Comparative Efficacy of Pharmacotherapy for Macular Edema Secondary to Retinal Vein Occlusion: A Network Meta-analysis.

Sheng Gao,Jianan Duan,Ge Ge,Xun Li,Chunyan Lei,Zhaolun Cai,Meixia Zhang,Yue Zeng,Yun Zhang

doi:10.3389/fphar.2021.752048

Abstract

Purpose: This network meta-analysis was conducted to obtain the relative effectiveness of different pharmacotherapy of macular edema secondary to retinal vein occlusion (RVO) by summarizing all available evidences. Methods: PubMed, Embase, and Cochrane Library databases were searched for all relevant randomized controlled trials. The outcomes were estimated through a network meta-analysis, including the mean change in best-corrected visual acuity (BCVA) from baseline, the proportion of patients who gained ≥15 letters in BCVA from baseline, the mean change in central retinal thickness (CRT). Results: We identified 15 randomized controlled trials (RCTs) involving 3,431 patients with RVO in our study. Different therapeutic regimens were compared including three anti-vascular endothelial growth factor (VEGF) agents (ranibizumab, bevacizumab, and aflibercept), ranibizumab with laser, dexamethasone intravitreal implant, and laser. For branch RVO, ranibizumab 0.5 mg monthly [weighted mean difference (WMD) = 11, 95% confidence intervals (CrI) 3.6 to 19], ranibizumab 0.5 mg 3 + pro re nata (WMD = 9.4, 95% CrI 0.43–18) is most effective in terms of changes of BCVA and 15 letters or more of BCVA improvement. For central RVO, three anti-VEGF regimens can improve visual acuity and there is no significant difference of efficacy among ranibizumab, bevacizumab and aflibercept (p > 0.05). Ranibizumab 0.5 mg monthly could achieve additional efficacy in CRT reduction in eyes with branch RVO or central RVO (WMD = -130, 95% CrI -400 to 140 or WMD = -280, 95% CrI -590 to 16)). Dexamethasone intravitreal implant (WMD = 1.7, 95% CrI -4.2 to 7.1 or WMD = 0.38, 95% CrI -9.8 to 8.8)) did not show a significant improvement in visual acuity at the end of 6 months follow-up in eyes with branch RVO or central RVO. Conclusion: In summary, this network meta-analysis demonstrated several anti-VEGF agents had equivalent effects on mean visual acuity changes and anatomical recovery in 6 months in eyes with branch or central RVO. Only one injection of dexamethasone intravitreal implant in 6 months could not maintain the visual benefit. Patients and clinicians could choose pharmacotherapies with further consideration toward personal factors.

Highlights

Retinal vein occlusion (RVO) is the second most common retinal vascular disease which threatens visual acuity (VA) through macular edema and neovascularization
2.3.1 Patients and Comparison of Interventions The randomized controlled trials (RCTs) that compared two or more of the following treatment strategies (different anti-VEGF monotherapy regimens, anti-VEGF agent combined with laser photocoagulation, intravitreal corticosteroid monotherapy, and sham-controlled group) for patients with branch RVO (BRVO) or central RVO (CRVO) were included in our analysis
Fifteen RCTs that conformed to the inclusion criteria were contained in the network analysis, including six RCTs for BRVO(Haller et al, 2010; Campochiaro et al, 2011; Tan et al, 2014; Li X. et al, 2017; Tadayoni et al, 2017; Hattenbach et al, 2018) and nine RCTs for CRVO(Brown et al, 2010a; Haller et al, 2010; Kinge et al, 2010; Boyer et al, 2012; Epstein et al, 2012; Holz et al, 2013; Hoerauf et al, 2016; Scott et al, 2017a; Li X. et al, 2017)

Summary

Introduction

Retinal vein occlusion (RVO) is the second most common retinal vascular disease which threatens visual acuity (VA) through macular edema and neovascularization. Several studies have confirmed the efficacy of pharmacotherapy for RVO secondary macular edema including anti-vascular endothelial growth factor (antiVEGF) and corticosteroids intravitreal injection (Brown et al, 2011; Campochiaro et al, 2011). The published guidelines highlight several therapeutic strategies as recommendable treatment for patients with macular edema secondary to RVO(Schmidt-Erfurth et al, 2019; Flaxel et al, 2020). It is still limited to an incomplete comparison of pharmacotherapy, or only one of the BRVO or CRVO has been analyzed (Ford et al, 2014; Regnier et al, 2015; Sermsiri et al, 2018). The network meta-analysis overcomes the limitation of traditional meta-analysis and a shortage of head-to-head trials (Rücker, 2012)

Methods

Results

Discussion

Conclusion