Zhang Yan, Chioreso Catherine, Schweizer Marin L, Abràmoff Michael D
Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, United States.
Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States.
Invest Ophthalmol Vis Sci. 2017 Nov 1;58(13):5616-5627. doi: 10.1167/iovs.17-22471.
To compare the effects of aflibercept and other anti-vascular endothelial growth factor (anti-VEGF) medications on both functional and anatomical outcomes for treatment-naïve neovascular age-related macular degeneration (nAMD) in the real world.
A systematic review and meta-analysis of observational comparative studies.
A total of 18 studies remained after literature selection and quality assessment of 1697 studies. The most common aflibercept treatment regimen was three monthly injections followed by pro re nata (PRN). Aflibercept and ranibizumab had similar effects in 2-year treatment. At 3, 6, 12, and 24 months, the differences in the logarithm of minimum angle of resolution (logMAR) decrease in aflibercept and ranibizumab groups were 0.00 (95% confidence interval [CI]: -0.03 to 0.02); 0.01 (95% CI: -0.02 to 0.05); -0.03 (95% CI: -0.07 to 0.01); and -0.06 (95% CI: -0.30 to 0.17), respectively; the differences in decrease of central retinal thickness (CRT) were 3.25 μm (95% CI: -15.03 to 21.53); 7.89 μm (95% CI: -31.91 to 47.69); 2.89 μm (95% CI: -18.33 to 24.11); and -2.42 μm (95% CI: -77.87 to 73.03), respectively. However, aflibercept was significantly more effective in patients with initial reduced visual acuity (logMAR >0.6 or <55 letters; P = 0.001). In the first year, treatment frequency was not significantly different for aflibercept and ranibizumab, but aflibercept required fewer injections than ranibizumab with PRN regimen (mean -0.90; 95% CI: -1.80 to 0.00).
Aflibercept has comparable effects with ranibizumab for treatment-naïve nAMD in the real world, and may be more effective for patients with initial lower visual acuity.
在现实世界中比较阿柏西普与其他抗血管内皮生长因子（抗VEGF）药物对初治新生血管性年龄相关性黄斑变性（nAMD）患者功能和解剖学结局的影响。
对观察性比较研究进行系统评价和荟萃分析。
在对1697项研究进行文献筛选和质量评估后，共保留18项研究。最常见的阿柏西普治疗方案是每月注射3次，然后按需（PRN）给药。阿柏西普和雷珠单抗在2年治疗中的效果相似。在3、6、12和24个月时，阿柏西普组和雷珠单抗组最小分辨角对数（logMAR）下降的差异分别为0.00（95%置信区间[CI]：-0.03至0.02）；0.01（95%CI：-0.02至0.05）；-0.03（95%CI：-0.07至0.01）；以及-0.06（95%CI：-0.30至0.17）；中心视网膜厚度（CRT）下降的差异分别为3.25μm（95%CI：-15.03至21.53）；7.89μm（95%CI：-31.91至47.69）；2.89μm（95%CI：-18.33至24.11）；以及-2.42μm（95%CI：-77.87至73.03）。然而，阿柏西普对初始视力下降的患者（logMAR>0.6或<55个字母；P=0.001）显著更有效。在第一年，阿柏西普和雷珠单抗的治疗频率没有显著差异，但在PRN方案中，阿柏西普比雷珠单抗所需的注射次数更少（平均-0.90；95%CI：-1.80至0.00）。
在现实世界中，阿柏西普与雷珠单抗对初治nAMD的效果相当，对初始视力较低的患者可能更有效。
