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

Xiao Xie; Chao Lian; Zhiping Zhang; Meng Feng; Wenqi Wang; Xiaomeng Yuan; Yanmei Shi; Tingting Liu

doi:10.3389/fendo.2023.1144422

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

Front Endocrinol (Lausanne). 2023 May 16:14:1144422. doi: 10.3389/fendo.2023.1144422. eCollection 2023.

Authors

Xiao Xie^{1

2

3}, Chao Lian^{2

3}, Zhiping Zhang⁴, Meng Feng⁵, Wenqi Wang^{1

2

3}, Xiaomeng Yuan^{2

3}, Yanmei Shi^{1

2

3}, Tingting Liu^{2

3}

Affiliations

¹ First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
² Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, Jinan, China.
³ State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China.
⁴ Chinese Medicine College, Shandong University of Traditional Chinese Medicine, Jinan, China.
⁵ Laboratory Department, Affiliated Hospital of Shanxi University of Chinese Medicine, Xianyang, China.

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.

Publication types

Meta-Analysis
Review
Research Support, Non-U.S. Gov't

MeSH terms

Angiogenesis Inhibitors / therapeutic use
Bevacizumab / therapeutic use
Diabetes Mellitus* / chemically induced
Diabetic Retinopathy* / complications
Diabetic Retinopathy* / drug therapy
Humans
Macular Edema* / drug therapy
Macular Edema* / etiology
Ranibizumab / adverse effects
Vascular Endothelial Growth Factor A

Substances

Ranibizumab
aflibercept
Angiogenesis Inhibitors
Bevacizumab
Vascular Endothelial Growth Factor A

Grants and funding

This work was supported by the Bethune Langmu Young Scholars Research Fund Project (BJ-LM2021007J) and New Ophthalmology Technology Incubation Fund Project.