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Review
. 2022 Oct 19:16:3503-3526.
doi: 10.2147/OPTH.S378392. eCollection 2022.

Real-World Evidence in the Management of Diabetic Macular Edema with Intravitreal Anti-VEGFs in Asia: A Systematic Literature Review

Yew Sen Yuen  1 , Gavin Siew Wei Tan  2 , Nicola Yi'An Gan  3 , Issac Horng Khit Too  4 , Raj Kumar Mothe  5 , Pradeep Basa  5 , Javed Shaikh  5
Affiliations
Review

Real-World Evidence in the Management of Diabetic Macular Edema with Intravitreal Anti-VEGFs in Asia: A Systematic Literature Review

Yew Sen Yuen et al. Clin Ophthalmol. .

Abstract

Purpose: To evaluate the visual outcomes and safety profile of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in the treatment of diabetic macular edema (DME) in real-world studies in Asian countries.

Methods: A systematic review of electronic literature databases (Embase, Medline, and the Cochrane Library from January 1, 2010, to March 16, 2021) was conducted to identify observational studies that reported clinical and safety outcomes of anti-VEGF treatments for DME in Asia. We analyzed baseline patient characteristics, treatment patterns, mean number of injections, best-corrected visual acuity (BCVA), retinal thickness, and safety outcomes.

Results: Seventy-one studies were included in this review. Most studies reported treatment of DME with ranibizumab (n = 33), followed by aflibercept (n = 13), bevacizumab (n = 28), and conbercept (n = 9). At 12 months, the cumulative mean number of injections for ranibizumab, aflibercept, and conbercept was 5.2, 4.6, and 6, respectively. At the 12-month follow-up, the cumulative mean BCVA gain was 6.8 letters (ranibizumab), 4.6 letters (aflibercept), 4.9 letters (bevacizumab), and 8.3 letters (conbercept). The cumulative mean reduction in retinal thickness at 12 months was 116.9 μm (ranibizumab), 105.9 μm (aflibercept), 81.7 μm (bevacizumab), and 135.2 μm (conbercept). A strong positive correlation (r = 0.78) was observed between mean number of injections and change in BCVA at 12 months. A moderate positive correlation (r = 0.54) was observed between mean number of injections and mean reduction in retinal thickness at 12 months. A weak positive correlation was observed between baseline retinal thickness and visual acuity at 12 months. Baseline BCVA and mean number of injections were predictors of BCVA at 12 months.

Conclusion: All anti-VEGFs were effective in the treatment of DME in Asia. The data suggest that a greater number of anti-VEGF injections was associated with better improvement in BCVA and moderate reduction in retinal thickness at the 1-year follow-up.

Keywords: DME; aflibercept; anti-vascular endothelial growth factors; bevacizumab; conbercept; ranibizumab; retinal thickness; visual acuity.

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Conflict of interest statement

IHT (Novartis Singapore Pte Ltd.), PB, and JS (Novartis Healthcare Pvt. Ltd.) are Novartis employees. RKM was an employee of Novartis when the review was being conducted. YSY, GSWT, and NYG have acted as consultants for Novartis for this work and other work. YSY is a consultant for Roche and receives financial support from Bayer. GSWT is a consultant for Roche, Bayer, Allergan, Zeiss, Nikon-Optos, Topcon, and Leica, has received grants from Santen, and owns equity in Eyris. NYG receives financial support from Bayer. The authors report no other conflicts of interest related to this work.

Figures

Figure 1
Figure 1
Correlation of BCVA gain with mean injections at 12 months for overall patients.
Figure 2
Figure 2
Mean injections and BCVA improvement at 12 months.
Figure 3
Figure 3
Correlation between baseline BCVA values and BCVA gain (ETDRS letters) at 12 months for (A) overall patients, (B) naive patients and (C) mixed treatment patients.
Figure 4
Figure 4
Correlation between reduction in retinal thickness and mean injections at 12 months for overall patients.
Figure 5
Figure 5
Correlation between baseline CRT and baseline BCVA for (A) naive patients and (B) mixed treatment patients.
Figure 6
Figure 6
Correlation between baseline CRT and BCVA letter score at 12 months for (A) overall patients, (B) naive patients and (C) mixed treatment patients.
Figure 7
Figure 7
Correlation between baseline CRT and BCVA gain at 12 months for (A) overall patients, (B) naive patients and (C) mixed treatment patients.
Figure 8
Figure 8
Correlation between reduction in retinal thickness and BCVA gain at 12 months for (A) overall patients, (B) naive patients and (C) mixed treatment patients.
Figure 9
Figure 9
Correlation between CRT and BCVA letter score at 12 months for (A) overall patients, (B) naive patients and (C) mixed treatment patients.
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