Network meta-analysis finds little difference among anti-VEGF regimens for wet AMD
A network meta-analysis comparing anti-VEGF agents, dosing and injection frequency for the treatment of neovascular age-related macular degeneration found comparable outcomes for all included anti-VEGF regimens, according to a presenter at the virtual Association for Research in Vision and Ophthalmology meeting.
“These data suggest that no single anti-VEGF regimen is associated with superior vision outcomes for patients with nAMD and that achieving further vision gains may require a different approach to treatment, such as a different drug delivery paradigm or drugs with an alternative mechanism of action,” Vincent Garmo, MHS, said.
Garmo and colleagues conducted a systemic literature review of randomized controlled trials of anti-VEGF therapy for the treatment of wet AMD. The researchers identified interventions based on anti-VEGF agents, the dose and the regimen, such as monthly or every 8 or 12 weeks after a period of monthly loading doses. As-needed and treat-and-extend schedules were also included.
As-needed ranibizumab and monthly ranibizumab were the most commonly reported treatment comparator arms. The researchers conducted a Bayesian network meta-analysis to estimate the relative efficacy of as-needed and monthly ranibizumab compared with all other anti-VEGF regimens, such as aflibercept, brolucizumab and off-label bevacizumab.
The meta-analysis, which included 21 trials, evaluated the mean change in best corrected visual acuity from baseline to month 12, the mean change in BCVA from baseline to month 24, and the proportion of patients who gained 15 or more ETDRS letters from baseline to month 12 across all anti-VEGF regimens.
The network meta-analysis found wet AMD treatment efficacy in the evaluated outcomes were generally comparable for all anti-VEGF regimens, Garmo said.
- Garmo V. Comparative efficacy of anti-vascular endothelial growth factor (VEGF) treatment regimens for neovascular age-related macular degeneration (nAMD): A network meta-analysis. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 6, 2020 (virtual meeting).