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Intravitreal anti‐vascular endothelial growth factors, panretinal photocoagulation and combined treatment for proliferative diabetic retinopathy: a systematic review and network meta‐analysis

Intravitreal anti‐vascular endothelial growth factors, panretinal photocoagulation and combined treatment for proliferative diabetic retinopathy: a systematic review and network meta‐analysis
Intravitreal anti‐vascular endothelial growth factors, panretinal photocoagulation and combined treatment for proliferative diabetic retinopathy: a systematic review and network meta‐analysis
Purpose: to conduct a systematic review with network meta‐analysis (NMA) of randomized clinical trials (RCTs) comparing panretinal photocoagulation (PRP) versus anti‐vascular endothelial growth factor (VEGF) treatment alone or in combination with PRP, for proliferative diabetic retinopathy (PDR).

Methods: PubMed, Medline and Embase databases were searched for RCTs comparing PRP versus intravitreal anti‐VEGF therapy and/or combined PRP and intravitreal anti‐VEGF for PDR. The primary outcome measures were the mean best corrected visual acuity (BCVA) change and the regression of neovascularization. Mean change of central macular thickness (CMT), the subgroup analyses of patients without diabetic macular oedema (DME) and the rate of vitreous haemorrhage and vitrectomy were secondary outcomes. Frequentist NMAs were performed.

Results: twelve RCTs were included. For the 12‐month mean BCVA change, NMA showed a better visual outcome in both the anti‐VEGF group and combined group compared to PRP [anti‐VEGF vs PRP, mean difference (MD) = 3.42; standard error (SE) = 1.5; combined vs PRP, MD = 3.92; SE = 1.65], with no difference between combined group and anti‐VEGF (MD = −0.50; SE = 1.87). No difference in neovascularization regression was found between PRP and anti‐VEGF alone or in combination with PRP, but there was significant inconsistency (p = 0.016). Subgroup analyses in patients without DME yielded no difference for the 12‐month visual outcome between the three interventions, but with significant inconsistency (p = 0.005).

Conclusion: this NMA showed limited evidence of comparable efficacy in terms of neovascularization regression between PRP and anti‐VEGF therapy alone or in combination with PRP, but better visual outcomes were associated with anti‐VEGF use. Intravitreal anti‐VEGF therapy could be a valid therapeutic option in association with PRP.
1755-375X
Fallico, Matteo
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Maugeri, Andrea
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Lotery, Andrew
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Longo, Antonio
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Bonfiglio, Vincenza
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Russo, Andrea
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Avitabile, Teresio
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Pulvirenti, Alfredo
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Furino, Claudio
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Cennamo, Gilda
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Barchitta, Martina
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Agodi, Antonella
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Reibaldi, Michele
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Fallico, Matteo
6b8163e9-d1fd-41ea-bd2e-449a0bdd5561
Maugeri, Andrea
22a51f26-2ce4-40ee-8b0b-3a7cfcc78372
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Longo, Antonio
c915254f-232d-4fa8-bce0-bac0932ac354
Bonfiglio, Vincenza
e0dca918-9dda-4186-a6a3-06d13807bff3
Russo, Andrea
0714d984-4869-4cb1-b481-33369d3145e2
Avitabile, Teresio
6a4dca14-5caf-4c17-ba3a-50f03dd7951c
Pulvirenti, Alfredo
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Furino, Claudio
afa13e57-68b1-4f8b-86c5-485f9002d848
Cennamo, Gilda
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Barchitta, Martina
5425c175-62d9-47b6-b146-eea59963e8af
Agodi, Antonella
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Reibaldi, Michele
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Fallico, Matteo, Maugeri, Andrea, Lotery, Andrew, Longo, Antonio, Bonfiglio, Vincenza, Russo, Andrea, Avitabile, Teresio, Pulvirenti, Alfredo, Furino, Claudio, Cennamo, Gilda, Barchitta, Martina, Agodi, Antonella and Reibaldi, Michele (2020) Intravitreal anti‐vascular endothelial growth factors, panretinal photocoagulation and combined treatment for proliferative diabetic retinopathy: a systematic review and network meta‐analysis. Acta Ophthalmologica. (doi:10.1111/aos.14681).

Record type: Article

Abstract

Purpose: to conduct a systematic review with network meta‐analysis (NMA) of randomized clinical trials (RCTs) comparing panretinal photocoagulation (PRP) versus anti‐vascular endothelial growth factor (VEGF) treatment alone or in combination with PRP, for proliferative diabetic retinopathy (PDR).

Methods: PubMed, Medline and Embase databases were searched for RCTs comparing PRP versus intravitreal anti‐VEGF therapy and/or combined PRP and intravitreal anti‐VEGF for PDR. The primary outcome measures were the mean best corrected visual acuity (BCVA) change and the regression of neovascularization. Mean change of central macular thickness (CMT), the subgroup analyses of patients without diabetic macular oedema (DME) and the rate of vitreous haemorrhage and vitrectomy were secondary outcomes. Frequentist NMAs were performed.

Results: twelve RCTs were included. For the 12‐month mean BCVA change, NMA showed a better visual outcome in both the anti‐VEGF group and combined group compared to PRP [anti‐VEGF vs PRP, mean difference (MD) = 3.42; standard error (SE) = 1.5; combined vs PRP, MD = 3.92; SE = 1.65], with no difference between combined group and anti‐VEGF (MD = −0.50; SE = 1.87). No difference in neovascularization regression was found between PRP and anti‐VEGF alone or in combination with PRP, but there was significant inconsistency (p = 0.016). Subgroup analyses in patients without DME yielded no difference for the 12‐month visual outcome between the three interventions, but with significant inconsistency (p = 0.005).

Conclusion: this NMA showed limited evidence of comparable efficacy in terms of neovascularization regression between PRP and anti‐VEGF therapy alone or in combination with PRP, but better visual outcomes were associated with anti‐VEGF use. Intravitreal anti‐VEGF therapy could be a valid therapeutic option in association with PRP.

Text
Intravitreal anti-Vascular endothelial growth factors - Accepted Manuscript
Restricted to Repository staff only until 16 December 2021.
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e-pub ahead of print date: 16 December 2020

Identifiers

Local EPrints ID: 446354
URI: http://eprints.soton.ac.uk/id/eprint/446354
ISSN: 1755-375X
PURE UUID: 3d22f1e0-46ec-47de-b084-13ccdf533b6f
ORCID for Andrew Lotery: ORCID iD orcid.org/0000-0001-5541-4305

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Date deposited: 05 Feb 2021 17:31
Last modified: 26 Nov 2021 02:47

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Contributors

Author: Matteo Fallico
Author: Andrea Maugeri
Author: Andrew Lotery ORCID iD
Author: Antonio Longo
Author: Vincenza Bonfiglio
Author: Andrea Russo
Author: Teresio Avitabile
Author: Alfredo Pulvirenti
Author: Claudio Furino
Author: Gilda Cennamo
Author: Martina Barchitta
Author: Antonella Agodi
Author: Michele Reibaldi

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