (RCTs) were performed; Ovid MEDLINE, EMBASE and CENTRAL were searched from inception to 4th March 2022. The change in any continuous measure of RNP at 12 months and 24 months was the primary and secondary outcomes, respectively. Outcomes were reported utilising standardised mean differences (SMD). The Cochrane Risk of Bias Tool version-2 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines informed risk of bias and certainty of evidence assessments.
RESULTS: Six RCTs (1296 eyes) and three RCTs (1131 eyes) were included at 12 and 24 months, respectively. Meta-analysis demonstrated that RNP progression may be slowed with anti-VEGF therapy compared with laser/sham at 12 months (SMD: -0.17; 95% confidence interval [CI]: -0.29, -0.06; p = 0.003; I2 = 0; GRADE rating: LOW) and 24-months (SMD: -0.21; 95% CI: -0.37, -0.05; p = 0.009; I2 = 28%; GRADE rating: LOW). The certainty of evidence was downgraded due to indirectness and due to imprecision.
CONCLUSION: Anti-VEGF treatment may slightly impact the pathophysiologic process of progressive RNP in DR. The dosing regimen and the absence of diabetic macular edema may impact this potential effect. Future trials are needed to increase the precision of the effect and inform the association between RNP progression and clinically important events.
PROSPERO REGISTRATION: CRD42022314418.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:102 |
|---|---|
| Enthalten in: |
Acta ophthalmologica - 102(2024), 1 vom: 01. Jan., Seite e31-e41 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Nanji, Keean [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 09.01.2024 Date Revised 09.01.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/aos.15673 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM355467895 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM355467895 | ||
| 003 | DE-627 | ||
| 005 | 20240114232917.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/aos.15673 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1253.xml |
| 035 | |a (DE-627)NLM355467895 | ||
| 035 | |a (NLM)37042340 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Nanji, Keean |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Anti-vascular endothelial growth factor therapy and retinal non-perfusion in diabetic retinopathy |b A meta-analysis of randomised trials |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 09.01.2024 | ||
| 500 | |a Date Revised 09.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation. | ||
| 520 | |a PURPOSE: Retinal non-perfusion (RNP) is fundamental to disease onset and progression in diabetic retinopathy (DR). Whether anti-vascular endothelial growth factor (anti-VEGF) therapy can modify RNP progression is unclear. This investigation quantified the impact of anti-VEGF therapy on RNP progression compared with laser or sham at 12 months | ||
| 520 | |a METHODS: A systematic review and meta-analysis of randomised controlled trials (RCTs) were performed; Ovid MEDLINE, EMBASE and CENTRAL were searched from inception to 4th March 2022. The change in any continuous measure of RNP at 12 months and 24 months was the primary and secondary outcomes, respectively. Outcomes were reported utilising standardised mean differences (SMD). The Cochrane Risk of Bias Tool version-2 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines informed risk of bias and certainty of evidence assessments | ||
| 520 | |a RESULTS: Six RCTs (1296 eyes) and three RCTs (1131 eyes) were included at 12 and 24 months, respectively. Meta-analysis demonstrated that RNP progression may be slowed with anti-VEGF therapy compared with laser/sham at 12 months (SMD: -0.17; 95% confidence interval [CI]: -0.29, -0.06; p = 0.003; I2 = 0; GRADE rating: LOW) and 24-months (SMD: -0.21; 95% CI: -0.37, -0.05; p = 0.009; I2 = 28%; GRADE rating: LOW). The certainty of evidence was downgraded due to indirectness and due to imprecision | ||
| 520 | |a CONCLUSION: Anti-VEGF treatment may slightly impact the pathophysiologic process of progressive RNP in DR. The dosing regimen and the absence of diabetic macular edema may impact this potential effect. Future trials are needed to increase the precision of the effect and inform the association between RNP progression and clinically important events | ||
| 520 | |a PROSPERO REGISTRATION: CRD42022314418 | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a anti-VEGF therapy | |
| 650 | 4 | |a diabetes | |
| 650 | 4 | |a diabetic retinopathy | |
| 650 | 4 | |a meta-analysis | |
| 650 | 4 | |a retina | |
| 650 | 4 | |a retinal non-perfusion | |
| 650 | 4 | |a systematic review | |
| 650 | 7 | |a Ranibizumab |2 NLM | |
| 650 | 7 | |a ZL1R02VT79 |2 NLM | |
| 650 | 7 | |a Bevacizumab |2 NLM | |
| 650 | 7 | |a 2S9ZZM9Q9V |2 NLM | |
| 650 | 7 | |a Endothelial Growth Factors |2 NLM | |
| 650 | 7 | |a Vascular Endothelial Growth Factor A |2 NLM | |
| 700 | 1 | |a Sarohia, Gurkaran S |e verfasserin |4 aut | |
| 700 | 1 | |a Xie, Jim |e verfasserin |4 aut | |
| 700 | 1 | |a Patil, Nikhil S |e verfasserin |4 aut | |
| 700 | 1 | |a Phillips, Mark |e verfasserin |4 aut | |
| 700 | 1 | |a Zeraatkar, Dena |e verfasserin |4 aut | |
| 700 | 1 | |a Thabane, Lehana |e verfasserin |4 aut | |
| 700 | 1 | |a Guymer, Robyn H |e verfasserin |4 aut | |
| 700 | 1 | |a Kaiser, Peter K |e verfasserin |4 aut | |
| 700 | 1 | |a Sivaprasad, Sobha |e verfasserin |4 aut | |
| 700 | 1 | |a Sadda, Srinivas R |e verfasserin |4 aut | |
| 700 | 1 | |a Wykoff, Charles C |e verfasserin |4 aut | |
| 700 | 1 | |a Chaudhary, Varun |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Acta ophthalmologica |d 2008 |g 102(2024), 1 vom: 01. Jan., Seite e31-e41 |w (DE-627)NLM171266315 |x 1755-3768 |7 nnns |
| 773 | 1 | 8 | |g volume:102 |g year:2024 |g number:1 |g day:01 |g month:01 |g pages:e31-e41 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/aos.15673 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 102 |j 2024 |e 1 |b 01 |c 01 |h e31-e41 | ||