Bevacizumab for ocular neovascular diseases: a systematic review

Detalhes bibliográficos
Autor(a) principal: Andriolo, Regis Bruni [UNIFESP]
Data de Publicação: 2009
Outros Autores: Puga, Maria Eduarda dos Santos [UNIFESP], Belfort, Rubens Junior [UNIFESP], Atallah, Álvaro Nagib [UNIFESP]
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://dx.doi.org/10.1590/S1516-31802009000200006
http://repositorio.unifesp.br/handle/11600/5003
Resumo: CONTEXT AND OBJECTIVE: Many eye diseases involve increased local levels of vascular endothelial growth factor (VEGF), and there are several therapeutic strategies for them. Thus, the aim of this study was to evaluate the effectiveness and safety of bevacizumab for treating eye diseases involving increased local levels of VEGF, as the assumed pathophysiological mechanism. DATA SOURCES: The following databases were systematically searched for evidence: PubMed, CENTRAL (Cochrane Library), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and reference lists, without language restrictions. Only randomized controlled trials were included. The primary outcome of interest was visual acuity, irrespective of the evaluation method. DATA SYNTHESIS: A total of 667 eyes in nine randomized trials were included. Meta-analysis showed that the proportion of patients with age-related macular degeneration who presented improvements from baseline regarding best-corrected visual acuity was higher among those treated with bevacizumab than among those in the photodynamic therapy group (risk ratio, RR, 0.49; 95% confidence interval, CI, 0.31 to 0.78; P = 0.01). CONCLUSIONS: The evidence available demonstrates that bevacizumab alone or combined with other treatments is more effective than other options, including photodynamic therapy, focal photocoagulation and triamcinolone. The use of bevacizumab instead of photodynamic therapy could reduce treatment costs by more than 99% and could significantly increase access to treatment. However, long-term studies are still needed in order to reduce uncertainty concerning the safety of this medication for all ocular neovascular diseases in which bevacizumab has the potential to improve visual acuity.
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spelling Bevacizumab for ocular neovascular diseases: a systematic reviewBevacizumabe para doenças oculares neovasculares: revisão sistemáticaAngiogenesis inhibitorsRetinal neovascularizationCorneal angiogenesisMacular degenerationReviewInibidores da angiogêneseNeovascularização retinianaNeovascularização da córneaDegeneração macularRevisãoCONTEXT AND OBJECTIVE: Many eye diseases involve increased local levels of vascular endothelial growth factor (VEGF), and there are several therapeutic strategies for them. Thus, the aim of this study was to evaluate the effectiveness and safety of bevacizumab for treating eye diseases involving increased local levels of VEGF, as the assumed pathophysiological mechanism. DATA SOURCES: The following databases were systematically searched for evidence: PubMed, CENTRAL (Cochrane Library), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and reference lists, without language restrictions. Only randomized controlled trials were included. The primary outcome of interest was visual acuity, irrespective of the evaluation method. DATA SYNTHESIS: A total of 667 eyes in nine randomized trials were included. Meta-analysis showed that the proportion of patients with age-related macular degeneration who presented improvements from baseline regarding best-corrected visual acuity was higher among those treated with bevacizumab than among those in the photodynamic therapy group (risk ratio, RR, 0.49; 95% confidence interval, CI, 0.31 to 0.78; P = 0.01). CONCLUSIONS: The evidence available demonstrates that bevacizumab alone or combined with other treatments is more effective than other options, including photodynamic therapy, focal photocoagulation and triamcinolone. The use of bevacizumab instead of photodynamic therapy could reduce treatment costs by more than 99% and could significantly increase access to treatment. However, long-term studies are still