贝伐单抗和雷珠单抗治疗渗出型老年性黄斑变性有效性meta分析

目的 系统评价贝伐单抗和雷珠单抗治疗渗出型老年性黄斑变性（AMD）的有效性。方法 计算机检索荷兰医学文摘数据库Embase、美国临床医学期刊全文数据库Ovid、美国国立医学图书馆医学数据库Pubmed、中国知网、万方数据库、维普中文期刊数据库。收集国内外公开发表的关于贝伐单抗和雷珠单抗治疗渗出型AMD的随机对照试验。检索时限截止至2013年11月。按照纳入与排除标准筛选文献、提取资料和进行质量评价。用RevMan 5.2.6软件进行统计分析。比较贝伐单抗和雷珠单抗治疗前与治疗后3、6、12个月渗出型AMD患者的视力和黄斑中心凹厚度。结果 最终纳入5个研究，共1954例渗出型AMD患者。其中，贝伐单抗治疗组967例，雷珠单抗治疗组987例。Meta分析结果显示，贝伐单抗治疗组与雷珠单抗治疗组视力提高值比较，差异无统计学意义［3个月：加权均数差（WMD）=0.32，95%可信区间（CI）为-0.84~1.49，P=0.59；6个月：WMD=0.47，95%CI为-0.67~1.62，P=0.42；12个月：WMD=0.84，95% CI为-0.23~1.90，P=0.12］；贝伐单抗治疗组与雷珠单抗治疗组黄斑中心凹厚度降低值比较，差异无统计学意义（3个月：WMD=6.21，95%CI为-6.23~18.65，P=0.33；6个月：WMD=4.06，95% CI为-6.16~14.27，P=0.44；12个月：WMD=-5.39，95%CI为-14.41~3.63，P=0.24）。结论 贝伐单抗与雷珠单抗治疗渗出型AMD具有相似的治疗效果。

Efficacy in the treatment of age-related macular degeneration by bevacizumab versus ranibizumab: a meta-analysis

Objective To evaluate the efficacy in the treatment of age-related macular degeneration (AMD) by bevacizumab versus ranibizumab. Methods A computerized search was conducted in the Embase, Ovid, PubMed, China National Knowledge Infrastructure (CNKI), WanFang Data and VIP database of Chinese journal. Randomized controlled trials (RCTs) comparing bevacizumab with ranibizumab for AMD from inception to November, 2013 were collected. Methodology qualifies of studies were performed by experienced reviewers according to the inclusion and exclusion criteria. Further, the materials were analyzed with software RevMan 5.2.6. Visual acuity and central foveal thickness before and 3, 6, 12 months after treatment between the two treatment methods were compared. Results A total of 5 RCTs were included in this meta analysis, including 1954 patients (967 patients in the bevacizumab group, 987 eyes in the ranibizumab group). There was no difference in improving visual acuity after treatment between two groups ［3 months: weighted mean difference (WMD)=0.32, 95%CI:-0.84 -1.49,P=0.59; 6 months:WMD=0.47, 95%CI:-0.67 -1.62,P=0.42; 12 months: WMD=0.84, 95%CI:-0.23 -1.90,P= 0.12］. There was no difference in cutting down the central foveal thickness after treatment between two groups (3 months: WMD=6.21, 95%CI:-6.23-18.65,P=0.33; 6 months: WMD=4.06,95%CI:-6.16-14.27,P=0.44;12months: WMD=-5.39, 95%CI:-14.41-3.63,P=0.24). Conclusion Bevacizumab has equal efficacy to ranibizumab in the treatment of AMD.