Antiangiogenic therapy with interferon alfa for neovascular age-related macular degeneration

 

Abstract

Background

Antiangiogenic therapy is a new approach to the treatment of neovascular age-related macular degeneration. Interferon alfa is one antiangiogenic agent thought to function by inhibiting the migration and proliferation of vascular endothelial cells. It has been used in the treatment of hepatitis, solid tumors and hematologic malignancies.

Objectives

The aim of this review was to investigate interferon alfa as a treatment modality for neovascular age-related macular degeneration.

Search methods

We searched and identified trials from the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Group Trials Register, in The Cochrane Library (Issue 3, 2007), the National Research Register (Issue 3, 2007), MEDLINE (1966 to July 2007), EMBASE (1980 to July 2007), LILACS (Latin American and Caribbean Health Science Literature Database) (July 2007) and the reference lists of included studies.

Selection criteria

We included randomized controlled trials evaluating interferon alfa therapy in people with neovascular age-related macular degeneration who were followed for at least one year.

Data collection and analysis

Both review authors independently extracted data and assessed trial quality. No data synthesis was conducted as only one trial met the inclusion criteria.

Main results

The one included trial enrolled and randomized 481 participants from 45 centers worldwide into four groups. The study allowed for analysis of the number of participants who had lost three or more lines of vision at 52 weeks in three interferon alfa-2a groups versus placebo. The results show an odds ratio of 1.60 (95% Confidence Interval 1.01 to 2.53) indicating that interferon is associated with a 60% increased odds of losing three or more lines at 52 weeks. This finding is marginally statistical with a P value of 0.04 and indicates that the treatment has the potential for harm rather than benefit.

Authors' conclusions

At present there is not enough evidence to recommend the use of interferon alfa-2a for the treatment of age-related macular degeneration.

 

Plain language summary

Interferon alfa for the treatment of neovascular age-related macular degeneration

Age-related macular degeneration (AMD) is a progressive and degenerative disease of the retina, causing blood vessels to develop under the retina which eventually lead to visual impairment. Antiangiogenic therapy is a new approach to the treatment of neovascular age-related macular degeneration. Interferon is one antiangiogenic agent thought to function by preventing the growth of vascular endothelial cells which help to form these new blood vessels. This review included one randomized controlled trial with 481 participants, all aged over 50 years from 45 different centers. The trial compared interferon alfa therapy to placebo with a follow up of 52 weeks. The proportion of participants who had lost at least three lines of vision at 52 weeks did not differ significantly between the control and treatment groups. The results of the trial were inconclusive and suggested that if anything, the intervention could be harmful. Since several new antiangiogenic interventions are now available, it is unlikely that further studies on interferon alfa can be justified.

 

摘要

背景

干擾素α的抗血管生成療法用於治療新生血管性老年黃斑部退化

抗血管生成療法是一種治療新生血管性老年黃斑退化的新方法。干擾素α是一種抗血管生成劑，其有抑制血管內皮細胞遷移與擴散的功能。它被用於治療肝炎，實質腫瘤與血液惡性腫瘤。

目標

這篇回顧的目的為研究干擾素α作為新生血管性老年黃斑部退化的治療方法。

搜尋策略

我們檢索並確定以下資料庫的試驗：考科藍圖書館的Cochrane Central Register of Controlled Trials (CENTRAL)，其包含the Cochrane Eyes and Vision Group Trials Register(2007年，第3期)，the National Research Register (2007年，第3期)，MEDLINE (1966至2007年7月)，EMBASE (1980至2007年7月)，LILACS (Latin American and Caribbean Health Science Literature Database) (2007年7月)與納入研究的參考文獻。

選擇標準

我們納入評估干擾素α療法用於治療新生血管性老年黃斑退化患者且至少追蹤一年的隨機對照研究。

資料收集與分析

兩名回顧作者分別摘錄資料並評估試驗品質。由於只有一篇試驗符合納入標準，因此沒有進行資料整合。

主要結論

納入一篇試驗，其隨機分配來自世界各地45個中心的481名研究對象，分為4組。研究允許分析52週時三組干擾素α−2a組對照安慰劑組其喪失3行或以上視力的研究對象人數。結果顯示odds ratio為1.60 (95% Confidence Interval為1.01至2.53)，顯示干擾素與52週時增加60%的勝算會喪失3行或以上的視力有關。這項結果具有P值為0.04的邊際統計性並顯示治療之潛在的有害性大於其效益。

作者結論

目前沒有足夠的證據建議使用干擾素α−2a用於治療老年性黃斑部退化。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

干擾素α用於治療新生血管性老年黃斑部退化。老年黃斑部退化(agerelated macular degeneration (AMD))是一種漸進式的過程，且退化性視網膜疾病會導致視網膜下新生血管而造成視力損傷。抗血管生成療法是一種新的方法用來治療新生血管性老年黃斑部退化。干擾素是一種抗血管生成劑，其功能為預防有助於這些新血管生成的血管內皮細胞生長。這篇回顧納入一篇隨機對照試驗，有481名來自45個不同中心之50歲以上的研究對象。這篇試驗比較干擾素α療法對照安慰劑並追蹤52週。52週時對照組與治療組間其研究對象喪失至少3行視力的比例沒有顯著差異。試驗結果沒有定論並認為介入措施如果有任何作用的話，可能是有害的。由於現有一些新的抗血管介入措施，因此不太可能進行干擾素治療的進一步研究是合理。