Matonti Frédéric, Korobelnik Jean-François, Dot Corinne, Gualino Vincent, Soler Vincent, Mrejen Sarah, Delyfer Marie-Noëlle, Baillif Stéphanie, Streho Maté, Gascon Pierre, Creuzot-Garcher Catherine, Kodjikian Laurent
Centre Monticelli Paradis, 433 Bis Rue Paradis, 13008 Marseille, France.
National Center for Scientific Research (CNRS), Timone Neuroscience Institue (INT), Aix Marseille University, 13008 Marseille, France.
J Clin Med. 2022 Mar 25;11(7):1834. doi: 10.3390/jcm11071834.
Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) have become the standard of care for age-related macular degeneration (AMD). Although most pivotal trials have used monthly injections, alternative strategies that enable the injections to be administered on a more flexible schedule, including pro re nata (PRN) and treat-and-extend (T&E) regimens, are being applied more frequently. This review sought to provide further scientific evidence about the visual outcomes and treatment burden among the currently available anti-VEGF agents and regimens, including aflibercept, ranibizumab, abicipar and brolucizumab. To this end, a systematic review of published randomized studies was conducted from the MEDLINE and EMBASE databases and the Cochrane library, and a meta-analysis was applied to the obtained data using single-means modeling to compare the efficacy and maintenance among the different available treatments and regimens at Years 1 and 2. Quality analysis identified the best-informed data for modeling purposes. Overall, 47 relevant publications were retrieved for the analysis. Superior efficacy, meaning that there were observed improvements in visual acuity (VA) and central retinal thickness (CRT), occurred with monthly versus PRN regimens, yet a higher IVI number was also observed. Conversely, the T&E regimens displayed similar efficacy to the monthly regimens, but with a reduced IVI number. Aflibercept T&E exhibited similar efficacy to ranibizumab T&E, but with significantly lower IVI numbers at both Year 1 (p < 0.0001) and Year 2 (p = 0.0011). Though all of the regimens resulted in maintained efficacy between Years 1 and 2, the required IVI number varied. The retrieved data did not enable other regimens or newer anti-VEGF agents such as brolucizumab to be compared. In conclusion, the T&E regimens were shown to be the most efficient, optimizing durable effectiveness whilst minimizing the IVI number in newly diagnosed exudative AMD, with aflibercept requiring the lowest IVI number.
玻璃体内注射抗血管内皮生长因子（anti-VEGF）已成为年龄相关性黄斑变性（AMD）的标准治疗方法。尽管大多数关键试验采用每月注射，但包括按需（PRN）和治疗并延长（T&E）方案在内的能够更灵活安排注射时间的替代策略正被更频繁地应用。本综述旨在提供关于目前可用的抗VEGF药物和方案（包括阿柏西普、雷珠单抗、阿比西帕和布罗利尤单抗）的视力结果和治疗负担的进一步科学证据。为此，从MEDLINE和EMBASE数据库以及Cochrane图书馆对已发表的随机研究进行了系统综述，并使用单均值模型对获得的数据进行荟萃分析，以比较不同可用治疗方法和方案在第1年和第2年的疗效和维持情况。质量分析确定了用于建模目的的最充分信息的数据。总体而言，共检索到47篇相关出版物进行分析。与PRN方案相比，每月注射方案显示出更高的疗效，即视力（VA）和中心视网膜厚度（CRT）有改善，但注射次数也更多。相反，T&E方案显示出与每月注射方案相似的疗效，但注射次数减少。阿柏西普T&E方案与雷珠单抗T&E方案疗效相似，但在第1年（p < 0.0001）和第2年（p = 0.0011）的注射次数均显著更低。尽管所有方案在第1年和第2年之间都保持了疗效，但所需的注射次数各不相同。检索到的数据无法对其他方案或更新的抗VEGF药物（如布罗利尤单抗）进行比较。总之，T&E方案被证明是最有效的，在新诊断的渗出性AMD中优化了持久疗效，同时将注射次数降至最低，阿柏西普所需的注射次数最少。
