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首页> 外文期刊>BMC Ophthalmology >An efficacy comparison of anti-vascular growth factor agents and laser photocoagulation in diabetic macular edema: a network meta-analysis incorporating individual patient-level data
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An efficacy comparison of anti-vascular growth factor agents and laser photocoagulation in diabetic macular edema: a network meta-analysis incorporating individual patient-level data

机译：抗血管生长因子试剂和激光光凝在糖尿病黄斑水肿中的疗效比较：一种包含个体患者级数据的网络元分析

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This was an updated network meta-analysis (NMA) of anti-vascular endothelial growth factor (VEGF) agents and laser photocoagulation in patients with diabetic macular edema (DME). Unlike previous NMA that used meta-regression to account for potential confounding by systematic variation in treatment effect modifiers across studies, this update incorporated individual patient-level data (IPD) regression to provide more robust adjustment. An updated review was conducted to identify randomised controlled trials for inclusion in a Bayesian NMA. The network included intravitreal aflibercept (IVT-AFL) 2?mg bimonthly (2q8) after 5 initial doses, ranibizumab 0.5?mg as-needed (PRN), ranibizumab 0.5?mg treat-and-extend (T&E), and laser photocoagulation. Outcomes included in the analysis were change in best-corrected visual acuity (BCVA), measured using an Early Treatment Diabetic Retinopathy Study (ETDRS) chart, and patients with ≥10 and?≥?15 ETDRS letter gains/losses at 12?months. Analyses were performed using networks restricted to IPD-only and IPD and aggregate data with (i) no covariable adjustment, (ii) covariable adjustment for baseline BVCA assuming common interaction effects (against reference treatment), and (iii) covariable adjustments specific to each treatment comparison (restricted to IPD-only network). Thirteen trials were included in the analysis. IVT-AFL 2q8 was superior to laser in all analyses. IVT-AFL 2q8 showed strong evidence of superiority (95% credible interval [CrI] did not cross null) versus ranibizumab 0.5?mg PRN for mean change in BCVA (mean difference 5.20, 95% CrI 1.90-8.52 ETDRS letters), ≥15 ETDRS letter gain (odds ratio [OR] 2.30, 95% CrI 1.12-4.20), and ≥10 ETDRS letter loss (OR 0.25, 95% CrI 0.05-0.74) (IPD and aggregate random-effects model with baseline BCVA adjustment). IVT-AFL 2q8 was not superior to ranibizumab 0.5?mg?T&E for mean change in BCVA (mean difference 5.15, 95% CrI -0.26-10.61 ETDRS letters) (IPD and aggregate random-effects model). This NMA, which incorporated IPD to improve analytic robustness, showed evidence of superiority of IVT-AFL 2q8 to laser and ranibizumab 0.5?mg PRN. These results were irrespective of adjustment for baseline BCVA.
机译：这是糖尿病黄斑水肿（DME）患者的抗血管内皮生长因子（VEGF）药物（VEGF）剂和激光光凝的更新网络荟萃分析（NMA）。与以前的NMA不同，使用Meta回归，以考虑通过研究的治疗效果改性剂的系统变化来占据潜在混淆，该更新纳入了个体患者级数据（IPD）回归，以提供更强大的调整。进行了更新的审查，以确定随机对照试验以包含在贝叶斯NMA中。该网络包括蛛网膜炎AFLiBercept（IVT-AFL）2？Mg双莫纳斯（2Q8）在5次初始剂量后，Ranibizumab0.5≤0.5μg（PRN），Ranibizumab 0.5？Mg治疗和 - 延伸（T＆E）和激光光凝。分析中包含的结果是在最佳校正的视力（BCVA）中的变化，使用早期治疗糖尿病视网膜病变研究（ETDRS）图表，≥10患者和≥10欧特的患者在12？月份收益/损失。使用限制为IPD和IPD和IPD的网络进行分析，并与（i）没有可协调的调整，（ii）基线BVCA的协调性调整假设常见的相互作用效应（针对参考处理），以及（iii）特定于每个特定的协调性调整治疗比较（仅限于IPD网络）。分析中包含十三项试验。 IVT-AFL 2Q8在所有分析中优于激光。 IVT-AFL 2Q8显示出优越性的强有力证据（95％可信间隔[CRI]没有交叉零），而RANIBIZUMAB 0.5？MG PRN在BCVA的平均变化（平均差异5.20,95％CRI 1.90-8.52 ETDRS字母），≥15 ETDRS字母增益（差距[或] 2.30,95％CRI 1.12-4.20），≥10个ETDRS字母损失（或0.25,95％CRI 0.05-0.74）（IPD和基线BCVA调整的聚集随机效应模型）。 IVT-AFL 2Q8与Ranibizumab 0.5？mg≤T＆E的平均变化不优于BCVA（平均差异5.15,95％CRI -0.26-10.61 ETDRS字母）（IPD和骨料随机效应模型）。该NMA融入了IPD以改善分析稳健性，显示出IVT-AFL 2Q8的优越性的证据，以激光和Ranibizumab 0.5？mg prn。这些结果与基线BCVA的调整无关。

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