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Drug treatment of macular oedema secondary to central retinal vein occlusion : a network meta-analysis
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Ford, John A., Shyangdan, D., Uthman, Olalekan A., Lois, Noemi and Waugh, Norman (2014) Drug treatment of macular oedema secondary to central retinal vein occlusion : a network meta-analysis. BMJ Open, Volume 4 (Number 7). e005292. doi:10.1136/bmjopen-2014-005292 ISSN 2044-6055.
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Official URL: http://dx.doi.org/10.1136/bmjopen-2014-005292
Abstract
Objective:
To indirectly compare aflibercept, bevacizumab, dexamethasone, ranibizumab and triamcinolone for treatment of macular oedema secondary to central retinal vein occlusion using a network meta-analysis (NMA).
Design:
NMA.
Data sources:
The following databases were searched from January 2005 to March 2013: MEDLINE, MEDLINE In-process, EMBASE; CDSR, DARE, HTA, NHSEED, CENTRAL; Science Citation Index and Conference Proceedings Citation Index-Science.
Eligibility criteria for selecting studies: Only randomised controlled trials assessing patients with macular oedema secondary to central retinal vein occlusion were included. Studies had to report either proportions of patients gaining ≥3 lines, losing ≥3 lines, or the mean change in best corrected visual acuity. Two authors screened titles and abstracts, extracted data and undertook risk of bias assessment. Bayesian NMA was used to compare the different interventions.
Results:
Seven studies, assessing five drugs, were judged to be sufficiently comparable for inclusion in the NMA. For the proportions of patients gaining ≥3 lines, triamcinolone 4 mg, ranibizumab 0.5 mg, bevacizumab 1.25 mg and aflibercept 2 mg had a higher probability of being more effective than sham and dexamethasone. A smaller proportion of patients treated with triamcinolone 4 mg, ranibizumab 0.5 mg or aflibercept 2 mg lost ≥3 lines of vision compared to those treated with sham. Patients treated with triamcinolone 4 mg, ranibizumab 0.5 mg, bevacizumab 1.25 mg and aflibercept 2 mg had a higher probability of improvement in the mean best corrected visual acuity compared to those treated with sham injections.
Conclusions:
We found no evidence of differences between ranibizumab, aflibercept, bevacizumab and triamcinolone for improving vision. The antivascular endothelial growth factors (VEGFs) are likely to be favoured because they are not associated with steroid-induced cataract formation. Aflibercept may be preferred by clinicians because it might require fewer injections.
Systematic review registration: Not registered.
Item Type: | Journal Article | ||||||||||
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Subjects: | R Medicine > RE Ophthalmology | ||||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Retina -- Diseases -- Treatment, Retinal degeneration | ||||||||||
Journal or Publication Title: | BMJ Open | ||||||||||
Publisher: | BMJ Publishing Group | ||||||||||
ISSN: | 2044-6055 | ||||||||||
Official Date: | 23 July 2014 | ||||||||||
Dates: |
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Volume: | Volume 4 | ||||||||||
Number: | Number 7 | ||||||||||
Article Number: | e005292 | ||||||||||
DOI: | 10.1136/bmjopen-2014-005292 | ||||||||||
Status: | Peer Reviewed | ||||||||||
Publication Status: | Published | ||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||
Date of first compliant deposit: | 27 December 2015 | ||||||||||
Date of first compliant Open Access: | 27 December 2015 |
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