Topic

Comparative efficacy and safety of different concentrations of atropine for myopia control.

Clinical Relevance

Atropine is known to be an effective intervention to delay myopia progression. Nonetheless, no well-supported evidence exists yet to rank the clinical outcomes of various concentrations of atropine.

Methods

We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov on April 14, 2021. We selected studies involving atropine treatment of at least 1 year’s duration for myopia control in children. We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs) and compared 8 atropine concentrations (1% to 0.01%). We ranked the atropine concentrations for the corresponding outcomes by P score (estimate of probability of being best treatment). Our primary outcomes were mean annual changes in refraction (diopters/year) and axial length (AXL; millimeters/year). We extracted data on the proportion of eyes showing myopia progression and safety outcomes (photopic and mesopic pupil diameter, accommodation amplitude, and distance and near best-corrected visual acuity [BCVA]).

Results

Thirty pairwise comparisons from 16 RCTs (3272 participants) were obtained. Our NMA ranked the 1%, 0.5%, and 0.05% atropine concentrations as the 3 most beneficial for myopia control, as assessed for both primary outcomes: 1% atropine (mean differences compared with control: refraction, 0.81 [95% confidence interval (CI), 0.58–1.04]; AXL, –0.35 [–0.46 to –0.25]); 0.5% atropine (mean differences compared with control: refraction, 0.70 [95% CI, 0.40–1.00]; AXL, –0.23 [–0.38 to –0.07]); 0.05% atropine (mean differences compared with control: refraction, 0.62 [95% CI, 0.17–1.07]; AXL, –0.25 [–0.44 to –0.06]). In terms of myopia control as assessed by relative risk (RR) for overall myopia progression, 0.05% was ranked as the most beneficial concentration (RR, 0.39 [95% CI, 0.27–0.57]). The risk for adverse effects tended to rise as the atropine concentration was increased, although this tendency was not evident for distance BCVA. No valid network was formed for near BCVA.

Discussion

The ranking probability for efficacy was not proportional to dose (i.e., 0.05% atropine was comparable with that of high-dose atropine [1% and 0.5%]), although those for pupil size and accommodation amplitude were dose related.

中文翻译：

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8种阿托品浓度控制儿童近视的疗效和安全性

话题

不同浓度阿托品控制近视的疗效和安全性比较。

临床相关性

众所周知，阿托品是一种延缓近视进展的有效干预措施。尽管如此，目前还没有充分支持的证据来对不同浓度阿托品的临床结果进行排序。

方法

我们于 2021 年 4 月 14 日检索了 PubMed、EMBASE、Cochrane Central Register of Controlled Trials、世界卫生组织国际临床试验注册平台和 ClinicalTrials.gov。我们选择了涉及阿托品治疗至少 1 年以控制儿童近视的研究. 我们对随机对照试验 (RCT) 进行了网络荟萃分析 (NMA)，并比较了 8 种阿托品浓度（1% 至 0.01%）。我们通过P对相应结果的阿托品浓度进行排名得分（估计最佳治疗的概率）。我们的主要结果是屈光度（屈光度/年）和眼轴长度（AXL；毫米/年）的平均年变化。我们提取了显示近视进展和安全结果的眼睛比例数据（明视和中视瞳孔直径、调节幅度、距离和接近最佳矫正视力 [BCVA]）。

结果

获得了来自 16 个 RCT（3272 名参与者）的 30 个成对比较。我们的 NMA 将 1%、0.5% 和 0.05% 的阿托品浓度列为对近视控制最有利的 3 个浓度，评估的两个主要结果为：1% 阿托品（与对照相比的平均差异：屈光度，0.81 [95% 置信区间（ CI)，0.58–1.04]；AXL，–0.35 [–0.46 至 –0.25])；0.5% 阿托品（与对照相比的平均差异：屈光度，0.70 [95% CI，0.40–1.00]；AXL，–0.23 [–0.38 至 –0.07]）；0.05% 阿托品（与对照相比的平均差异：屈光度，0.62 [95% CI，0.17–1.07]；AXL，–0.25 [–0.44 至 –0.06]）。在通过整体近视进展的相对风险 (RR) 评估的近视控制方面，0.05% 被列为最有益的浓度 (RR, 0.39 [95% CI, 0.27–0.57])。随着阿托品浓度的增加，不良反应的风险趋于上升，尽管这种趋势对于距离 BCVA 并不明显。BCVA 附近没有形成有效的网络。

讨论

疗效的排序概率与剂量不成比例（即，0.05% 阿托品与高剂量阿托品 [1% 和 0.5%] 相当），尽管瞳孔大小和调节幅度与剂量相关。