Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial
Age-Related Eye Disease Study 2 Research Group
JAMA · 949 citas
Cómo se estudió
- Diseño
- Ensayo controlado aleatorizado (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- National Institutes of Health
- Gobierno
- U.S. Public Health Service
- Gobierno
- National Eye Institute
- Gobierno
- NEI NIH HHS
- Gobierno
- Intramural NIH HHS
- Gobierno
- PHS HHS
- Subvenciones
- U.S. Public Health Service (HHS-N-260-2005-00007-C); National Eye Institute (N01-EY-5-0007)
Según 6 financiadores declarados.
Publicación
- Publicado
- 2013-05-15 · JAMA · vol. 309 · número 19 · pág. 2005
- Editorial
- American Medical Association
- Citado
- 1,353 citas · más que el 100% de estudios similares · 110.3× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 39 trabajos
- Acceso
- De pago
- Áreas de investigación
- Retinal Diseases and Treatments · Antioxidant Activity and Oxidative Stress · Retinal Imaging and Analysis
- Palabras clave
- age-related macular degeneration, lutein, zeaxanthin, omega-3 fatty acids, docosahexaenoic acid, eicosapentaenoic acid, AREDS2, beta-carotene, carotenoids, dietary supplementation, drusen, macular pigment optical density
- MeSH
- humans, lung neoplasms, macular degeneration, disease progression, zinc, beta carotene, xanthophylls, lutein, docosahexaenoic acids, eicosapentaenoic acid, vitamins, treatment outcome, drug therapy, combination, incidence, risk, double-blind method, dietary supplements, aged, middle aged, female, male, zeaxanthins
Resumen
El texto original del estudio, en el idioma en que se publicó.
Importance
Oral supplementation with the Age-Related Eye Disease Study (AREDS) formulation (antioxidant vitamins C and E, beta carotene, and zinc) has been shown to reduce the risk of progression to advanced age-related macular degeneration (AMD). Observational data suggest that increased dietary intake of lutein + zeaxanthin (carotenoids), omega-3 long-chain polyunsaturated fatty acids (docosahexaenoic acid [DHA] + eicosapentaenoic acid [EPA]), or both might further reduce this risk.
Objectives
To determine whether adding lutein + zeaxanthin, DHA + EPA, or both to the AREDS formulation decreases the risk of developing advanced AMD and to evaluate the effect of eliminating beta carotene, lowering zinc doses, or both in the AREDS formulation.
Design, setting, and participants
The Age-Related Eye Disease Study 2 (AREDS2), a multicenter, randomized, double-masked, placebo-controlled phase 3 study with a 2 × 2 factorial design, conducted in 2006-2012 and enrolling 4203 participants aged 50 to 85 years at risk for progression to advanced AMD with bilateral large drusen or large drusen in 1 eye and advanced AMD in the fellow eye.
Interventions
Participants were randomized to receive lutein (10 mg) + zeaxanthin (2 mg), DHA (350 mg) + EPA (650 mg), lutein + zeaxanthin and DHA + EPA, or placebo. All participants were also asked to take the original AREDS formulation or accept a secondary randomization to 4 variations of the AREDS formulation, including elimination of beta carotene, lowering of zinc dose, or both.
Main outcomes and measures
Development of advanced AMD. The unit of analyses used was by eye.
Results
Median follow-up was 5 years, with 1940 study eyes (1608 participants) progressing to advanced AMD. Kaplan-Meier probabilities of progression to advanced AMD by 5 years were 31% (493 eyes [406 participants]) for placebo, 29% (468 eyes [399 participants]) for lutein + zeaxanthin, 31% (507 eyes [416 participants]) for DHA + EPA, and 30% (472 eyes [387 participants]) for lutein + zeaxanthin and DHA + EPA. Comparison with placebo in the primary analyses demonstrated no statistically significant reduction in progression to advanced AMD (hazard ratio [HR], 0.90 [98.7% CI, 0.76-1.07]; P = .12 for lutein + zeaxanthin; 0.97 [98.7% CI, 0.82-1.16]; P = .70 for DHA + EPA; 0.89 [98.7% CI, 0.75-1.06]; P = .10 for lutein + zeaxanthin and DHA + EPA). There was no apparent effect of beta carotene elimination or lower-dose zinc on progression to advanced AMD. More lung cancers were noted in the beta carotene vs no beta carotene group (23 [2.0%] vs 11 [0.9%], nominal P = .04), mostly in former smokers.
Conclusions and relevance
Addition of lutein + zeaxanthin, DHA + EPA, or both to the AREDS formulation in primary analyses did not further reduce risk of progression to advanced AMD. However, because of potential increased incidence of lung cancer in former smokers, lutein + zeaxanthin could be an appropriate carotenoid substitute in the AREDS formulation.
Trial registration
clinicaltrials.gov Identifier: NCT00345176.
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