needed in order to reduce uncertainty concerning the safety of this medication for all ocular neovascular diseases in which bevacizumab has the potential to improve visual acuity.CONTEXTO E OBJETIVOS: Muitas doenças oculares envolvem o aumento dos níveis locais de fator de crescimento do endotélio vascular (FCEV), uma diversidade de estratégias terapêuticas para tais condições. Assim, o objetivo do presente estudo é avaliar a efetividade e a segurança de bevacizumabe para o tratamento de pacientes com doença ocular que envolva o aumento dos níveis locais de FCEV, como mecanismo patofisiológico assumido. FONTE DAS INFORMAÇÕES: Foi realizada busca sistemática pelas evidências disponíveis nas seguintes bases de dados da eletrônicas: PubMed, CENTRAL (The Cochrane Library), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), além de referências bibliográficas de estudos relevantes, sem restrições de língua. Foram incluídos apenas ensaios controlados e aleatórios. Acuidade visual, independentemente do método de avaliação, foi considerada o desfecho primário de interesse. SÍNTESE DOS DADOS: Foi incluído um total de 667 olhos testados em nove ensaios clínicos aleatórios. A metanálise demonstrou que a proporção de pacientes com degeneração macular relacionada à idade que melhoraram a acuidade visual foi maior entre os tratados com bevacizumabe do que entre os pacientes em terapia fotodinâmica (risco relativo [RR] 0.49, 95% intervalo de confiança [IC] 0,31 a 0,78, P = 0,01). CONCLUSÕES: A evidência disponível demonstra que bevacizumabe isolado ou combinado com outras terapias é mais eficaz que terapia fotodinâmica, fotocoagulação focal e triancinolona. O uso de bevacizumabe em vez da terapia fotodinâmica poderia reduzir os custos do tratamento em mais de 99% e aumentar significativamente o acesso ao tratamento. Entretanto, o aspecto de segurança do fármaco ainda necessita ser avaliado por estudos em longo prazo com todas as doenças neovasculares em que bevacizumabe tenha o potencial de melhorar acuidade visual.Brazilian Cochrane CenterUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of MedicineUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of OphthalmologyUNIFESP, EPM, Department of MedicineUNIFESP, EPM, Department of OphthalmologySciELOAssociação Paulista de Medicina - APMBrazilian Cochrane CenterUniversidade Federal de São Paulo (UNIFESP)Andriolo, Regis Bruni [UNIFESP]Puga, Maria Eduarda dos Santos [UNIFESP]Belfort, Rubens Junior [UNIFESP]Atallah, Álvaro Nagib [UNIFESP]2015-06-14T13:39:11Z2015-06-14T13:39:11Z2009-05-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion84-91application/pdfhttp://dx.doi.org/10.1590/S1516-31802009000200006ANDRIOLO, Regis Bruni et al . Bevacizumab for ocular neovascular diseases: a systematic review. Sao Paulo Med. J., São Paulo , v. 127, n. 2, p. 84-91, maio 200910.1590/S1516-31802009000200006S1516-31802009000200006.pdf1516-3180S1516-31802009000200006http://repositorio.unifesp.br/handle/11600/5003WOS:000267899500006engSão Paulo Medical Journalinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-07-30T01:05:36Zoai:repositorio.unifesp.br/:11600/5003Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-07-30T01:05:36Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Bevacizumab for ocular neovascular diseases: a systematic review
Bevacizumabe para doenças oculares neovasculares: revisão sistemática
title Bevacizumab for ocular neovascular diseases: a systematic review
spellingShingle Bevacizumab for ocular neovascular diseases: a systematic review
Andriolo, Regis Bruni [UNIFESP]
Angiogenesis inhibitors
Retinal neovascularization
Corneal angiogenesis
Macular degeneration
Review
Inibidores da angiogênese
Neovascularização retiniana
Neovascularização da córnea
Degeneração macular
Revisão
title_short Bevacizumab for ocular neovascular diseases: a systematic review
title_full Bevacizumab for ocular neovascular diseases: a systematic review
title_fullStr Bevacizumab for ocular neovascular diseases: a systematic review
title_full_unstemmed Bevacizumab for ocular neovascular diseases: a systematic review
title_sort Bevacizumab for ocular neovascular diseases: a systematic review
