抗血管内皮生长因子药物、康柏西普、雷珠单抗、贝伐单抗和激光治疗早产儿视网膜病变的疗效和眼安全性：系统评价和荟萃分析。
The efficacy and ocular safety following aflibercept, conbercept, ranibizumab, bevacizumab, and laser for retinopathy of prematurity: a systematic review and meta-analysis.
机构信息
Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
出版信息
Ital J Pediatr. 2023 Oct 9;49(1):136. doi: 10.1186/s13052-023-01543-3.
BACKGROUND
Retinopathy of prematurity (ROP) is typically treated with laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF). To the best of our knowledge, most systematic reviews have focused on comparing anti-VEGF against laser treatment while comparisons between different anti-VEGF agents are lacking. Thus, we conducted this meta-analysis to compare the efficacy and safety of different anti-VEGF agents or laser after primary ROP therapy.
METHODS
We conducted a comprehensive search across multiple databases up to November 2022. We included studies that used anti-VEGF or laser for ROP with comparable cohorts.
RESULTS
Overall, 44 studies were included in this meta-analysis. When comparing anti-VGEF with laser, we found that the anti-VEGF group had a significantly higher retreatment rate (RR = 1.56, 95%CI = [1.06, 2.31], p = 0.03), a longer time from treatment to retreatment (WMD = 5.99 weeks, 95%CI = [4.03, 7.95], p < 0.001), a lower retinal detachment rate (RR = 0.55, 95%CI = [0.30, 0.91], p = 0.02), higher spherical equivalent (WMD = 1.69D, 95%CI = [0.61, 2.77], p = 0.002), lower myopia rate (RR = 0.69, 95%CI = [0.50, 0.97], p = 0.03) and lower anisometropia rate (RR = 0.44, 95%CI = [0.29, 0.67], p = 0.0001). In comparisons between ranibizumab and bevacizumab, the intravitreal ranibizumab (IVR) group was associated with higher recurrence rate (RR = 2.02, 95%CI = [1.49, 2.73], p < 0.0001), higher retreatment rate (RR = 1.70, 95%CI = [1.17, 2.47], p = 0.0006), and lower high myopia rate (RR = 0.31, 95%CI = [0.12, 0.77], p = 0.01). Similarly, when compared to aflibercept and conbercept, the IVR cohort also demonstrated higher recurrence and retreatment rates. While no significant differences were observed in any of the variables included in the statistical analysis in the comparison between bevacizumab and aflibercept.
CONCLUSIONS
Anti-VEGF was associated with higher retreatment and lesser incidence of myopia as compared to laser. Laser therapy was linked to more complications like retinal detachment and myopia. Ranibizumab exhibited higher recurrence and retreatment rates compared to bevacizumab, aflibercept, and conbercept.
背景
早产儿视网膜病变（ROP）通常采用激光光凝和/或玻璃体内抗血管内皮生长因子（anti-VEGF）治疗。据我们所知，大多数系统评价都集中在比较抗 VEGF 与激光治疗上，而缺乏不同抗 VEGF 药物之间的比较。因此，我们进行了这项荟萃分析，以比较原发性 ROP 治疗后不同抗 VEGF 药物或激光的疗效和安全性。
方法
我们在多个数据库中进行了全面搜索，截至 2022 年 11 月。我们纳入了使用抗 VEGF 或激光治疗 ROP 且具有可比性队列的研究。
结果
总体而言，共有 44 项研究纳入了本荟萃分析。与激光相比，抗 VEGF 组的再治疗率显著更高（RR=1.56，95%CI=[1.06，2.31]，p=0.03），从治疗到再治疗的时间更长（WMD=5.99 周，95%CI=[4.03，7.95]，p<0.001），视网膜脱离率更低（RR=0.55，95%CI=[0.30，0.91]，p=0.02），等效球镜度数更高（WMD=1.69D，95%CI=[0.61，2.77]，p=0.002），近视率更低（RR=0.69，95%CI=[0.50，0.97]，p=0.03）和屈光参差率更低（RR=0.44，95%CI=[0.29，0.67]，p=0.0001）。在比较雷珠单抗和贝伐单抗时，玻璃体内雷珠单抗（IVR）组的复发率更高（RR=2.02，95%CI=[1.49，2.73]，p<0.0001），再治疗率更高（RR=1.70，95%CI=[1.17，2.47]，p=0.0006），高度近视率更低（RR=0.31，95%CI=[0.12，0.77]，p=0.01）。同样，与康柏西普相比，IVR 组的复发和再治疗率也更高。而贝伐单抗与阿柏西普之间的统计学分析中纳入的任何变量均无显著差异。
结论
与激光相比，抗 VEGF 与更高的再治疗率和较少的近视发生率相关。激光治疗与视网膜脱离和近视等更多并发症相关。雷珠单抗的复发和再治疗率高于贝伐单抗、阿柏西普和康柏西普。
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