Home > Archive>Volume 16, Issue 7, 2023 >1145-1154. DOI:10.18240/ijo.2023.07.21
PDF HTML XML Export Cite reminder
Comparison of efficacy of conbercept, aflibercept, and ranibizumab ophthalmic injection in the treatment of macular edema caused by retinal vein occlusion: a Meta-analysis
Author:
Corresponding Author:

Li Peng. Department of Ophthalmology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, 43 People Road, Haikou 570000, Hainan Province, China. mj.pengli@163.com

Fund Project:

Supported by the Natural Science Foundation of Hainan Province (No.821QN1005); Hainan Provincial Health Commission Project (No.21A200067); Hainan Provincial Classification of Project (No.ZDYF2020110).

  • Article
    • | |
  • Metrics
    • |
  • Reference [48]
    • |
  • Related [20]
    • | | |
  • Comments
    Abstract:

    AIM: To evaluate and compare the anatomical and functional outcomes and negative effects of the three anti-vascular endothelial growth factor (VEGF) drugs in the treatment of macular edema (ME) due to retinal vein occlusion (RVO) based on the evidence pooled from current clinical trials and observational studies. METHODS: A systematic literature search was conducted on nine online databases from inception until April 30, 2022. The main endpoints were best corrected visual acuity (BCVA), central macular thickness (CMT), and adverse events (AEs). Cumulative Meta-analysis was conducted to synthesize the outcomes of the drugs. The retrieved data were analyzed using Stata software (version 12.0). RESULTS: A total of 20 studies comprising 1674 eyes met the inclusion criteria to the Meta-analysis. It was observed that conbercept and aflibercept had better visual acuity effects compared with ranibizumab at 1mo [weight mean difference (WMD)=-0.03, P=0.001; WMD=-0.05, P=0.019], but the effects were not different from that of ranibizumab at 6mo. Moreover, there was not statistically significant difference in the proportion of patients gaining ≥15 letters at 12-24mo between aflibercept and ranibizumab [odds ratio (OR)=1.16, P=0.427]. Conbercept had higher mean CMT change effects at 1mo (WMD= -14.43, P=0.014) and 6mo (WMD=-35.63, P≤0.001) compared with ranibizumab. Meanwhile, the mean CMT change effects at 1mo (WMD=-10.14, P=0.170), 6mo (WMD=-26.98, P=0.140) and 12-24mo (WMD=-12.34, P=0.071) were comparable among the groups. Similarly, AEs were not significantly different among the treatments (OR=0.75, P=0.305; OR=1.04, P=0.89). The stability of effect size of mean BCVA and CMT improved with the increase in sample size. Aflibercept and conbercept required fewer injections compared with ranibizumab. CONCLUSION: This is the first study to evaluate the efficacy and AEs of intravitreal administration of conbercept, ranibizumab, and aflibercept in the treatment of RVO-ME. Intravitreal aflibercept or conbercept results in better mean change in vision and CMT reduction compared with ranibizumab. Conbercept can be considered to be a promising and innovative drug with good anti-VEGF effects.

