Meta-analysis and review on the effect of bevacizumab in diabetic macular edema
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Systematic review and meta-analysis to evaluate the effect of bevacizumab (Avastin) in diabetic macular edema (DME)
Pertinent publications were identified through systematic searches of PUBMED and Cochrane Central Register of Controlled Trials. Change in central subfield macular thickness (CSMT) in μm and best-corrected visual acuity (BCVA) in log MAR equivalents were extracted at 6, 12 and 24 weeks, and results compared between groups receiving intravitreal bevacizumab (IVB), a combination of IVB and intravitreal triamcinolone acetonide (IVT), and macular laser photocoagulation or sham control groups.
The summary mean difference indicated a statistically significant reduction in CSMT at 6 weeks when treated with bevacizumab compared to control. IVB treatment, however, lost significance at 12 weeks and 24 weeks. The summary mean difference in BCVA for IVB group compared to control reached significance only at 6 and 24 weeks. Combination therapy of IVB and IVT did not result in any significant reduction in CSMT or gain in vision compared to treatment with IVB alone at any point in time.
Current data suggests that IVB is an effective short-term treatment for diabetic macular edema, and that its efficacy wanes after 6 weeks. More trials exploring the therapeutic role of intravitreal bevacizumab in DME need to be conducted to define the role of bevacizumab.
KeywordsAvastin Angiogenesis Anti-VEGF therapy Bevacizumab Diabetic macular edema
- 6.Antcliff RJ, Marshall J (1999) The pathogenesis of edema in diabetic maculopathy. Semin Ophthalmol 14:223–32Google Scholar
- 8.Early Treatment Diabetic Retinopathy Study Research Group (1985) Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report no 1. Arch Ophthalmol 103:1796–1806Google Scholar
- 9.Nasrallah FP, Jalkh AE, Van Coppenolle F, Kado M, Trempe CL, McMeel JW, Schepens CL (1988) The role of the vitreous in diabetic macular edema. Ophthalmol 95:1335–1339Google Scholar
- 15.Cunningham ET Jr, Adamis AP, Altaweel M, Aiello LP, Bressler NM, D'Amico DJ, Goldbaum M, Guyer DR, Katz B, Patel M, Schwartz SD, Macugen Diabetic Retinopathy Study Group (2005) A phase II randomized double-masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmol 112:1747–1757CrossRefGoogle Scholar
- 21.Soheilian M, Ramezani A, Bijanzadeh B, Yaseri M, Ahmadieh H, Dehghan MH, Azarmina M, Moradian S, Tabatabaei H, Peyman GA (2007) Intravitreal bevacizumab (avastin) injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment of diabetic macular edema. Retina 27:1187–1195CrossRefPubMedGoogle Scholar
- 23.Ahmadieh H, Ramezani A, Shoeibi N, Bijanzadeh B, Tabatabaei A, Azarmina M, Soheilian M, Keshavarzi G, Mohebbi MR (2008) Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular edema; a placebo-controlled, randomized clinical trial. Graefes Arch Clin Exp Ophthalmol 246:483–489CrossRefPubMedGoogle Scholar
- 25.Soheilian M, Ramezani A, Obudi A, Bijanzadeh B, Salehipour M, Yaseri M, Ahmadieh H, Dehghan MH, Azarmina M, Moradian S, Peyman GA (2009) Randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus macular photocoagulation in diabetic macular edema. Ophthalmology 116:1142–1150CrossRefPubMedGoogle Scholar
- 29.Arevalo JF, Fromow-Guerra J, Quiroz-Mercado H, Pan-American Collaborative Retina Study Group (2007) Primary intravitreal bevacizumab (Avastin) for diabetic macular edema: results from the Pan-American Collaborative Retina Study Group at 6-month follow-up. Ophthalmology 114:743–750CrossRefPubMedGoogle Scholar
- 39.Arevalo JF, Sanchez JG, Fromow-Guerra J, Pan-American Collaborative Retina Study Group (2009) Comparison of two doses of primary intravitreal bevacizumab (Avastin) for diffuse diabetic macular edema: results from the Pan-American Collaborative Retina Study Group (PACORES) at 12-month follow-up. Graefes Arch Clin Exp Ophthalmol 247:735–43CrossRefPubMedGoogle Scholar
- 41.Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F (2000) Methods for Meta-Analysis in Medical Research. John Wiley & Sons, New York, pp 31–33Google Scholar
- 50.Wu L, Martínez-Castellanos MA, Quiroz-Mercado H, Arevalo JF, Berrocal MH, Farah ME, Maia M, Roca JA, Rodriguez FJ, Pan American Collaborative Retina Group (PACORES) (2008) Twelve-month safety of intravitreal injections of bevacizumab(Avastin): results of the Pan-American Collaborative RetinaStudy Group (PACORES). Graefes Arch Clin Exp Ophthalmol 246:81–87CrossRefPubMedGoogle Scholar