학술논문
Efficacy, safety, and treatment burden of treat-and-extend versus alternative anti-VEGF regimens for nAMD: a systematic review and meta-analysis.
Document Type
Academic Journal
Author
Rosenberg D; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada.; Deonarain DM; St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, L8G 5E4, Canada.; Gould J; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada.; Sothivannan A; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada.; Phillips MR; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8P 1H6, Canada.; Sarohia GS; Department of Ophthalmology and Visual Sciences, University of Alberta, 400, 10924, 107 Avenue, Edmonton, AB, T5H 0X5, Canada.; Sivaprasad S; NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, EC1V 2PD, UK.; Wykoff CC; Retina Consultants of Houston, Houston, TX, 77030, USA.; Cheung CMG; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke NUS Medical School, Singapore, Singapore.; Sarraf D; Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Administration Healthcare Center, Los Angeles, CA, 90095, USA.; Greater Los Angeles VA Center, Los Angeles, CA, USA.; Bakri SJ; Department of Ophthalmology, Mayo Clinic, Rochester, MN, 55905, USA.; Chaudhary V; St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, L8G 5E4, Canada. vchaudh@mcmaster.ca.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8P 1H6, Canada. vchaudh@mcmaster.ca.; Department of Surgery, McMaster University, Hamilton, ON, L8P 1H6, Canada. vchaudh@mcmaster.ca.
Source
Publisher: Nature Publishing Group Country of Publication: England NLM ID: 8703986 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-5454 (Electronic) Linking ISSN: 0950222X NLM ISO Abbreviation: Eye (Lond) Subsets: MEDLINE
Subject
Language
English
Abstract
This study aimed to compare efficacy and treatment burden of treat-and-extend (T&E) anti-VEGF against fixed and pro re nata (PRN) regimens for neovascular age-related macular degeneration (nAMD). MEDLINE, CENTRAL, and EMBASE were searched. Randomized-controlled trials and observational studies comparing T&E to PRN or fixed dosing for treatment-naïve AMD patients were included. Mean difference (MD) for visual acuity (VA) and number of injections are presented. Risk of bias was assessed according to Cochrane guidelines. Methodology was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). VA improvement was similar with T&E and fixed dosing at one (MD -0.08 letters, p = 0.95) and two years (MD 0.58 letters, p = 0.62). In contrast, VA improvements were significantly greater for T&E when compared against a PRN regimen at one (MD 3.95 letters, p < 0.0001) and two years (MD 4.08 letters, p < 0.001). Significantly fewer ranibizumab injections were administered in the T&E arm at one (MD -2.42 injections, p < 0.0001) and two years (MD -6.06 injections, p < 0.00001) relative to fixed dosing. Fewer aflibercept injections were likewise administered to patients on a T&E regimen versus fixed dosing at one year (MD -0.78 injections, p < 0.0001). Low-certainty evidence from the present synthesis implies that T&E preserves VA similar to fixed schedules with significantly fewer injections at one and two years. Also, patients with T&E dosing achieved better VA outcomes than those on PRN regimen but T&E dosing was associated with more injections.
(© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)
(© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)