    Reference
    1 Hirano Y, Suzuki N, Tomiyasu T, Kurobe R, Yasuda Y, Esaki Y, Yasukawa T, Yoshida M, Ogura Y. Multimodal imaging of microvascular abnormalities in retinal vein occlusion. J Clin Med 2021;10(3):405.
    2 Qin HF, Shi FJ, Zhang CY, Luo DW, Qin SY, Wu J, Xie H, Zhang JT, Qiu QH, Liu K, Xu GT, Xu GX, Zhang JF. Anti-VEGF reduces inflammatory features in macular edema secondary to retinal vein occlusion. Int J Ophthalmol 2022;15(8):1296-1304.
    3 Chen KH, Hsiang EL, Hsu MY, Chou YC, Lin TC, Chang YL, Tsai CY, Li TH, Woung LC, Chen SJ, Peng CH, Hwang DK. Elevation of serum oxidative stress in patients with retina vein occlusions. Acta Ophthalmol 2019;97(2):e290-e295.
    4 Hykin P, Prevost AT, Vasconcelos JC, Murphy C, Kelly J, Ramu J, Hounsome B, Yang Y, Harding SP, Lotery A, Chakravarthy U, Sivaprasad S, LEAVO Study Group. Clinical effectiveness of intravitreal therapy with ranibizumab vs aflibercept vs bevacizumab for macular edema secondary to central retinal vein occlusion: a randomized clinical trial. JAMA Ophthalmol 2019;137(11):1256-1264.
    5 Song WQ, Jiao WZ, Li FJ, Ma AH, Zhao BJ. Evaluation of microvascular structure changes after conbercept treatment on macular edema secondary to retinal vein occlusion. Biomed Res Int 2020;2020:9046781.
    6 Ding XX, Wang Y, Zou B, Zang DX, Hao Y. Effect of conbercept treatment on macular edema and microvascular structure in eyes with retinal vein occlusions. Int J Gen Med 2022;15:7311-7318.
    7 Zhu XM, Yu YY, Zhuoga SN, Dawa X, Zhou YK, Wangmu OZ, Yangzong DJ, An F, Miao H, Zhao MW. Real-world outcomes of anti-vascular endothelial growth factor therapy for retinal vascular vein occlusion in Tibet, China. Int J Ophthalmol 2022;15(11):1814-1820.
    8 Vader MJC, Schauwvlieghe AME, Verbraak FD, et al. Comparing the efficacy of bevacizumab and ranibizumab in patients with retinal vein occlusion: the bevacizumab to ranibizumab in retinal vein occlusions (BRVO) study, a randomized trial. Ophthalmol Retina 2020;4(6):576-587.
    9 Yoshino T, Portnoy DC, Obermannová R, et al. Biomarker analysis beyond angiogenesis: RAS/RAF mutation status, tumour sidedness, and second-line ramucirumab efficacy in patients with metastatic colorectal carcinoma from RAISE-a global phase III study. Ann Oncol 2019;30(1):124-131.
    10 Liu K, Wang HY, He W, et al. Intravitreal conbercept for diabetic macular oedema: 2-year results from a randomised controlled trial and open-label extension study. Br J Ophthalmol 2022;106(10):1436-1443.
    11 Li FJ, Sun M, Guo JL, Ma AH, Zhao BJ. Comparison of conbercept with ranibizumab for the treatment of macular edema secondary to branch retinal vein occlusion. Curr Eye Res 2017;42(8):1174-1178.
    12 Zeng HY, Liu Q, Li XX, Sun YX, Zhang ZJ. One-year efficacy of intravitreal conbercept injection for macular oedema secondary to central retinal vein occlusion in Chinese patients. Eye (Lond) 2020;34(8):1459-1464.
    13 Bai JY, Wang WY, Dou ZZ, Geng BC, Xu XY, Zhu YZ, Zhao SY, Liu M, Jia SY, Luo WJ. Efficacy of intravitreal conbercept injection on short-and long-term macular edema in branch retinal vein occlusion. Int J Ophthalmol 2022(3):489-494.
    14 Zhang WY, Liu Y, Sang AM. Efficacy and effectiveness of anti-VEGF or steroids monotherapy versus combination treatment for macular edema secondary to retinal vein occlusion: a systematic review and meta-analysis. BMC Ophthalmol 2022;22(1):472.
    15 Zhao T, Chen Y, Zhang HS, Chen Y, Wang ZJ. Efficacy of conbercept after switching from bevacizumab/ranibizumab in eyes of macular edema secondary to central retinal vein occlusion. Int J Ophthalmol 2022;15(4):609-614.
    16 Qian T, Zhao M, Xu X. Comparison between anti-VEGF therapy and corticosteroid or laser therapy for macular oedema secondary to retinal vein occlusion: a meta-analysis. J Clin Pharm Ther 2017;42(5):519-529.
