Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options

Daniele Veritti,1 Valentina Sarao,1,2 Valentina Soppelsa,1 Paolo Lanzetta1,2 1Department of Medicine - Ophthalmology, University of Udine, Udine, Italy; 2Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, ItalyCorrespondence: Paolo LanzettaDepartment of Medicine - Ophthalmology, University of...

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Autores principales:	Veritti D, Sarao V, Soppelsa V, Lanzetta P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	aflibercept anti-vegf bevacizumab dexamethasone diabetic macular edema ranibizumab Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/d81567f61d014f609cc36e0b81425949
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spelling	oai:doaj.org-article:d81567f61d014f609cc36e0b814259492021-12-02T13:53:35ZManaging Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options1177-5483https://doaj.org/article/d81567f61d014f609cc36e0b814259492021-01-01T00:00:00Zhttps://www.dovepress.com/managing-diabetic-macular-edema-in-clinical-practice-systematic-review-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Daniele Veritti,1 Valentina Sarao,1,2 Valentina Soppelsa,1 Paolo Lanzetta1,2 1Department of Medicine - Ophthalmology, University of Udine, Udine, Italy; 2Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, ItalyCorrespondence: Paolo LanzettaDepartment of Medicine - Ophthalmology, University of Udine, P.le Santa Maria della Misericordia 15, Udine, 33100, ItalyTel +39 0432 559907Fax +39 0432 559904Email paolo.lanzetta@uniud.itPurpose: This meta-analysis aims to summarize 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-vascular endothelial growth factor (VEGF) therapy and dexamethasone implant for the treatment of diabetic macular edema (DME) and to identify factors affecting treatment response using evidence generated from meta-regression.Methods: A systematic review of electronic databases was conducted to identify randomized controlled trials (RCTs) and real-life/observational studies that reported 12-month changes in BCVA in patients with DME on anti-VEGF or dexamethasone implant treatment in monotherapy. Study factors that were analyzed are baseline patient characteristics, study type, drug employed, number of injections and 12-month change in BCVA. Data were pooled in a random-effects meta-analysis with BCVA change as the main outcome. Meta-regression was conducted to assess the impact of multiple covariates.Results: One-hundred-five heterogeneous study populations (45,032 eyes) were identified and included in the analysis. The use of anti-VEGFs and dexamethasone implant induced an overall increase of +8.13 ETDRS letters in BCVA at 12 months of follow-up. Meta-regression provided evidence that mean BCVA change using anti-VEGFs was not statistically higher for RCTs (p=0.35) compared to observational studies. Dexamethasone implant showed a trend for better results in observational studies over RCTs. Populations following a fixed aflibercept regimen performed better than those following a reactive treatment regimen. Mean BCVA gain was higher in younger populations (p< 0.001), with lower baseline BCVA (p< 0.0001) and longer diabetes duration (p< 0.0001), receiving a higher number of injections (p< 0.0001).Conclusion: Intravitreal therapy with anti-VEGFs or dexamethasone implant produces a significant improvement in BCVA at 12 months in patients with DME. Meta-regression identified the modifiable covariates that can be targeted in order to maximize functional results.Keywords: aflibercept, anti-VEGF, bevacizumab, dexamethasone, diabetic macular edema, ranibizumabVeritti DSarao VSoppelsa VLanzetta PDove Medical Pressarticleafliberceptanti-vegfbevacizumabdexamethasonediabetic macular edemaranibizumabOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 375-385 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	aflibercept anti-vegf bevacizumab dexamethasone diabetic macular edema ranibizumab Ophthalmology RE1-994
spellingShingle	aflibercept anti-vegf bevacizumab dexamethasone diabetic macular edema ranibizumab Ophthalmology RE1-994 Veritti D Sarao V Soppelsa V Lanzetta P Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options
description	Daniele Veritti,1 Valentina Sarao,1,2 Valentina Soppelsa,1 Paolo Lanzetta1,2 1Department of Medicine - Ophthalmology, University of Udine, Udine, Italy; 2Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, ItalyCorrespondence: Paolo LanzettaDepartment of Medicine - Ophthalmology, University of Udine, P.le Santa Maria della Misericordia 15, Udine, 33100, ItalyTel +39 0432 559907Fax +39 0432 559904Email paolo.lanzetta@uniud.itPurpose: This meta-analysis aims to summarize 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-vascular endothelial growth factor (VEGF) therapy and dexamethasone implant for the treatment of diabetic macular edema (DME) and to identify factors affecting treatment response using evidence generated from meta-regression.Methods: A systematic review of electronic databases was conducted to identify randomized controlled trials (RCTs) and real-life/observational studies that reported 12-month changes in BCVA in patients with DME on anti-VEGF or dexamethasone implant treatment in monotherapy. Study factors that were analyzed are baseline patient characteristics, study type, drug employed, number of injections and 12-month change in BCVA. Data were pooled in a random-effects meta-analysis with BCVA change as the main outcome. Meta-regression was conducted to assess the impact of multiple covariates.Results: One-hundred-five heterogeneous study populations (45,032 eyes) were identified and included in the analysis. The use of anti-VEGFs and dexamethasone implant induced an overall increase of +8.13 ETDRS letters in BCVA at 12 months of follow-up. Meta-regression provided evidence that mean BCVA change using anti-VEGFs was not statistically higher for RCTs (p=0.35) compared to observational studies. Dexamethasone implant showed a trend for better results in observational studies over RCTs. Populations following a fixed aflibercept regimen performed better than those following a reactive treatment regimen. Mean BCVA gain was higher in younger populations (p< 0.001), with lower baseline BCVA (p< 0.0001) and longer diabetes duration (p< 0.0001), receiving a higher number of injections (p< 0.0001).Conclusion: Intravitreal therapy with anti-VEGFs or dexamethasone implant produces a significant improvement in BCVA at 12 months in patients with DME. Meta-regression identified the modifiable covariates that can be targeted in order to maximize functional results.Keywords: aflibercept, anti-VEGF, bevacizumab, dexamethasone, diabetic macular edema, ranibizumab
format	article
author	Veritti D Sarao V Soppelsa V Lanzetta P
author_facet	Veritti D Sarao V Soppelsa V Lanzetta P
author_sort	Veritti D
title	Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options
title_short	Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options
title_full	Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options
title_fullStr	Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options
title_full_unstemmed	Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options
title_sort	managing diabetic macular edema in clinical practice: systematic review and meta-analysis of current strategies and treatment options
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/d81567f61d014f609cc36e0b81425949
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Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options

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