Zhang Xiao-Yu, Guo Xiao-Fan, Zhang Shao-Dan, He Jing-Na, Sun Cao-Yu, Zou Yin, Bi Han-Si, Qu Yang
Department of Ophthalmology, the Fourth People's Hospital of Shenyang, Shenyang 110031, Liaoning Province, China.
Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
Int J Ophthalmol. 2014 Apr 18;7(2):355-64. doi: 10.3980/j.issn.2222-3959.2014.02.30. eCollection 2014.
To compare the effectiveness and safety between bevacizumab and ranibizumab in the treatment of age-related macular degeneration (AMD) through a systematic review and meta-analysis.
We performed a comprehensive search of randomized controlled trials (RCTs), non-RCTs, case-control and cohort studies that compared bevacizumab and ranibizumab using PubMed and the Cochrane Library. After the related data were extracted by two investigators independently, pooled weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects or a fixed-effects model.
A total of four RCTs involving 1927 patients and eleven retrospective case series involving 2296 patients were included. For the primary outcomes, no significant differences were found between ranibizumab group and bevacizumab group in visual acuity (WMD: -0.04; 95%CI: -0.08 to 0.00; P=0.06), best corrected visual acuity (WMD: -0.05; 95%CI: -0.10 to 0.00; P=0.05), retina thickness (WMD: -4.69; 95%CI: -13.15 to 3.76; P=0.86) and foveal thickness (WMD: 10.91; 95%CI: -14.73 to 36.56; P=0.40). The pooled analyses in the evaluation of safety showed that compared to bevacizumab, ranibizumab was associated with decreased risks of ocular inflammation (RR: 0.45; 95% CI: 0.23 to 0.89; P=0.02) and venous thrombotic events (RR: 0.27; 95%CI: 0.08 to 0.89; P=0.03). However, there were no significant differences observed in deaths (P=0.69) and arterial thromboembolic events (P=0.71) between the two groups.
With equal clinical efficacy, ranibizumab was found to be associated with less adverse events compared to bevacizumab, indicating that ranibizumab might be a safer management.
通过系统评价和荟萃分析比较贝伐单抗和雷珠单抗治疗年龄相关性黄斑变性（AMD）的有效性和安全性。
我们使用PubMed和Cochrane图书馆对比较贝伐单抗和雷珠单抗的随机对照试验（RCT）、非RCT、病例对照和队列研究进行了全面检索。由两名研究人员独立提取相关数据后，使用随机效应或固定效应模型估计合并加权平均差（WMD）和风险比（RR）以及95%置信区间（CI）。
共纳入4项涉及1927例患者的RCT和11项涉及2296例患者的回顾性病例系列。对于主要结局，雷珠单抗组和贝伐单抗组在视力（WMD：-0.04；95%CI：-0.08至0.00；P=0.06）、最佳矫正视力（WMD：-0.05；95%CI：-0.10至0.00；P=0.05）、视网膜厚度（WMD：-4.69；95%CI：-13.15至3.76；P=0.86）和黄斑中心凹厚度（WMD：10.91；95%CI：-14.73至36.56；P=0.40）方面均未发现显著差异。安全性评估的汇总分析表明，与贝伐单抗相比，雷珠单抗与眼部炎症风险降低（RR：0.45；95%CI：0.23至0.89；P=0.02）和静脉血栓形成事件风险降低（RR：0.27；95%CI：0.08至0.89；P=0.03）相关。然而，两组在死亡（P=0.69）和动脉血栓栓塞事件（P=0.71）方面未观察到显著差异。
在临床疗效相当的情况下，发现雷珠单抗与贝伐单抗相比不良事件更少，这表明雷珠单抗可能是一种更安全的治疗方法。
