Intravitreal Bevacizumab Versus Ranibizumab for Treatment of Neovascular Age-Related Macular Degeneration: Findings from a Cochrane Systematic Review

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• 作者：Sharon D. Solomon ; MD¹ ; Kristina B. Lindsley ; MS² ; Magdalena G. Krzystolik ; MD³ ; Satyanarayana S. Vedula ; MBBS ; PhD⁴ ; Barbara S. Hawkins ; PhD¹ ; ² ; ^{bhawkins@jhmi.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：BCVA ; best-corrected visual acuity ; CATT ; Comparison of Age-related macular degeneration Treatment Trial ; CI ; confidence interval ; CNV ; choroidal neovascularization ; DA ; disc area ; IQR ; interquartile range ; IVAN ; Inhibit VEGF in Age-related choroidal Neovascularization ; MD ; mean difference ; NVAMD ; neovascular age-related macular degeneration ; RR ; risk ratio ; VEGF ; vascular endothelial growth factor
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：123
• 期：1
• 页码：70-77.e1
• 全文大小：958 K

文摘

To summarize the relative effects of bevacizumab (Avastin; Genentech, Inc, South San Francisco, CA) and ranibizumab (Lucentis; Genentech, Inc.), using findings from a Cochrane Eyes and Vision Group systematic review.

Clinical Relevance

Neovascular age-related macular degeneration (NVAMD) is the most common cause of uncorrectable vision loss among the elderly in developed countries. Bevacizumab and ranibizumab are the most frequently used anti–vascular endothelial growth factor (VEGF) agents injected intravitreally to treat NVAMD.

Methods

For this systematic review, we included only randomized controlled trials in which the 2 anti-VEGF agents had been compared directly. The primary outcome was 1-year gain in best-corrected visual acuity (BCVA) of ≥15 letters. We followed Cochrane methods for trial selection, data extraction, and data analyses. Relative effects of bevacizumab versus ranibizumab are presented as estimated risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).

Results

We identified 6 eligible randomized controlled trials with 2809 participants. The proportion of eyes that gained ≥15 letters of BCVA by 1 year was similar for the 2 agents when the same regimens were compared (RR, 0.90; 95% CI, 0.73–1.11). The mean change in BCVA from baseline also was similar (MD, −0.5 letter; 95% CI, −1.6 to +0.6). Other BCVA and quality of life outcomes were similar for the 2 agents. One-year treatment cost with ranibizumab was 5.1 and 25.5 times the cost for bevacizumab in the 2 largest trials. Ocular adverse events were uncommon (<1%), and rates were similar for the 2 agents.

Conclusions

We found no important difference in effectiveness or safety between bevacizumab and ranibizumab for NVAMD treatment, but there was a large cost difference.