Comparative Efficacy and Safety of Advanced Intravitreal Therapeutic Agents for Noninfectious Uveitis: A Systematic Review and Network Meta-Analysis

Abstract

Background: 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.Methods: 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.Results: 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).Conclusion: 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.Systematic Review Registration:clinicaltrials.gov, identifier CRD42020172953

Long-Acting Fluocinolone Acetonide Intravitreal Implant for Recurrent Bilateral Non-Infectious Posterior Uveitis

“… 13 Additionally, YUTIQ was ranked higher in probability of being the most efficacious drug for improving BCVA at 6 months over Ozurdex. 13 Unlike Ozurdex, the YUTIQ implant is made of an inert non-biodegradable material that does not require surgical removal. 5 , 7 Furthermore, the active compound FA in YUTIQ is more potent than dexamethasone, but is in a lower dose compared to its predecessor Retisert to minimize the side effects and is placed through a less invasive intravitreal injection.…”

“…11,12 A recent systemic review and network meta-analysis comparing efficacy and safety of intravitreal therapeutic agents for NIU concluded that YUTIQ (FA implant 0.2 µg/day, calculated delivered dose) improved BCVA as much as Ozurdex (0.7 mg dexamethasone implant) at 6 months, but no 12 month data was provided for Ozurdex and this meta-analysis does not highlight the efficacy of YUTIQ over Ozurdex in patients refractory to topical corticosteroids and Ozurdex treatment. 13 Additionally, YUTIQ was ranked higher in probability of being the most efficacious drug for improving BCVA at 6 months over Ozurdex. 13 Unlike Ozurdex, the YUTIQ implant is made of an inert non-biodegradable material that does not require surgical removal.…”