二甲双胍治疗老年性黄斑变性的潜在疗效：系统综述和荟萃分析

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-02-15 DOI:10.1016/j.xops.2025.100741

Matthew D. Huh BA , Simon N. Le BA , Kieran S. O'Brien PhD, MPH , Jeremy D. Keenan MD, MPH , Jay M. Stewart MD

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引用次数: 0

摘要

主题：二甲双胍是一种广泛使用的糖尿病药物，由于其抗氧化、抗炎和抗血管生成的特性，已显示出治疗老年性黄斑变性（AMD）的潜力。本研究旨在系统回顾和分析二甲双胍降低AMD患病率的疗效。临床意义甲双胍治疗AMD的潜力可以显著减轻视力丧失的负担，提供了一种具有成本效益和广泛可及的解决方案。方法系统检索2024年5月2日的OVID Embase、OVID MEDLINE、Cochrane Library和Web of Science数据库。观察性和介入性研究都包括在AMD诊断前口服二甲双胍的研究。数据提取和分析采用随机效应模型荟萃分析，并根据研究设计、AMD亚型、性别和二甲双胍剂量进行亚组分析。结果共纳入观察性研究18项，共纳入受试者2 683 234人。9项研究采用病例对照设计，7项为回顾性队列研究，2项为横断面研究。荟萃分析显示，二甲双胍使用者患AMD的几率显著降低（合并优势比[OR] = 0.86, 95%可信区间= 0.79-0.93,P = 0.0002, I2 = 90%）。该相关性在糖尿病患者（合并OR = 0.89）和非糖尿病患者（合并OR = 0.70）中都很显著，尽管只有2项研究报告了非糖尿病OR。剂量-反应分析显示，低剂量有显著的保护作用。敏感性分析表明，剔除一个异常值研究并没有改变总体效果。使用非随机干预研究的偏倚风险工具进行偏倚分析，发现了显著的偏倚风险，特别是由于混杂。尽管目前的证据表明二甲双胍在AMD中具有潜在的保护作用，但所有显示二甲双胍作用的研究都是观察性的，因此存在偏倚。需要随机临床试验来确定二甲双胍预防AMD发病的有效性。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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Potential Efficacy of Metformin for Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis

Topic

Metformin, a widely used diabetes medication, has shown potential for treating age-related macular degeneration (AMD) due to its antioxidative, anti-inflammatory, and antiangiogenic properties. This study aims to systematically review and analyze the efficacy of metformin in reducing AMD prevalence.

Clinical Relevance

Metformin's potential to serve as a treatment for AMD could significantly reduce the burden of vision loss, offering a cost-effective and widely accessible solution.

Methods

A systematic search was conducted in OVID Embase, OVID MEDLINE, Cochrane Library, and Web of Science databases on May 2, 2024. Both observational and interventional studies were included if they involved oral metformin use before AMD diagnosis. Data were extracted and analyzed using a random-effects model meta-analysis, with subgroup analyses based on study design, AMD subtype, sex, and metformin dosage.

Results

Eighteen observational studies were identified, which together included a total of 2 683 234 individuals. Nine studies had a case–control design, 7 were retrospective cohort studies, and 2 were cross-sectional studies. The meta-analysis revealed a significant reduction in the odds of AMD among metformin users (pooled odds ratio [OR] = 0.86, 95% confidence interval = 0.79–0.93, P = 0.0002, I² = 90%). The association was significant in both patients with diabetes (pooled OR = 0.89) and without diabetes (pooled OR = 0.70), although only 2 studies reported nondiabetic ORs. Dose–response analysis revealed significant protective effects at low doses. Sensitivity analysis indicated that the removal of an outlier study did not alter the overall effect. Bias analysis using the Risk of Bias in Nonrandomized Studies of Interventions tool revealed significant risks of bias, particularly due to confounding.

Conclusion

Although the current evidence suggests a potential protective role of metformin in AMD, all studies showing an effect of metformin have been observational and thus subject to bias. Randomized clinical trials are needed to determine the effectiveness of metformin for preventing the onset of AMD.