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Intravitreal Injection of Anti-vascular Endothelial Growth Factor in Age-related Macular Degeneration: a Systematic Review
습성 나이관련황반변성에서 항혈관내피성장인자의 유효성과 안전성: 네트워크 메타분석
JKOS 2019 Aug;60(8):748-57
Published online August 15, 2019;  https://doi.org/10.3341/jkos.2019.60.8.748
Copyright © 2019 The Korean Ophthalmological Society.
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Min Joo Kang, MS1, Sang Jin Shin, PhD1, Jae Kyung Suh, PhD1, Songhee Cho, MS1, Hajin Tchoe, MS1, Jangmi Yang, MS1, Donghyun Jee, MD, PhD, MPH2
강민주1 · 신상진1 · 서재경1 · 조송희1 · 최하진1 · 양장미1 · 지동현2

Office of Economic Evaluation Research, National Evidence Based Healthcare Collaborating Agency1, Seoul, Korea
Department of Ophthalmology and Visual Science, St. Vincent Hospital, College of Medicine, The Catholic University of Korea2, Seoul, Korea
한국보건의료연구원 경제성평가연구단1, 가톨릭대학교 의과대학 성빈센트병원 안과 및 시과학교실2
Received May 3, 2018; Revised July 13, 2018; Accepted July 18, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: To compare the efficacy and safety of intravitreal injections of bevacizumab, ranibizumab, and aflibercept for the treatment of new patients with age-related macular degeneration (AMD).
Methods: We conducted an update of the most recent and high quality systematic reviews (Canadian Agency for Drug Technology in Health [CADTH] 2016). Three randomized clinical trials were added to 13 trials identified from the CADTH report. The efficacy outcomes were 1) average improvement in visual acuity, 2) proportion of patients who experienced an improvement in vision (an increase in best-corrected visual acuity (BCVA) of ≥ 15 on Early Treatment Diabetic Retinopathy Study [ETDRS] letters), and 3) proportion of patients who experienced worsening of vision (decrease in BCVA of ≥ 15 ETDRS letters). In addition, safety outcomes included systemic adverse events and ocular-related adverse events. To analyze the outcomes of 16 randomized controlled trials, we conducted meta-analyses on the outcome measures.
Results: There was no significant difference in efficacy outcomes among anti-vascular endothelial growth factor (anti-VEGF) drugs. The mean difference in BCVA between ranibizumab and bevacizumab was 0.33 (95% confidence interval [CI]: -1.29, 1.95), and the odds ratio (OR) for a vision gain in the BCVA of ≥ 15 ETDRS letters for the ranibizumab versus aflibercept treatment was 1.02 (95% CI: 0.80, 1.30). There was also no significant difference in safety outcomes, except in terms of arterial thromboembolic events (ranibizumab vs. bevacizumab; OR: 2.15; 95% CI: 1.04, 4.41).
Conclusions: The efficacy of anti-VEGF drugs for AMD patients was not significantly different. The safety of the drugs was also not significantly different, except in terms of arterial thromboembolic events.
Keywords : Age-related macular degeneration, Intravitreal injection, Meta-analysis, Ranibizumab

 

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