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Meta-Analysis
. 2017 Nov 1;58(13):5616-5627.
doi: 10.1167/iovs.17-22471.

Effects of Aflibercept for Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis of Observational Comparative Studies

Yan Zhang  1 , Catherine Chioreso  1 , Marin L Schweizer  2 , Michael D Abràmoff  3   4   5   6   7   8
Affiliations
Meta-Analysis

Effects of Aflibercept for Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis of Observational Comparative Studies

Yan Zhang et al. Invest Ophthalmol Vis Sci. .

Abstract

Purposes: To compare the effects of aflibercept and other anti-vascular endothelial growth factor (anti-VEGF) medications on both functional and anatomical outcomes for treatment-naïve neovascular age-related macular degeneration (nAMD) in the real world.

Methods: A systematic review and meta-analysis of observational comparative studies.

Results: A total of 18 studies remained after literature selection and quality assessment of 1697 studies. The most common aflibercept treatment regimen was three monthly injections followed by pro re nata (PRN). Aflibercept and ranibizumab had similar effects in 2-year treatment. At 3, 6, 12, and 24 months, the differences in the logarithm of minimum angle of resolution (logMAR) decrease in aflibercept and ranibizumab groups were 0.00 (95% confidence interval [CI]: -0.03 to 0.02); 0.01 (95% CI: -0.02 to 0.05); -0.03 (95% CI: -0.07 to 0.01); and -0.06 (95% CI: -0.30 to 0.17), respectively; the differences in decrease of central retinal thickness (CRT) were 3.25 μm (95% CI: -15.03 to 21.53); 7.89 μm (95% CI: -31.91 to 47.69); 2.89 μm (95% CI: -18.33 to 24.11); and -2.42 μm (95% CI: -77.87 to 73.03), respectively. However, aflibercept was significantly more effective in patients with initial reduced visual acuity (logMAR >0.6 or <55 letters; P = 0.001). In the first year, treatment frequency was not significantly different for aflibercept and ranibizumab, but aflibercept required fewer injections than ranibizumab with PRN regimen (mean -0.90; 95% CI: -1.80 to 0.00).

Conclusions: Aflibercept has comparable effects with ranibizumab for treatment-naïve nAMD in the real world, and may be more effective for patients with initial lower visual acuity.

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Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection.
Figure 2
Figure 2
Changes in (A) BCVA (logMAR) and (B) CRT after aflibercept treatment. BCVA, best-corrected visual acuity; CL, confidence limit; CRT, central retinal thickness; logMAR, logarithm of minimum angle of resolution; mo, months.
Figure 3
Figure 3
Differences in BCVA (logMAR) changes between aflibercept and ranibizumab treatment at (A) 3, (B) 6, (C) 12, and (D) 24 months. BCVA, best-corrected visual acuity; logMAR, logarithm of minimum angle of resolution.
Figure 4
Figure 4
Differences in CRT changes between aflibercept and ranibizumab treatment at (A) 3, (B) 6, (C) 12, and (D) 24 months. CRT, central retinal thickness.
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References

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