Anti‐VEGF monotherapy versus anti‐VEGF therapy combined with laser or intravitreal glucocorticoid therapy for diabetic macular edema: A Bayesian network meta‐analysis

Abstract Aims To conduct a network meta‐analysis (NMA) comparing the efficacy of anti‐vascular endothelial growth factor (VEGF) monotherapy versus anti‐VEGF therapy combined with laser or intravitreal glucocorticoid therapy for diabetic macular edema (DME). Materials and Methods PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials comparing anti‐VEGF monotherapy with anti‐VEGF therapy combined with laser or intravitreal glucocorticoid therapy for DME. The primary outcomes included the mean best‐corrected visual acuity (BCVA) and central macular thickness (CMT) changes from the baseline. A NMA for continuous outcomes was conducted using a fixed‐effects model, with mean difference (MD) and corresponding 95% credible interval (CI) reported. Results The NMA included 21 randomized controlled trials involving 1798 eyes. Anti‐VEGF monotherapy and anti‐VEGF combined with laser or intravitreal glucocorticoid therapy did not significantly change the mean CMT and BCVA at 6 and 12 months from the baseline. Simulation‐based ranking results for mean BCVA changes suggested that anti‐VEGF therapy combined with laser therapy was likely the most effective at 6 (70.7515%) and 12 (70.9315%) months. Similar results were observed in the simulation‐based ranking of mean CMT changes, suggesting that anti‐VEGF therapy combined with laser therapy was likely the most effective at 6 (83.6350%) and 12 (74.7730%) months. Conclusions Anti‐VEGF monotherapy and anti‐VEGF therapy combined with laser or intravitreal glucocorticoid therapy exerted comparable effects. However, the ranking chart recommends anti‐VEGF therapy combined with laser therapy. Meanwhile, anti‐VEGF therapy combined with intravitreal glucocorticoid therapy did not demonstrate significant benefits.