    17 Li T, Zhang L, Wang J, et al. Comparison of effects of intravitreal injection of ranibizumab and conbercept for macular edema secondary to retinal vein occlusion. Chin Heal Care Nutrit 2017;27(11):150-151.
    18 Bai S, Yu XB. The efficacy of intravitreal ranibizumab and (or) triamcinolone combined with laser photocoagulation for macular edema secondary to branch retinal vein occlusion. Int Eye Sci 2017;17(4):648-651.
    19 Chen B, Chen F. Comparison of the therapeutic effect and safety of anti-VEGF drugs on macular edema secondary to non-ischemic retinal vein occlusion. Int Eye Sci 2019;19(3):426-429.
    20 Chen X, Zhao M, Jiang Y, et al. Efficacy and safety of Conbercept Ophthalmic Injection and Ranibizumab Injections in the treatment of CRVO macular edema. Drug Eval Res 2018;41(2):279-282.
    21 Ma Q, Chen Z, Zhang S, et al. Comparison of effects of intravitreal Ranibizumab and Conbercept for macular edema secondary to retinal vein occlusion. Ningxia Med J 2019;41(7):650-652.
    22 Ou Y, Zhou X, Xie L, et al. Anti-VEGF combined with retinal laser in treatment of retinal vein occlusion with macular edema. Int Eye Sci 2019;19(7):1162-1165.
    23 Wang D. Comparative studies of conbercept with ranibizumab for the treatment of macular edema due to central retinal vein occlusion. Ophthalomoly, China: Nanchang University, 2016:55.
    24 Zhang X, Zheng X, Wu R, et al. Efficacy of intravitreal ranibizumab and Conbercept for macular edema secondary to retinal vein occlusion. Chin J Gerontol 2018;38(6):1414-1416
    25 Chen T, Zhu D, Yang L. Efficacy of retinal photocoagulation combined with Rnibizumab or Conbercept in patients with macular edema secondary to retinal vein occlusion. Int Eye Sci 2018;18(9):1594-1598.
    26 Chen L, Li M. Comparison of effects and safety of intravitreal injection of ranibizumab and conbercept for cystoids macular edema secondary to retinal vein occlusion. Chin J Ophthalmol Otorhinolaryngol 2019;19(1):26-30.
    27 Saishin Y, Ito Y, Fujikawa M, Sawada T, Ohji M. Comparison between ranibizumab and aflibercept for macular edema associated with central retinal vein occlusion. Jpn J Ophthalmol 2017;61(1):67-73.
    28 Pichi F, Elbarky AM, Elhamaky TR. Outcome of “treat and monitor” regimen of aflibercept and ranibizumab in macular edema secondary to non-ischemic branch retinal vein occlusion. Int Ophthalmol 2019;39(1):145-153.
    29 Kotake O, Noma H, Yasuda K, Motohashi R, Goto H, Shimura M. Comparing cytokine kinetics between ranibizumab and aflibercept in central retinal vein occlusion with macular edema. Ophthalmic Res 2018:1-8.
    30 Casselholm de Salles M, Amrén U, Kvanta A, Epstein DL. Injection frequency of aflibercept versus ranibizumab in a treat-and-extend regimen for central retinal vein occlusion: a randomized clinical trial. Retina 2019;39(7):1370-1376.
    31 Chatziralli I, Theodossiadis G, Moschos MM, Mitropoulos P, Theodossiadis P. Ranibizumab versus aflibercept for macular edema due to central retinal vein occlusion: 18-month results in real-life data. Graefes Arch Clin Exp Ophthalmol 2017;255(6):1093-1100.
    32 Kaldırım HE, Yazgan S. A comparison of three different intravitreal treatment modalities of macular edema due to branch retinal vein occlusion. Int Ophthalmol 2018;38(4):1549-1558.
    33 Küçük B, Sirakaya E, Karaca C. Comparison of ranibizumab versus aflibercept in treating macular edema among patients with serous retinal detachment secondary to branch retinal vein occlusion. Ocul Immunol Inflamm 2021;29(2):403-410.
    34 Yucel OE, Birinci H, Sullu Y. The short-term efficacy of intravitreal ranibizumab, aflibercept and dexamethasone implant in the treatment of macular edema due to non-ischemic central retinal vein occlusion. Int Ophthalmol 2019;39(4):891-901.
    35 Abraham NS, Byrne CJ, Young JM, Solomon MJ. Meta-analysis of well-designed nonrandomized comparative studies of surgical procedures is as good as randomized controlled trials. J Clin Epidemiol 2010;63(3):238-245.
