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2015 ; 10
(9
): e0137866
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Treatment as Required versus Regular Monthly Treatment in the Management of
Neovascular Age-Related Macular Degeneration: A Systematic Review and
Meta-Analysis
#MMPMID26368921
Schmucker CM
; Rücker G
; Sommer H
; Virgili G
; Loke YK
; Oeller P
; Agostini H
; Ehlken C
PLoS One
2015[]; 10
(9
): e0137866
PMID26368921
show ga
BACKGROUND: To investigate whether treatment as required 'pro re nata' (PRN)
versus regular monthly treatment regimens lead to differences in outcomes in
neovascular age-related macular degeneration (nAMD). Regular monthly
administration of vascular endothelial growth factor (VEGF) inhibitors is an
established gold standard treatment, but this approach is costly. Replacement of
monthly by PRN treatment can only be justified if there is no difference in
patient relevant outcomes. METHODS: Systematic review and meta-analysis. The
intervention was PRN treatment and the comparator was monthly treatment with
VEGF-inhibitors. Four bibliographic databases were searched for randomised
controlled trials comparing both treatment regimens directly (head-to-head
studies). The last literature search was conducted in December 2014. Risk of bias
assessment was performed after the Cochrane Handbook for Systematic Reviews of
Interventions. FINDINGS: We included 3 head-to-head studies (6 reports) involving
more than 2000 patients. After 2 years, the weighted mean difference in best
corrected visual acuity (BCVA) was 1.9 (95% CI 0.5 to 3.3) ETDRS letters in
favour of monthly treatment. Systemic adverse events were higher in PRN treated
patients, but these differences were not statistically significant. After 2
years, the total number of intravitreal injections required by the patients in
the PRN arms were 8.4 (95% CI 7.9 to 8.9) fewer than those having monthly
treatment. The studies were considered to have a moderate risk of bias.
CONCLUSIONS: PRN treatment resulted in minor but statistically significant
decrease in mean BCVA which may not be clinically meaningful. There is a small
increase in risk of systemic adverse events for PRN treated patients. Overall,
the results indicate that an individualized treatment approach with anti-VEGF
using visual acuity and OCT-guided re-treatment criteria may be appropriate for
most patients with nAMD.