Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review.
Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review.
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DOI：
10.1136/bmjopen-2015-007746
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发表时间：
2015-05-03
期刊：
影响因子：
2.9
通讯作者：
Pereira A
中科院分区：
文献类型：
--
作者：
Stuart A;Ford JA;Duckworth S;Jones C;Pereira A
本研究的目的是系统地回顾抗血管内皮生长因子（VEGF）治疗继发于年龄相关性黄斑变性以外疾病的脉络膜新生血管形成的证据。检索了MEDLINE、MEDLINE进程中、EMBASE和CENTRAL数据库和会议摘要（从开始到2014年1月）。纳入了随访至少6个月的随机和非随机比较研究，并用于评估临床有效性。使用科克伦偏倚风险工具和改良的Newcastle-Ottawa量表评估偏倚风险。由于方法学异质性，无法进行荟萃分析。16项研究符合纳入标准（1091只眼; 963例病理性近视，74例其他疾病）。研究间偏倚风险差异较大。所有研究均报告抗VEGF组的最佳矫正视力优于对照组。抗VEGF治疗组中改善至少15个字母的患者比例范围为27.3%至70%。贝伐珠单抗和雷珠单抗之间没有显著差异。由于继发于年龄相关性黄斑变性或病理性近视以外的疾病的脉络膜新生血管罕见，因此在这些人群中不太可能进行充分把握度的试验。贝伐单抗和雷珠单抗似乎能有效改善继发于年龄相关性黄斑变性以外疾病的脉络膜新生血管患者的视力。继发于病理性近视的脉络膜新生血管形成的证据基础最强，然而，根据目前的证据和可能的药理学途径，临床医生应考虑使用贝伐珠单抗或雷珠单抗治疗罕见原因。
The aim of this study is to systematically review the evidence for anti-vascular endothelial growth factor (VEGF) therapy in choroidal neovascularisation secondary to conditions other than age-related macular degeneration. MEDLINE, MEDLINE in-process, EMBASE and CENTRAL databases and conference abstracts were searched (from inception to Jan 2014). Randomised and non-randomised comparative studies with follow-up of at least 6 months were included and were used to assess clinical effectiveness. Risk of bias was assessed using the Cochrane risk of bias tool and modified Newcastle-Ottawa Scale. Meta-analysis was not possible due to methodological heterogeneity. 16 studies met the inclusion criteria (1091 eyes; 963 pathological myopia, 74 other conditions). There was large variation in risk of bias across studies. An improvement in best-corrected visual acuity in anti-VEGF arms over comparators was reported in all studies. The proportion of patients improving by at least 15 letters in anti-VEGF arms ranged from 27.3% to 70%. There were no significant differences between bevacizumab and ranibizumab. Owing to the rarity of choroidal neovascularisation secondary to conditions other than age-related macular degeneration or pathological myopia, there are unlikely to ever be sufficiently powered trials in these populations. Bevacizumab and ranibizumab appear to be effective in improving visual acuity for patients with choroidal neovascularisation secondary to conditions other than age-related macular degeneration. The evidence base is strongest for choroidal neovascularisation secondary to pathological myopia, however, based on current evidence and likely pharmacological pathways, clinicians should consider treatment with either bevacizumab or ranibizumab for rarer causes.
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