Intravitreal antivascular endothelial growth factor in diabetic macular oedema: scoping review of clinical practice guidelines recommendations

Abstract

BackgroundDiabetic macular oedema (DME) is a worldwide major cause of low vision and blindness. Intravitreal antivascular endothelial growth factor (anti-VEGF) constitutes an effective treatment. Clinical practice guidelines (CPGs) are synthesis documents that seek to improve patient care.ObjectivesTo identify CPGs that make anti-VEGF recommendations for DME and to assess their reporting quality and their considerations when making recommendations.Eligibility criteriaCPGs published between December 2009 and December 2019 that make explicit anti-VEGF recommendations in DME.Sources of evidenceSensitive search strategy in Embase, Google Scholar and hand-searching on 165 websites.MethodsWe extracted information from each CPG with a previously piloted sheet. Two independent authors applied theAppraisal of Guidelines, Research and Evaluation tool (AGREE-II) assessment for each CPG.ResultsThe 21 included CPGs recommend anti-VEGF for DME, but there is a wide variation among the clinical aspects included, such as location of DME, visual acuity required, therapeutical alternatives or discontinuation. Most have a poor quality of reporting based on the AGREE-II tool assessment, especially those developed by ophthalmological societies, those that have an exclusive content about DME, and those where most of their authors disclose conflict of interest (COI) with pharmaceutical industry or where their authors did not report COIs. Pharmaceutical-sponsored CPGs did not use systematic reviews (SRs) to support their recommendations. Very few recommendations consider patient values and preferences, equity, acceptability and feasibility of the intervention.ConclusionsMost of the CPGs that made recommendations of anti-VEGF for DME have poor quality of reporting, do not use SRs and do not consider patients’ values and preferences.

Sustained Disease Control in DME Patients upon Treatment Cessation with Brolucizumab

“…Many guidelines have defined the roles of anti-VEGF and corticosteroid treatment in DME, including strategies to cope with cases insufficiently responsive to anti-VEGF agents [ 8 , 9 , 12 , 47 , 48 ]. The option of treatment cessation in eyes achieving a dry retina under stable ≥12-weekly intervals using anti-VEGF therapy has never systematically been considered [ 11 ].…”

“…(B) Is the chance for and time to treatment cessation linked to the severity of the underlying disease and the preexisting vascular damage or to the anti-VEGF drug under which a dry retina has been removed? Many guidelines have defined the roles of anti-VEGF and corticosteroid treatment in DME, including strategies to cope with cases insufficiently responsive to anti-VEGF agents [8,9,12,47,48]. The option of treatment cessation in eyes achieving a dry retina under stable ≥12-weekly intervals using anti-VEGF therapy has never systematically been considered [11].…”

“…This may explain the differences between randomized clinical trial outcomes and unfiltered real-word evidence, most frequently, but not exclusively, explained by limited compliance and treatment adherence, as outlined above [11]. In the absence of robust 2 of 13 evidence, the majority of guidelines on how to improve real-world outcomes are grounded in expert opinion [12].…”

Clinical practice guidelines for the diagnosis and management of Duchenne muscular dystrophy: a scoping review

“…Scoping reviews cover a broader field of review than systematic reviews (SRs); in addition, they can be used to qualitatively describe and evaluate the methodology of a CPG (9). Some similar papers were related to the diagnosis and treatment of liver tumors, diabetic macular edema and atopic dermatitis (10)(11)(12). Due to the importance of high-quality CPGs for RDs, it is necessary to evaluate them critically; thus, our objective was to identify CPGs for the diagnosis and management of DMD through an evaluation of methodology formulation and a comparison of clinical recommendations for a better application in clinical practice.…”