Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Feb;261(2):303-315.
doi: 10.1007/s00417-022-05770-y. Epub 2022 Jul 30.

Treat and extend regimen for diabetic macular oedema-a systematic review and meta-analysis

Sheng Yang Lim #  1 , Wendy Meihua Wong #  2 , Ivan Seah  2 , Hwei Wuen Chan  2 , Xinyi Su  2 , Gopal Lingam  2 , Yew Sen Yuen  3
Affiliations
Meta-Analysis

Treat and extend regimen for diabetic macular oedema-a systematic review and meta-analysis

Sheng Yang Lim et al. Graefes Arch Clin Exp Ophthalmol. 2023 Feb.

Abstract

Purpose: Various treatment regimens are currently practiced in the treatment of CI-DMO (centre-involving diabetic macular oedema). In recent years, there has been a growing body of evidence supporting a treat and extend (T&E) regimen for DMO which offers the promise of comparable visual and anatomical outcomes while reducing injection burden. This meta-analysis was hence performed to evaluate the aforementioned outcomes in the treatment of DMO. Ten studies met the inclusion criteria.

Methods: A search of PubMed, MEDLINE, Current Contents, and Cochrane Central Register of Controlled Trials (CENTRAL) databases was performed. We employed the terms 'treat AND extend AND (diabetic AND macular AND edema OR oedema)' to ensure a comprehensive search. The search workflow adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Results: The pooled analysis of the mean number of injections in 1 year for T&E-aflibercept (AFL), T&E-ranibizumab (RBZ) and collectively was 9.1 (95% CI: 7.63-10.63), 10.0 (95% CI: 9.55-10.47) and 9.6 (95% CI: 8.62-10.49), respectively. Improvements in vision at 1 year for T&E-AFL, T&E-RBZ and collectively were 6.26 (95% CI: 3.24-9.29), 7.14 (95% CI: 4.76-9.52) and 7.08 (95% CI: 5.32-8.84) letters, respectively. The improvements in central subfield thickness at 1 year for T&E-AFL, T&E-RBZ and collectively were 131.94 (95% CI: 100.29-163.60), 108.64 (95% CI: 82.82-134.46) and 121.32 (95% CI: 102.89-139.75) microns, respectively.

Conclusion: The meta-analysis of T&E for DMO did not show a clear advantage in reducing the number of injections compared to landmark clinical trials with pro-re-nata (PRN) treatment regimens in the first year of treatment with limited gains in visual and anatomical outcomes. However, the T&E approach offers the potential for fewer patient visits, thereby reducing treatment burden. Longer term studies on T&E with a standardised protocol would be required to assess the longevity of the vision gain in the first year despite a likely reduced treatment burden compared to the PRN trials.

Keywords: Aflibercept; Bevacizumab; Diabetic macular oedema; Meta-analysis; Ranibizumab; Systematic review; Treat and extend.

PubMed Disclaimer

References

    1. Nguyen QD, Brown DM, Marcus DM et al (2012) Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology 119(4):789–801 - DOI
    1. Heier JS, Korobelnik JF, Brown DM et al (2016) Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID studies. Ophthalmology 123(11):2376–2385 - DOI
    1. Elman MJ, Qin H, Aiello LP et al (2012) Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: three-year randomized trial results. Ophthalmology 119(11):2312–2318 - DOI
    1. Jeon HL, Lee H, Yoon D et al (2020) Burden of diabetic macular oedema in patients receiving antivascular endothelial growth factor therapy in South Korea: a healthcare resource use and cost analysis. BMJ Open 10(12):e042484 - DOI
    1. Ruiz-Moreno JM, de Andrés-Nogales F, Oyagüez I (2020) Cost-consequence analysis of extended loading dose of anti-VEGF treatment in diabetic macular edema patients. BMC Ophthalmol [Internet] 20(1):371. https://doi.org/10.1186/s12886-020-01637-0 - DOI

MeSH terms

Substances

LinkOut - more resources