author Andriolo, Regis Bruni [UNIFESP]
author_facet Andriolo, Regis Bruni [UNIFESP]
Puga, Maria Eduarda dos Santos [UNIFESP]
Belfort, Rubens Junior [UNIFESP]
Atallah, Álvaro Nagib [UNIFESP]
author_role author
author2 Puga, Maria Eduarda dos Santos [UNIFESP]
Belfort, Rubens Junior [UNIFESP]
Atallah, Álvaro Nagib [UNIFESP]
author2_role author
author
author
dc.contributor.none.fl_str_mv Brazilian Cochrane Center
Universidade Federal de São Paulo (UNIFESP)
dc.contributor.author.fl_str_mv Andriolo, Regis Bruni [UNIFESP]
Puga, Maria Eduarda dos Santos [UNIFESP]
Belfort, Rubens Junior [UNIFESP]
Atallah, Álvaro Nagib [UNIFESP]
dc.subject.por.fl_str_mv Angiogenesis inhibitors
Retinal neovascularization
Corneal angiogenesis
Macular degeneration
Review
Inibidores da angiogênese
Neovascularização retiniana
Neovascularização da córnea
Degeneração macular
Revisão
topic Angiogenesis inhibitors
Retinal neovascularization
Corneal angiogenesis
Macular degeneration
Review
Inibidores da angiogênese
Neovascularização retiniana
Neovascularização da córnea
Degeneração macular
Revisão
description CONTEXT AND OBJECTIVE: Many eye diseases involve increased local levels of vascular endothelial growth factor (VEGF), and there are several therapeutic strategies for them. Thus, the aim of this study was to evaluate the effectiveness and safety of bevacizumab for treating eye diseases involving increased local levels of VEGF, as the assumed pathophysiological mechanism. DATA SOURCES: The following databases were systematically searched for evidence: PubMed, CENTRAL (Cochrane Library), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and reference lists, without language restrictions. Only randomized controlled trials were included. The primary outcome of interest was visual acuity, irrespective of the evaluation method. DATA SYNTHESIS: A total of 667 eyes in nine randomized trials were included. Meta-analysis showed that the proportion of patients with age-related macular degeneration who presented improvements from baseline regarding best-corrected visual acuity was higher among those treated with bevacizumab than among those in the photodynamic therapy group (risk ratio, RR, 0.49; 95% confidence interval, CI, 0.31 to 0.78; P = 0.01). CONCLUSIONS: The evidence available demonstrates that bevacizumab alone or combined with other treatments is more effective than other options, including photodynamic therapy, focal photocoagulation and triamcinolone. The use of bevacizumab instead of photodynamic therapy could reduce treatment costs by more than 99% and could significantly increase access to treatment. However, long-term studies are still needed in order to reduce uncertainty concerning the safety of this medication for all ocular neovascular diseases in which bevacizumab has the potential to improve visual acuity.
publishDate 2009
dc.date.none.fl_str_mv 2009-05-01
2015-06-14T13:39:11Z
2015-06-14T13:39:11Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1590/S1516-31802009000200006
ANDRIOLO, Regis Bruni et al . Bevacizumab for ocular neovascular diseases: a systematic review. Sao Paulo Med. J., São Paulo , v. 127, n. 2, p. 84-91, maio 2009
10.1590/S1516-31802009000200006
S1516-31802009000200006.pdf
1516-3180
S1516-31802009000200006
http://repositorio.unifesp.br/handle/11600/5003
WOS:000267899500006
url http://dx.doi.org/10.1590/S1516-31802009000200006
http://repositorio.unifesp.br/handle/11600/5003
identifier_str_mv ANDRIOLO, Regis Bruni et al . Bevacizumab for ocular neovascular diseases: a systematic review. Sao Paulo Med. J., São Paulo , v. 127, n. 2, p. 84-91, maio 2009
10.1590/S1516-31802009000200006
S1516-31802009000200006.pdf
1516-3180
S1516-31802009000200006
WOS:000267899500006
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv São Paulo Medical Journal
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 84-91
application/pdf
dc.publisher.none.fl_str_mv Associação Paulista de Medicina - APM
publisher.none.fl_str_mv Associação Paulista de Medicina - APM
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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