Efficacy/safety of ranibizumab monotherapy or with laser versus laser monotherapy in DME

Berger, Alan R.; Sheidow, Tom; Cruess, Alan F.; Arbour, Jean Daniel; Courseau, Anne-Sophie; Takacsy, Frederica de

doi:10.1016/j.jcjo.2014.12.014

Cited by 30 publications

(38 citation statements)

References 12 publications

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“…1). There were five RCTs1920212223 and 17 non-RCT studies1415161724252627282930313233343536. The latter group included 11 retrospective case series1417242526272829303132, two prospective studies3334, and four post hoc analyses15163536.…”

Section: Resultsmentioning

confidence: 99%

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Sustained Elevation of Intraocular Pressure Associated with Intravitreal Administration of Anti-vascular Endothelial Growth Factor: A Systematic Review and Meta-Analysis

Zhou

Xia

et al. 2016

Sci Rep

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This study aimed to assess whether repetitive intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) cause sustained elevation of intraocular pressure (SE-IOP). We conducted a systematic review and meta-analysis based on five randomized controlled trials (RCTs) assessing 1428 subjects and 17 non-RCTs evaluating 8358 cases. In the RCTs, an increased risk of SE-IOP was found in the anti-VEGF group (summary risk ratio [RR] = 3.00, 95% confidence interval [CI]: 1.63–5.53) compared with the sham injection or laser group. The increased risk of SE-IOP was correlated with follow-up duration (RR = 2.14, 95% CI 0.69–6.57 at 6 months; RR = 3.15, 95% CI 0.99–10.09 at 12 months; RR = 3.48, 95% CI 1.38–8.78 at 23 months). The risk of SE-IOP after non-exclusion of pre-existing glaucoma patients (RR = 3.48, 95% CI 1.38–8.78) was higher than that obtained after excluding pre-existing glaucoma patients (RR = 2.6, 95% CI 1.16–5.81). In non-RCTs, the pooled prevalence of SE-IOP was 4.7% (95% CI 3.7–5.8) regardless of diagnosis criteria. In conclusion, repeated intravitreal injections of anti-VEGF agents cause a 2-fold elevation in SE-IOP risk.

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Section: Resultsmentioning

confidence: 99%

“…All the RCTs1920212223 were included comparing anti-VEGF mono-therapy and control (sham injection or laser treatment) groups. Follow-up of the included cases in all RCTs was at least three months.…”

Section: Resultsmentioning

confidence: 99%

Sustained Elevation of Intraocular Pressure Associated with Intravitreal Administration of Anti-vascular Endothelial Growth Factor: A Systematic Review and Meta-Analysis

Zhou

Xia

et al. 2016

Sci Rep

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“…The change of macular thickness at the final visit from baseline may be further reduced when laser is added to injections, as described in READ-2 study with 3 years of follow-up; this has been also described in a short-term case series at 12 months (152 versus 143 microns reductions with bevacizumab monotherapy and combination therapy, resp.) [31]. Also, in DRCR.net Protocol I, prior laser monotherapy group with ranibizumab added from week 74, achieved the greatest CMT reduction at 5 years.…”

Section: Discussionmentioning

confidence: 99%

Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review

Distéfano

García-Arumí

Martínez-Castillo

et al. 2017

Journal of Ophthalmology

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Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients. Thirty years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) demonstrated that focal/grid laser photocoagulation reduces moderate vision loss from DME by 50% or more; thus, macular photocoagulation became the gold standard treatment for DME. However, with the development of anti-VEGF drugs (bevacizumab, ranibizumab, and aflibercept), better outcomes were obtained in terms of visual acuity gain and decrease in macular thickness in some studies when antiangiogenic drugs were administered in monotherapy. Macular laser therapy may still play an important role as an adjuvant treatment because it is able to improve macular thickness outcomes and reduce the number of injections needed. Here, we review some of the clinical trials that have assessed the efficacy of macular laser treatment, either as part of the treatment protocol or as rescue therapy.

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“…Table 1a–c; for all online suppl. material, see www.karger.com/doi/10.1159/000505070, for studies with 12-, 24-, and 36-month data, respectively) [6, 10, 12, 13, 20-48].…”

Section: Resultsmentioning

confidence: 99%

“…The meta-analyses were performed using the DerSimonian-Laird random-effect method, regardless of the amount of heterogeneity between studies. Notably, changes in BCVA of 10 letters have been shown to be clinically significant in a number of studies [20]. The amount of heterogeneity between studies was based on the significance of the between-study heterogeneity, as well as on the size of the I 2 value.…”

Section: Methodsmentioning

confidence: 99%

Impact of Intravitreal Ranibizumab Therapy on Vision Outcomes in Diabetic Macular Edema Patients: A Meta-Analysis

Falcão

2019

Ophthalmologica

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Purpose: Evaluation of the impact of the injection frequency of ranibizumab on best-corrected visual acuity (BCVA) outcomes in patients with diabetic macular edema (DME). Methods: A meta-analysis of randomized controlled trials (RCTs) and real-world studies was performed to quantify the effect of ranibizumab treatment on BCVA and central foveal thickness (CFT) in DME as well as the relationship between the number of injections and the change in BCVA/CFT. Results: All combined sources (29 RCTs and 11 real-life studies) showed a significant increase in BCVA from baseline following anti-vascular endothelial growth factor (VEGF) treatment (8.2, 9.4, and 10.3 ETDRS letters gained after 12, 24, and 36 months of ranibizumab treatment, respectively). The largest changes in BCVA were observed in RCTs and the smallest in real-life studies at 12 months. A significant relationship was found between the number of injections and change in BCVA at 12 months. Conclusions: Inferior vision outcomes were observed in clinical practice compared with RCTs and might be partly attributable to administration of fewer anti-VEGF injections. Physicians should be aware that early and appropriate anti-VEGF treatment regimens are necessary to obtain the results reported in RCTs and help prevent irreversible vision loss in DME patients.

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Efficacy/safety of ranibizumab monotherapy or with laser versus laser monotherapy in DME

Cited by 30 publications

References 12 publications

Sustained Elevation of Intraocular Pressure Associated with Intravitreal Administration of Anti-vascular Endothelial Growth Factor: A Systematic Review and Meta-Analysis

Sustained Elevation of Intraocular Pressure Associated with Intravitreal Administration of Anti-vascular Endothelial Growth Factor: A Systematic Review and Meta-Analysis

Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review

Impact of Intravitreal Ranibizumab Therapy on Vision Outcomes in Diabetic Macular Edema Patients: A Meta-Analysis

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