局部非甾体抗炎药与抗血管内皮生长因子联合治疗年龄相关性黄斑变性的荟萃分析

Combinatorial treatment with topical NSAIDs and anti-VEGF for age-related macular degeneration, a meta-analysis.

作者信息

Li Songshan, Hu Andina, Wang Wei, Ding Xiaoyan, Lu Lin

机构信息

State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China.

出版信息

PLoS One. 2017 Oct 6;12(10):e0184998. doi: 10.1371/journal.pone.0184998. eCollection 2017.

Inflammation is a key pathogenic factor in age-related macular degeneration (AMD). However, the clinical importance of combining anti-VEGF agents and topical NSAIDs to reduce inflammation remains unclear. In this study, we systematically reviewed clinical trials comparing combined treatment versus anti-VEGF alone in AMD patients. We quantified treatment effects via meta-analysis. The pooled weighted mean difference (WMD, -0.91, 95%CI: -1.39 to -0.42, P = 0.0003) demonstrates that combined treatment may reduce required anti-VEGF injection number, probably by means of decreasing central retina thickness (CRT) (WMD = -22.9, 95% CI: -41.20 to -4.59, P = 0.01). The best corrected visual acuity (BCVA) did not change significantly between these two groups (WMD = - 0.01, 95%CI: -0.23 to 0.20, P = 0.90). Topical NSAIDs slightly increased the incidence of foreign body sensation (Odds Ratio [OR] = 2.63, 95%Cl: 1.06 to 6.52, P = 0.76). Combining topical NSAIDs and anti-VEGF agents may provide a new strategy for AMD treatment.

炎症是年龄相关性黄斑变性（AMD）的关键致病因素。然而，联合使用抗血管内皮生长因子（VEGF）药物和局部非甾体抗炎药（NSAIDs）以减轻炎症的临床重要性仍不明确。在本研究中，我们系统回顾了比较AMD患者联合治疗与单纯抗VEGF治疗的临床试验。我们通过荟萃分析对治疗效果进行了量化。汇总加权平均差（WMD，-0.91，95%置信区间：-1.39至-0.42，P = 0.0003）表明，联合治疗可能会减少所需的抗VEGF注射次数，可能是通过降低中央视网膜厚度（CRT）来实现的（WMD = -22.9，95%置信区间：-41.20至-4.59，P = 0.01）。两组之间的最佳矫正视力（BCVA）没有显著变化（WMD = -0.01，95%置信区间：-0.23至0.20，P = 0.90）。局部NSAIDs略微增加了异物感的发生率（优势比[OR] = 2.63，95%置信区间：1.06至6.52，P = 0.76）。联合使用局部NSAIDs和抗VEGF药物可能为AMD治疗提供一种新策略。