Ranibizumab for age-related macular degeneration: A meta-analysis of dose effects and comparison with no anti-VEGF treatment and bevacizumab

Abstract

What is known and objectives Ranibizumab is used monthly or as-needed (PRN) for the treatment of age-related macular degeneration. However, which treatment regimen is more effective remains unknown. The objectives of this study are to: (i) compare the efficacy of monthly versus as-needed quarterly treatment; and (ii) compare the efficacy of ranibizumab 0·5 mg treatment with: (a) no anti-vascular endothelial growth factor (VEGF); (b) ranibizumab 0·3 mg; and (c) bevacizumab. Method This is a systematic meta-analytic review of randomized-controlled clinical trials of ranibizumab in neovascular AMD. Weighted multiple regression analyses were used to compare the monthly vs. PRN/quarterly treatment. Results Eight randomized controlled trials met our inclusion criteria. Patients on the monthly ranibizumab treatment had higher visual acuity letter gains (β = 0·441, P < 0·05) compared with patients on as-needed/quarterly treatment. More patients on the monthly treatment gained ≥15 letters than as-needed/quarterly treatment (β = 0·582, P < 0·05). Ranibizumab produced significantly higher improvement in visual acuity (d = 1·20, z = 7·14, P < 0·05) and led to a higher proportion of patients gaining ≥15 letters (OR: 6·67; 95% CI 3·16-14·06; P < 0·05) when compared with non-anti-VEGF. Ranibizumab did not show any advantage in visual acuity compared with bevacizumab. No significant differences were found between ranibizumab 0·3 mg and 0·5 mg. What is new and conclusion This is the first meta-analysis to systematically evaluate the efficacy of different treatment regimens for anti-VEGF therapy. Ranibizumab 0·3 or 0·5 mg monthly treatment was more effective for neovascular AMD than non-anti-VEGF treatments but is no better than bevacizumab. This is the first meta-analysis to systematically evaluate the efficacy of different treatment regimens for anti-VEGF therapy. Ranibizumab 0·3 or 0·5 mg monthly treatment was more effective for neovascular AMD than non-anti-VEGF treatments but is no better than bevacizumab. © 2014 John Wiley & Sons Ltd.