Comparative efficacy and safety of approved treatments for macular oedema secondary to branch retinal vein occlusion: a network meta-analysis.

Abstract

OBJECTIVE:

To compare the efficacy and safety of approved treatments for macular oedema secondary to branch retinal vein occlusion (BRVO).

DESIGN:

Randomised controlled trials (RCTs) evaluating the efficacy and safety of approved treatments for macular oedema secondary to BRVO were identified from an updated systematic review.

SETTING:

A Bayesian network meta-analysis of RCTs of treatments for macular oedema secondary to BRVO.

INTERVENTIONS:

Ranibizumab 0.5 mg pro re nata, aflibercept 2 mg monthly (2q4), dexamethasone 0.7 mg implant, laser photocoagulation, ranibizumab+laser, or sham intervention. Bevacizumab and triamcinolone were excluded.

OUTCOME MEASURES:

Efficacy outcomes were mean change in best corrected visual acuity (Early Treatment Diabetic Retinopathy Study scale) and the percentage of patients gaining ≥ 15 letters. Safety outcome was the percentage of patients with increased intraocular pressure (IOP)/ocular hypertension (OH).

RESULTS:

8 RCTs were identified for inclusion with 1743 adult patients. The probability of being the most efficacious treatment at month 6 or 12 based on letters gained was 54% for ranibizumab monotherapy, 30% for aflibercept, 16% for ranibizumab plus laser (adjunctive or prompt), and 0% for dexamethasone implant, laser or sham. The probability of being the most efficacious treatment for patients gaining ≥ 15 letters was 39% for aflibercept, 35% for ranibizumab monotherapy, 24% for ranibizumab plus laser, 2% for dexamethasone implant, and less than 1% for laser or sham. There was no statistical difference between ranibizumab monotherapy and aflibercept for letters gained (+1.4 letters for ranibizumab vs aflibercept with 95% credible interval (CrI) of -5.2 to +8.5 letters) or the OR for gaining ≥ 15 letters: 1.06 (95% CrI 0.16 to 8.94)). Dexamethasone implant was associated with significantly higher IOP/OH than antivascular endothelial growth factor agents (OR 13.1 (95% CrI 1.7 to 116.9)).

CONCLUSIONS:

There was no statistically significant difference between ranibizumab and aflibercept.

• Authors: Stephane A Regnier, Michael Larsen, Vladimir Bezlyak, Felicity Allen
• Journal: BMJ open (BMJ Open) Vol. 5 Issue 6 Pg. e007527 (Jun 05 2015) ISSN: 2044-6055 [Electronic] England
• PMID: 26048209 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Recombinant Fusion Proteins
• aflibercept
• Dexamethasone
• Receptors, Vascular Endothelial Growth Factor
• Ranibizumab

Topics

• Adult
• Dexamethasone (administration & dosage, adverse effects)
• Humans
• Laser Coagulation (adverse effects, methods)
• Macular Edema (etiology, therapy)
• Randomized Controlled Trials as Topic
• Ranibizumab (administration & dosage, adverse effects)
• Receptors, Vascular Endothelial Growth Factor (administration & dosage, adverse effects)
• Recombinant Fusion Proteins (administration & dosage, adverse effects)
• Retinal Vein Occlusion (complications)
• Treatment Outcome