The Efficacy and Safety of Current Treatments in Diabetic Macular Edema: A Systematic Review and Network Meta-Analysis.
The Efficacy and Safety of Current Treatments in Diabetic Macular Edema: A Systematic Review and Network Meta-Analysis.
复制标题
当前治疗糖尿病黄斑水肿的疗效和安全性：系统回顾和网络荟萃分析
DOI：
10.1371/journal.pone.0159553
复制
发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Xie L
中科院分区：
文献类型：
--
作者：
Zhang L;Wang W;Gao Y;Lan J;Xie L
目的比较糖尿病性黄斑水肿（DME）的有效性和安全性。方法对截至2015年8月的关于DME当前治疗的随机对照试验的PubMed、Embase和CENTRAL进行系统综述。提取最佳矫正视力（BCVA）和中心黄斑厚度（CMT）的平均变化数据，并收集不良事件（AE）。结果共纳入21篇临床试验。玻璃体内雷珠单抗在6个月内最显著地改善BCVA（OR：+7.01 95%CI（2.56至11.39）），玻璃体内阿柏西普在12个月内改善BCVA（+8.19（5.07至11.96））。玻璃体内注射曲安奈德联合激光治疗6个月后CMT下降最显著（-111.34（-254.61至37.93）），玻璃体内注射阿柏西普治疗12个月后CMT下降最显著（-110.83（-190.25至35.27））。与类固醇给药组中眼部AE的发生率相对较高相比，血管内皮生长因子抑制剂组中全身性AE的发生率更高。结论我们的分析证实，在12个月内，玻璃体内注射aflibercept在BCVA改善和CMT降低方面优于目前其他治疗DME的方法。由于全身性AE，DME应谨慎使用血管内皮生长因子抑制剂。联合玻璃体腔注射曲安奈德和激光治疗在降低CMT方面的效果优于其他治疗方法。需要更多高质量的随机对照试验。
Purpose To compare the efficacy and safety of current treatments in diabetic macular edema (DME). Methods PubMed, Embase and CENTRAL were systematically reviewed for randomized controlled trials of current treatments in DME through August 2015. Data on the mean change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) were extracted, and adverse events (AEs) were collected. Results A total of 21 trials were included in our network meta-analysis. Intravitreal ranibizumab improved BCVA most significantly (OR: +7.01 95%CI (2.56 to 11.39)) in 6 months and intravitreal aflibercept (+8.19 (5.07 to 11.96)) in 12 months. Intravitreal triamcinolone combined with LASER decreased CMT most significantly (-111.34 (-254.61 to 37.93)) in 6 months and intravitreal aflibercept (-110.83 (-190.25 to -35.27)) in 12 months. Compared with the relatively high rate of ocular AEs in the groups with administration of steroids, systematic AEs occurred more frequently in the groups with vascular endothelial growth factor inhibitors involved. Conclusions Our analysis confirms that intravitreal aflibercept is most favorable with both BCVA improvement and CMT decrease than other current therapies in the management of DME within 12 months. Vascular endothelial growth factor inhibitors for DME should be used with caution due to systematic AEs. Combined intravitreal triamcinolone with LASER has a stronger efficacy in decreasing CMT than the other interventions in the early stage after injection. More high-quality randomized controlled trials will be necessary.