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Efficacy comparison of anti-vascular endothelial growth factor drugs for the treatment of type 1 retinopathy of prematurity: A network meta-analysis of randomised controlled trials

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Abstract

Purpose

To compare the efficacy of different anti-vascular endothelial growth factor (VEGF) agents for the treatment of retinopathy of prematurity (ROP) in preterm infants.

Methods

Seven databases were searched for eligible literature up to February 22, 2023. Studies were included if they were randomised controlled trials (RCTs) investigating the efficacy of anti-VEGF agents for ROP in infants. A network meta-analysis (NMA) was performed. We also conducted subgroup analyses to determine the efficacy ranking of regimens used in different regions. The odds ratio (OR), standardised mean difference (SMD), and surface under the cumulative ranking curve (SUCRA) were calculated for each outcome.

Results

Thirteen RCTs of 10 different regimens, involving 1196 infants (2388 eyes), were identified. Bevacizumab (0.625 mg; OR = 0.16, 95% confidence interval [CI] 0.06–0.40, SUCRA = 80.6%) and conbercept (0.15 mg; OR = 0.08, 95% CI 0.02–0.30, SUCRA = 96.0%) were the most effective regimens in reducing the risk of ROP recurrence requiring retreatment in Western countries and China, respectively. Compared with laser therapy, bevacizumab (0.625 mg; SMD = 1.54, 95% CI 0.06–3.02) achieved significantly longer intervals between treatment and recurrence. No significant difference in the risk of retinal detachment was detected between any anti-VEGF agent and laser (p > 0.05).

Conclusions

Bevacizumab (0.625 mg) and conbercept (0.15 mg) appeared to be the most effective therapies for ROP in Western countries and China, respectively. More high-quality RCTs are warranted to evaluate the efficacy and long-term safety of anti-VEGF drugs for the management of ROP.

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Funding

This study was supported by the National Natural Science Foundation of China (Grant No. 81970815) and the National Key Research and Development Program of China (2020YFC2008200).

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Author notes

  1. Miao Zhou, Kinji Hashimoto and Wenbo Liu contributed equally to the work presented here and should be considered equivalent authors.

Authors and Affiliations

  1. Department of Ophthalmology, Peking University People’s Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China

    Miao Zhou, Kinji Hashimoto, Wenbo Liu, Yi Cai, Jianhong Liang, Xuan Shi & Mingwei Zhao

  2. Eye Diseases and Optometry Institute, Beijing, China

    Miao Zhou, Kinji Hashimoto, Wenbo Liu, Yi Cai, Jianhong Liang, Xuan Shi & Mingwei Zhao

  3. Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China

    Miao Zhou, Kinji Hashimoto, Wenbo Liu, Yi Cai, Jianhong Liang, Xuan Shi & Mingwei Zhao

  4. College of Optometry, Peking University Health Science Center, Beijing, China

    Miao Zhou, Kinji Hashimoto, Wenbo Liu, Yi Cai, Jianhong Liang, Xuan Shi & Mingwei Zhao

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  1. Miao Zhou
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Contributions

JHL, XS, and MWZ contributed substantially to the conception and design of this paper. MZ and WBL conducted the literature searches and extracted the data from published papers. MZ, YC, and KH drafted the paper and carried out the statistical analysis.

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Correspondence to Jianhong Liang or Xuan Shi.

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Zhou, M., Hashimoto, K., Liu, W. et al. Efficacy comparison of anti-vascular endothelial growth factor drugs for the treatment of type 1 retinopathy of prematurity: A network meta-analysis of randomised controlled trials. Graefes Arch Clin Exp Ophthalmol 262, 1409–1419 (2024). https://doi.org/10.1007/s00417-023-06224-9

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  • DOI: https://doi.org/10.1007/s00417-023-06224-9

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