Bevacizumab did not improve diabetic macular oedema at 12 weeks

Macular_oedema

We recently reported on new guidance from NICE about the treatment of diabetic macular oedema with ranibizumab.  Another systematic review recently looked at another injectable drug with a similar role: bevacizumab, or Avastin.

Clinical question:

In patients with diabetic macular oedema (DMO), does intravitral injection of bevacizumab (IVB) improve visual acuity?

The review focused on previously untreated cases of DMO rather than those that had been previously unsuccessfully treated.

The evidence:

Four randomised trials were found that met compared IVB with laser treatment (macular photocoagulation).  Three compared IVB with the combined treatment of  IVB and intravitral triamcinolone acetonide injection.

Both comparisons found a significant benefit for IVB at six weeks, but not at 12 weeks.

Appraisal hints:

  • What was the methodological quaility of the individual trials?
  • How were the visual acuity outcomes measured?  Were they consistent between studies?
  • Note that visual acuity improved at 6 weeks but this improvement was not maintained at 12 weeks.

Reference:

Yilmaz T, Cordero-Coma M, Gallagher MJ, Teasley LA. Systematic review of intravitreal bevacizumab injection for treatment of primary diabetic macular oedema.  Acta Ophthalmol. 2011 Dec;89(8):709-17.

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Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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