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Review
. 2023 May 16:14:1144422.
doi: 10.3389/fendo.2023.1144422. eCollection 2023.

Aflibercept for long-term treatment of diabetic macular edema and proliferative diabetic retinopathy: a meta-analysis

Xiao Xie  1   2   3 , Chao Lian  2   3 , Zhiping Zhang  4 , Meng Feng  5 , Wenqi Wang  1   2   3 , Xiaomeng Yuan  2   3 , Yanmei Shi  1   2   3 , Tingting Liu  2   3
Affiliations
Review

Aflibercept for long-term treatment of diabetic macular edema and proliferative diabetic retinopathy: a meta-analysis

Xiao Xie et al. Front Endocrinol (Lausanne). .

Abstract

Purpose: This meta-analysis compared the long-term (12 months or 24 months) efficacy and safety of intravitreal aflibercept injection (IAI) for diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR).

Methods: We selected 16 randomized controlled trials (RCTs) performed after 2015 that had a minimum of 12 months and up to 24 months of treatment and conducted a meta-analysis with Review Manager version 5.3. Visual acuity (VA), central subfield thickness (CST) and adverse events were the outcomes selected for evaluation from the eligible studies.

Results: Based on 16 RCTs, we evaluated a total of 7125 patients. For PDR and severe DME with poor baseline vision, after a minimum of 12 months and up to 24 months of treatment, the aflibercept treatment group obtained better VA improvement than the focal/grid laser photocoagulation treatment group (MD=13.30; 95%CI: 13.01~13.58; P<0.001) or other treatments (ranibizumab, focal/grid laser photocoagulation, PRP, et al.) group (MD=1.10; 95%CI: 1.05~1.16; P<0.001). In addition, the aflibercept treatment group got higher CST reduction than the focal/grid laser photocoagulation treatment (MD=-33.76; 95%CI: -45.53 ~ -21.99; P<0.001) or other treatments (ranibizumab, focal/grid laser photocoagulation, et al.) group (MD=-33.76; 95%CI: -45.53 ~ -21.99; P<0.001). There was no significant difference in the overall incidence of ocular and non-ocular adverse events in each treatment group.

Conclusions: This meta-analysis showed that the advantages of IAI are obvious in the management of DME and PDR with poor baseline vision for long-term observation (a minimum of 12 months and up to 24 months) with both VA improvement and CST reduction. Applied IAI separately trended to be more effective than panretinal photocoagulation separately in VA improvement for PDR. More parameters should be required to assess functional and anatomic outcomes.

Keywords: aflibercept; anti-vascular endothelial growth factor; diabetic macular edema; focal/grid laser photocoagulation; meta-analysis; panretinal photocoagulation; proliferative diabetic retinopathy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer MC declared a shared affiliation with the authors to the handling editor at the time of review.

Figures

Figure 1
Figure 1
Flow chart of literature searching.
Figure 2
Figure 2
Risk of bias graph and summary for each included study.
Figure 3
Figure 3
The mean changes from baseline in BCVA in the aflibercept group and focal/grid laser photocoagulation treatment group.
Figure 4
Figure 4
The mean changes from baseline in BCVA in the aflibercept group and other treatments group.
Figure 5
Figure 5
The mean changes from baseline in CST in the aflibercept group and focal/grid laser photocoagulation treatment group.
Figure 6
Figure 6
The mean changes from baseline in CST in the aflibercept group and other treatments group.
Figure 7
Figure 7
The adverse events in the aflibercept group and other treatments group.
See this image and copyright information in PMC

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References

    1. Heng LZ, Comyn O, Peto T, Tadros C, Ng E, Sivaprasad S, et al. . Diabetic retinopathy: pathogenesis, clinical grading, management and future developments. Diabetes Med (2013) 30(6):640–50. doi: 10.1111/dme.12089 - DOI - PubMed
    1. Hou Y, Cai Y, Jia Z, Shi S. Risk factors and prevalence of diabetic retinopathy: A protocol for meta-analysis. Med (Baltimore) (2020) 99(42):e22695. doi: 10.1097/MD.0000000000022695 - DOI - PMC - PubMed
    1. Varma R, Bressler NM, Doan QV, Gleeson M, Danese M, Bower JK, et al. . Prevalence of and risk factors for diabetic macular edema in the united states. JAMA Ophthalmol (2014) 132(11):1334–40. doi: 10.1001/jamaophthalmol.2014.2854 - DOI - PMC - PubMed
    1. Chauhan MZ, Rather PA, Samarah SM, Elhusseiny AM, Sallam AB. Current and novel therapeutic approaches for treatment of diabetic macular edema. Cells (2022) 11(12):1950. doi: 10.3390/cells11121950 - DOI - PMC - PubMed
    1. Yonekawa Y, Modi YS, Kim LA, Skondra D, Kim JE, Wykoff CC. American society of retina specialists clinical practice guidelines on the management of nonproliferative and proliferative diabetic retinopathy without diabetic macular edema. J Vitreoretin Dis (2020) 4(2):125–35. doi: 10.1177/2474126419893829 - DOI - PMC - PubMed

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