康柏西普和雷珠单抗治疗黄斑水肿有效性的Meta分析

目的:运用循证医学系统评价与分析的研究方法,探讨康柏西普(conbercept)和雷珠单抗(ranibizumab)治疗黄斑水肿的有效性.方法:分别在Pubmed、EMbase、Cochrane Library Central Register of Controlled Trials(CENTRAL)、Google scholar、ClinicalTrials.gov、中国知网(CNKI)、维普数据库(VIP)和万方数据库(WanFang Database)中检索发表于2012-01-01/2017-07-01关于对比康柏西普和雷珠单抗治疗各种继发性黄斑水肿的临床疗效的文章,将视力(visual acuity,VA)的改善和黄斑中心凹视网膜厚度(central macular thickness,CMT)作为主要的结局指标进行Meta分析以评价药物的有效性.用Review Manager 5.3和Stata 12.0软件进行数据分析.结果:经过系统性文献检索,本Meta分析纳入11个临床随机对照研究(randomized controlled trial,RCT),共812眼,其中康柏西普组414眼,雷珠单抗组398眼,主要为老年性黄斑变性、糖尿病视网膜病变、视网膜静脉阻塞所致的黄斑水肿.统计分析结果发现,康柏西普和雷珠单抗对于短期内(治疗3mo)视力改善和CMT变化差异均无统计学意义(P>0.05);在治疗不同原发病导致的黄斑水肿方面两种药物效果相当,但与雷珠单抗相比,康柏西普对于远期(治疗6mo)黄斑水肿的消退效果显著(OR=-58.50,95%CI:-108.04~-8.95,P=0.02).结论:康柏西普在治疗继发性黄斑水肿方面疗效优于雷珠单抗.

Comparison of Conbercept with Ranibizumab for the treatment efficiency of macular edema: a meta-analysis

AIM: To study the clinical effect of Conbercept and Ranibizumab for macular edema(ME)with meta-analysis.

METHODS:We searched Pubmed, EMBASE, Cochrane Library Central Register of Controlled Trials(CENTRAL), Google scholar, ClinicalTrials.gov, CNKI, VIP and wanfang database for studies which published between January 1 2012 and July 1 2017, on the comparison of conbercept with ranibizumab for the clinical effect of secondary macular edema. The primary endpoints were visual acuity(VA)and central macular thickness in this study to assess the efficiency of the drugs. Review Manager 5.3 and Stata 12.0 were used for data analysis with the pooled odds ratios(OR), mean difference and 95% confidence interval(CI).

RESULTS: Eleven RCTs involving 812 patients met inclusion criteria and included in this meta-analysis, including 414 eyes in conbercept group and 398 eyes in ranibizumab group. Macular edema in this study were secondary to age-related macular degeneration, diabetic retinopathy and retinal vein occlusion. No significant differences in improvement of vision acuity(P=0.09)or reduction of CMT(P>0.05)were noted at the end of 3mo between two groups. Compared to ranibizumab, conbercept showed a better effectiveness in macular edema alleviation in the end of 6mo in the present study(OR=-58.50, 95%CI: -108.04 to -8.95; P=0.02).

CONCLUSION: Despite evidence from the meta-analysis of the RCTs suggesting a strong difference of the effectiveness for macular edema between conbercept and ranibizumab, more clinical trials are still needed to confirm our results because of the heterogeneity in the collected data.