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. 2016 Jul 19;11(7):e0159553.
doi: 10.1371/journal.pone.0159553. eCollection 2016.

The Efficacy and Safety of Current Treatments in Diabetic Macular Edema: A Systematic Review and Network Meta-Analysis

Lu Zhang  1   2 , Wen Wang  3 , Yan Gao  2 , Jie Lan  2 , Lixin Xie  2
Affiliations

The Efficacy and Safety of Current Treatments in Diabetic Macular Edema: A Systematic Review and Network Meta-Analysis

Lu Zhang et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart indicating the selection process for this network meta-analysis.
Fig 2
Fig 2. Network of eligible comparisons for the meta-analysis.
Fig 3
Fig 3. Risk of bias graph.
Fig 4
Fig 4. Risk of bias summary.
Fig 5
Fig 5. Forest plots for BCVA and CMT in 12 months.
Abbreviations: 1, IVA; 2, IVB; 3, IVR; 4, IVR+LASER; 5, LASER; 6, DDSI; 7, IVB+IVT; 8, DDSI+LASER; 9, IVB+LASER; 10, IVT+LASER; 11, Placebo.
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