A systematic review and meta-analysis, published by British Medical Journal Open (2019), has included 19 randomized controlled trials (RCTs) to evaluate the comparative effectiveness and safety of intravitreal bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (Eylea) for patients with cn-AMD, DMO, RVO-MO and m-CNV. According to the study review, intravitreal bevacizumab was as effective as ranibizumab in patients with cn-AMD, DMO, RVO-MO and m-CNV for the outcomes examined. While also, ranibizumab was as effective as aflibercept in patients with cn-AMD. The study additionally identified that rates of systemic serious harms were similarly low among the anti-VEGF drugs across the retinal conditions.
The researchers conducted the review using “the Cochrane Handbook for Systematic Reviews and reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis”. MEDLINE, Embase and Cochrane Central Register of Controlled Trials were searched, but the researchers also used the “grey literature”, including commercial sources, government reports, website theses and others. This methodical approach aims to obtain as wide as a selection of relevant materials to minimize bias. In the study, the report consolidated the evidence for treatment choices of all common retinal conditions and summarised information regarding treatment regimens; the reviews were limited to English.
This was a significant volume of work and the study was reported by several researchers among St. Michael’s Hospital, Toronto, Ontario and the University in Toronto, Ontario, Canada. In the research, the studies screened 3176 titles/abstracts, 440 full-text articles, 19 head-to-head RCTs including of 7,459 patients. Twelve (12) RCTs were for cn-AMD, three (3) RCTs were for DMO, two (2) RCTs were for RVO-MO and two (2) RCTs were for m-CNV. From the analysis, it appeared that vision gain was not significantly different in patients with cn-AMD, DMO, RVO-MO and m-CNV treated with bevacizumab vs. ranibizumab. And similarly, vision gain was not significantly different between cn-AMD patients treated with aflibercept vs. ranibizumab. DMO treated with aflibercept experienced significantly higher vision gain at 1-year than patients receiving ranibizumab or bevacizumab but this difference was not significant at 2-years. 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.