Evidence-based Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA
Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA.
Br J Ophthalmol. 2019 Apr;103(4):442-451. doi: 10.1136/bjophthalmol-2018-312691. Epub 2018 Nov 8.
Intravitreal antivascular endothelial growth factor (VEGF) agents are widely used to treat ocular conditions but the benefits and harms of these treatments are uncertain. We conducted a systematic review to compare the effects of aflibercept, bevacizumab and ranibizumab on best-corrected visual acuity (BCVA) changes, quality of life and ocular or systemic adverse events in patients with neovascular age-related macular degeneration (NVAMD), diabetic macular oedema (DME) and central or branch retinal vein occlusion (RVO). We searched published and unpublished literature sources to February 2017 for randomised controlled trials and cohort or modelling studies reporting comparative costs in the USA. Two reviewers extracted data and graded the strength of the evidence using established methods. Of 17 included trials, none reported a clinically important difference (≥ 5 letters) in visual acuity gains between agents. Nine trials provide high-strength evidence of no difference between bevacizumab and ranibizumab for NVAMD. Three trials provide moderate-strength evidence of no difference between bevacizumab and ranibizumab for DME. There was low-strength evidence of similar effects between aflibercept and ranibizumab for NVAMD, aflibercept and bevacizumab for RVO and all three agents for DME. There was insufficient evidence to compare bevacizumab and ranibizumab for RVO. Rates of ocular adverse events were low, and systemic harms were generally similar between groups, although 1 DME trial reported more arterial thrombotic events with ranibizumab versus aflibercept. Overall, no agent had a clear advantage over another for effectiveness or safety. Aflibercept and ranibizumab were significantly less cost-effective than repackaged bevacizumab in two trials. Systematic review registration number: CRD42016034076.
玻璃体内抗血管内皮生长因子 (VEGF) 药物被广泛用于治疗眼部疾病，但这些治疗的益处和危害尚不确定。我们进行了一项系统评价，以比较阿柏西普、贝伐单抗和雷珠单抗对新生血管性年龄相关性黄斑变性（NVAMD）、糖尿病性黄斑水肿（DME）和中心或分支视网膜静脉阻塞（RVO）患者最佳矫正视力（BCVA）变化、生活质量和眼部或全身不良事件的影响。我们搜索了截至 2017 年 2 月发表和未发表的文献来源，以获取在美国报告比较成本的随机对照试验和队列或模型研究。两位审查员使用既定方法提取数据并评估证据强度。在纳入的 17 项试验中，没有一项报告在视力提高方面药物之间存在临床重要差异（≥5 个字母）。9 项试验提供了高强度证据，表明 NVAMD 中贝伐单抗和雷珠单抗之间无差异。3 项试验提供了中等强度证据，表明 DME 中贝伐单抗和雷珠单抗之间无差异。阿柏西普和雷珠单抗对 NVAMD、阿柏西普和贝伐单抗对 RVO 以及所有三种药物对 DME 的疗效相似，有低强度证据。没有足够的证据比较 RVO 中贝伐单抗和雷珠单抗。眼部不良事件发生率低，各组之间的全身危害通常相似，尽管一项 DME 试验报告雷珠单抗组比阿柏西普组发生动脉血栓栓塞事件更多。总体而言，没有一种药物在有效性或安全性方面明显优于另一种药物。在两项试验中，阿柏西普和雷珠单抗的成本效益明显低于重新包装的贝伐单抗。系统评价注册编号：CRD42016034076。
