Liao Weiting, Zhong Zhenyu, Su Guannan, Feng Xiaojie, Yang Peizeng
The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China.
Front Pharmacol. 2022 Apr 5;13:749312. doi: 10.3389/fphar.2022.749312. eCollection 2022.
To compare the efficacy and safety of advanced intravitreal therapeutic regimens, including a dexamethasone implant at 350 and 700 μg; a fluocinolone acetonide (FA) implant, 0.2 µg/day, 0.59 and 2.1 mg; intravitreal bevacizumab, 1.25 mg; intravitreal ranibizumab, 0.5 mg; intravitreal triamcinolone acetonide (IVTA), 2 and 4 mg; and standard of care (SOC, systemic therapy) for noninfectious uveitis. We searched the Cochrane Library database, EMBASE, Medline, clinicaltrials.gov until April 2021 with 13 RCTs (1806 participants) identified and conducted a pairwise and Bayesian network meta-analysis with random effects. No specific regimen showed a statistically significant advantage or disadvantage to another treatment regimen with regard to efficacy. However, the FA implant, 0.59 mg was associated with a higher risk of cataract (RR 4.41, 95% CI 1.51-13.13) and raise in intraocular pressure (IOP) (RR 2.53 95% CI 1.14-6.25) compared with SOC at 24 months. IVTA, 4 mg at 6 months was associated with lower risk of IOP rising compared with FA implant, 0.2 µg/day at 36 months (RR 3.43 95% CI 1.12-11.35). No intravitreal therapeutic regimens showed a significant advantage or disadvantage with regard to efficacy. However, SOC was associated with lower risk of side effects compared with FA implants. IVTA, 4 mg, might be the best choice with lowest risk of IOP rising. clinicaltrials.gov, identifier CRD42020172953.
为比较先进玻璃体内治疗方案的疗效和安全性，这些方案包括350μg和700μg的地塞米松植入物；0.2μg/天、0.59mg和2.1mg的醋酸氟轻松（FA）植入物；1.25mg玻璃体内注射贝伐单抗；0.5mg玻璃体内注射雷珠单抗；2mg和4mg玻璃体内注射曲安奈德；以及非感染性葡萄膜炎的标准治疗（SOC，全身治疗）。我们检索了Cochrane图书馆数据库、EMBASE、Medline、clinicaltrials.gov直至2021年4月，共识别出13项随机对照试验（1806名参与者），并进行了随机效应的成对和贝叶斯网络荟萃分析。在疗效方面，没有特定方案显示出相对于其他治疗方案有统计学上的显著优势或劣势。然而，与24个月时的SOC相比，0.59mg的FA植入物与更高的白内障风险（风险比4.41，95%置信区间1.51 - 13.13）和眼压（IOP）升高风险（风险比2.53，95%置信区间1.14 - 6.25）相关。与36个月时0.2μg/天的FA植入物相比，6个月时4mg的玻璃体内注射曲安奈德与更低的IOP升高风险相关（风险比3.43，95%置信区间1.12 - 11.35）。没有玻璃体内治疗方案在疗效方面显示出显著优势或劣势。然而，与FA植入物相比，SOC的副作用风险更低。4mg的玻璃体内注射曲安奈德可能是IOP升高风险最低的最佳选择。clinicaltrials.gov，标识符CRD4202
