Abstract | OBJECTIVES: DESIGN: Systematic review and random-effects meta-analysis. METHODS: Multiple databases were searched from inception to 17 August 2017. Eligible head-to-head randomised controlled trials (RCTs) comparing the (anti- VEGF) drugs in adult patients aged ≥18 years with the retinal conditions of interest. Two reviewers independently screened studies, extracted data and assessed risk of bias. RESULTS: 19 RCTs involving 7459 patients with cn-AMD (n=12), DMO (n=3), RVO-MO (n=2) and m-CNV (n=2) were included. Vision gain was not significantly different in patients with cn-AMD, DMO, RVO-MO and m-CNV treated with bevacizumab versus ranibizumab. Similarly, vision gain was not significantly different between cn-AMD patients treated with aflibercept versus ranibizumab. Patients with DMO treated with aflibercept experienced significantly higher vision gain at 12 months than patients receiving ranibizumab or bevacizumab; however, this difference was not significant at 24 months. Rates of systemic serious harms were similar across anti- VEGF agents. Posthoc analyses revealed that an as-needed treatment regimen (6-9 injections per year) was associated with a mortality increase of 1.8% (risk ratio: 2.0 [1.2 to 3.5], 2 RCTs, 1795 patients) compared with monthly treatment in cn-AMD patients. CONCLUSIONS: Intravitreal bevacizumab was a reasonable alternative to ranibizumab and aflibercept in patients with cn-AMD, DMO, RVO-MO and m-CNV. The only exception was for patients with DME and low visual acuity (<69 early treatment diabetic retinopathy study [ETDRS] letters), where treatment with aflibercept was associated with significantly higher vision gain (≥15 ETDRS letters) than bevacizumab or ranibizumab at 12 months; but the significant effects were not maintained at 24 months. The choice of anti- VEGF drugs may depend on the specific retinal condition, baseline visual acuity and treatment regimen. PROSPERO REGISTRATION NUMBER: CRD42015022041.
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Authors | Ba' Pham, Sonia M Thomas, Erin Lillie, Taehoon Lee, Jemila Hamid, Trevor Richter, Ghayath Janoudi, Arnav Agarwal, Jane P Sharpe, Alistair Scott, Rachel Warren, Ronak Brahmbhatt, Erin Macdonald, Sharon E Straus, Andrea C Tricco |
Journal | BMJ open
(BMJ Open)
Vol. 9
Issue 5
Pg. e022031
(05 28 2019)
ISSN: 2044-6055 [Electronic] England |
PMID | 31142516
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review)
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Copyright | © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. |
Chemical References |
- Recombinant Fusion Proteins
- Vascular Endothelial Growth Factor A
- aflibercept
- Bevacizumab
- Receptors, Vascular Endothelial Growth Factor
- Ranibizumab
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Topics |
- Bevacizumab
(administration & dosage, adverse effects, therapeutic use)
- Choroidal Neovascularization
(drug therapy)
- Diabetic Retinopathy
(drug therapy)
- Humans
- Macular Degeneration
(drug therapy)
- Macular Edema
(drug therapy)
- Ranibizumab
(administration & dosage, adverse effects, therapeutic use)
- Receptors, Vascular Endothelial Growth Factor
(administration & dosage, therapeutic use)
- Recombinant Fusion Proteins
(administration & dosage, adverse effects, therapeutic use)
- Retinal Diseases
(drug therapy)
- Retinal Vein Occlusion
(drug therapy)
- Vascular Endothelial Growth Factor A
(antagonists & inhibitors)
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