Bevacizumab for ocular neovascular diseases: a systematic review
Autor(a) principal: | |
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Data de Publicação: | 2009 |
Outros Autores: | , , |
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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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 |
_version_ |
1814268342501900288 |