Researchers based at the Cantonal Hospital of Lucerne, Switzerland have published research findings suggesting a modest superiority of aflibercept (2 mg) and ranibizumab (0.5 mg) in the treatment of age-related macular degeneration (AMD). The Swiss researchers under-took the study to gain further insight into the on-going debate concerning the optimal treatment of AMD. The researchers examined results from the use of the three main anti-VEGF medicaments, ranibizumab (Lucentis), bevacizumab (Avastin) and aflibercept (Eylea) and published their findings in the British Journal of Ophthalmology.
The Swiss research team stated that, while several studies have been performed comparing various anti-VEGF treatments for AMD, a number of the systematic reviews have not been clear on what might be the most effective intervention. The reason for such, according the study’s authors, was due to previous reviews not integrating all the available randomised evidence into a single analysis, or did not include an assessment of all currently available anti-VEGF treatments. The Swiss analysis aimed to overcome these deficits by combining the results from two network meta-analyses assessing the various treatment options for AMD management. The authors claimed that their approach facilitated the joint assessment of all randomised controlled trials quantifying the efficacy and serious side effects of the three therapies in a head-to-head comparison. In addition, the Swiss research emphasized a trade-off analysis, which aimed to evaluate efficacy in conjunction with side effect profiles and dosages, more accurately reflecting the decision-analysis required of clinicians in their day-to-day patient care.
The study identified an initial 1,325 records from which eleven trials assessing five active treatments were included (ranibizumab 0.3 mg, ranibizumab 0.5 mg, bevacizumab 1.25 mg, aflibercept 0.5 mg and aflibercept 2 mg). In total, the analysis covered 8,341 patients with an average age of 76.7 years of age and a male to female ratio of 57:43. From their analysis, the study authors concluded that “upon review, there is no treatment clearly standing out. Differences between the various treatments are rather small. The study revealed only a modest superiority of aflibercept 2 mg and ranibizumab 0.5 mg against other formulations and dosages. Bevacizumab 1.25 mg showed no additional efficacy compared with ranibizumab 0.3 mg but had a higher rate of serious side effects”. The researchers additionally commented that while a theoretical advantage for aflibercept over ranibizumab and bevacizumab could be argued (as both ranibizumab and bevacizumab require monthly review and/or an injection) a more complete analysis incorporating the average frequency of injections in the second year of analysed studies indicated that only a modest difference of 4.2 injections for aflibercept versus 4.7 injections for ranibizumab actually existed.