    36 Sangroongruangsri S, Ratanapakorn T, Wu O, Anothaisintawee T, Chaikledkaew U. Comparative efficacy of bevacizumab, ranibizumab, and aflibercept for treatment of macular edema secondary to retinal vein occlusion: a systematic review and network meta-analysis. Expert Rev Clin Pharmacol 2018;11(9):903-916.
    37 Nghiem-Buffet S, Glacet-Bernard A, Addou-Regnard M, Souied EH, Cohen SY, Giocanti-Auregan A. Extended injection intervals after switching from ranibizumab to aflibercept in macular edema due to central retinal vein occlusion. J Ophthalmol 2018;2018:8656495.
    38 Kaya F, Kocak I, Aydin A, Baybora H, Koc H, Karabela Y. Effect of aflibercept on persistent macular edema secondary to central retinal vein occlusion. J Fr Ophtalmol 2018;41(9):809-813.
    39 Konidaris V, Al-Hubeshy Z, Tsaousis KT, Gorgoli K, Banerjee S, Empeslidis T. Outcomes of switching treatment to aflibercept in patients with macular oedema secondary to central retinal vein occlusion refractory to ranibizumab. Int Ophthalmol 2018;38(1):207-213.
    40 Spooner K, Hong T, Bahrami B, Chang A. A meta-analysis of patients with treatment-resistant macular oedema secondary to retinal vein occlusions following switching to aflibercept. Acta Ophthalmol 2019;97(1):15-23.
    41 Yang LPH, McKeage K. Intravitreal aflibercept (Eylea®): a review of its use in patients with macular oedema secondary to central retinal vein occlusion. Drugs Aging 2014;31(5):395-404.
    42 Cai SW, Yang QH, Li XR, Zhang Y. The efficacy and safety of aflibercept and conbercept in diabetic macular edema. Drug Des Devel Ther 2018;12:3471-3483.
    43 Li H, Lei N, Zhang M, Li Y, Xiao HB, Hao XF. Pharmacokinetics of a long-lasting anti-VEGF fusion protein in rabbit. Exp Eye Res 2012;97(1):154-159.
    44 Yao TT, Jin XL, Yang Y, Wang YX, Zhou YL, He FL, Wang ZY. Intraocular pharmacokinetics and safety of subretinal injection compared with intravitreal application of conbercept in vitrectomized rabbit eyes. J Ophthalmol 2020;2020:2674780.
    45 Stewart MW, Rosenfeld PJ. Predicted biological activity of intravitreal VEGF Trap. Br J Ophthalmol 2008;92(5):667-668.
    46 Reibaldi M, Pulvirenti A, Avitabile T, Bonfiglio V, Russo A, Mariotti C, Bucolo C, Mastropasqua R, Parisi G, Longo A. Pooled estimates of incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents with and without topical antibiotic prophylaxis. Retina 2018;38(1):1-11.
    47 Hara C, Wakabayashi T, Fukushima Y, Sayanagi K, Kawasaki R, Sato S, Sakaguchi H, Nishida K. Tachyphylaxis during treatment of exudative age-related macular degeneration with aflibercept. Graefes Clin Exp Ophthalmol 2019;257(11):2559-2569.
    48 Yamamoto M, Miura Y, Hirayama K, Kohno T, Kabata D, Theisen-Kunde D, Brinkmann R, Honda S. Predictive factors of outcome of selective retina therapy for diabetic macular edema. Int Ophthalmol 2020;40(5):1221-1232.
    Cited by
    Comments
    Comments
    分享到微博
    Submit
Get Citation

Qiu Xing, Ya-Nan Dai, Xiao-Bo Huang,/et al.Comparison of efficacy of conbercept, aflibercept, and ranibizumab ophthalmic injection in the treatment of macular edema caused by retinal vein occlusion: a Meta-analysis. Int J Ophthalmol, 2023,16(7):1145-1154

Copy
Share
Article Metrics
  • Abstract:463
  • PDF: 824
  • HTML: 0
  • Cited by: 0
Publication History
  • Received:September 16,2022
  • Revised:May 29,2023
  • Online: June 27,2023
You are the 4446672 Visitors
Governing Body：Department of Health, Provincial Government of Shaanxi, China
Organizer：Xi'an Medical Association of China
Address：Room 11707-08, Building 2, Unit 1, Wanda Plaza, No.8 Yanta North Road, Xi'an 710054, Shaanxi Province, China
Fax：(8629)82245172 Phone：(+8629)82245172/82210956
Email：ijopress@163.com
International Journal of Ophthalmology ® 2025 All Rights Reserved   The terms of CC BY-NC-ND 4.0 are applicable to all open access content.