Clinical Ophthalmology (Oct 2022)
Real-World Evidence in the Management of Diabetic Macular Edema with Intravitreal Anti-VEGFs in Asia: A Systematic Literature Review
Abstract
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 Shaikh5 1Department of Ophthalmology, National University Hospital, Singapore; 2Singapore Eye Research Institute, Singapore National Eye Centre, Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; 3Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore; 4Novartis Singapore Pte. Ltd., Mapletree Business City, Singapore; 5Novartis Healthcare Pvt. Ltd, Hyderabad, IndiaCorrespondence: Issac Horng Khit Too, Novartis Singapore Pte Ltd, Mapletree Business City, 20 Pasir Panjang Road #10-25/28, 117439, Singapore, Tel +6567226189, Email [email protected]: 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: aflibercept, anti-vascular endothelial growth factors, bevacizumab, conbercept, DME, ranibizumab, retinal thickness, visual acuity
