Effectiveness of monthly and fortnightly anti-VEGF treatments for age-related macular degeneration

Abstract

To study the efficacy and safety of treatments with ranibizumab and bevacizumab for exudative age-related macular degeneration. Methods: A parallel randomized clinical trial was conducted to compare the efficacy and safety of three regimens (bevacizumab every month, bevacizumab every 2 weeks, and ranibizumab every month), followed by as-needed retreatments, for 1 year, in previously untreated individuals with age-related macular degeneration. The primary outcome was change in visual acuity and in central macular thickness after 1 year of follow-up. Subjects were assigned randomly to one of the three groups in a 1:1:1 ratio, and investigators and examiners were blinded to the randomization results. Results: We included 15 patients in each group. After 1 year of follow-up, we found statistically significant improvements in visual acuity and central macular thickness reduction in all groups. However, we found no statistically significant differences between the three groups. Conclusions: The biweekly follow-up was effective and we found no significant differences in efficacy or safety between the treatments with ranibizumab and bevacizumab.

Efficacy and safety of faricimab for neovascular age-related macular degeneration: a systematic review and network meta-analysis

“…The NMA of the frequency of injections included 17 studies, 13 treatment regimens and 5948 patients. 13 1531 The base case and the sensitivity analysis (9050 patients) are presented in figure 3 . Both analyses were similar in their findings; still, the sensitivity analysis had a larger number of comparisons.…”

Risk of Intraocular Inflammation After Injection of Antivascular Endothelial Growth Factor Agents

“…We compared anti-VEGF agents which, for certain RCTs, required us to combine different dosing regimens for the same agent into a single group. 8,13,14,16,22 There was variability between studies regarding the definitions used for various IOI events, and a standardized classification of adverse ocular events used between RCTs would improve the clarity of results. Generally, there was inconsistent reporting between studies for adverse ocular inflammatory events and our study was limited by the use of only published data.…”

“…Overall, 11,460 unique studies were screened, of which 241 articles were advanced to full-text screening and 14 RCTs from 13 published articles were included in the meta-analysis (Figure 1). 8,[12][13][14][15][16][17][18][19][20][21][22][23] The included studies randomized 6,759 eyes at baseline to different anti-VEGF treatment groups. The mean patient age ranged between 63 and 80 years, and the proportion of male patients in treatment groups ranged from 29% to 100%.…”

“…Included study arms used ranibizumab that was dosed at 0.5 mg and bevacizumab that was dosed at 1.25 mg. [12][13][14][16][17][18][20][21][22][23] Aflibercept was dosed at 2.0 mg and brolucizumab was dosed at 6 mg. 8,14,15,24 Dose frequencies for included study arms included single dose, monthly, bimonthly, as needed, treat and extend, and mixed protocols. 8,[12][13][14][15][16][17][18][19][20][21][22][23] Two study arms used single dose, 14 two study arms used monthly, 16 four study arms used bimonthly, 8,15 four study arms used treat and extend, 20,21 13 study arms used as needed, 12,13,[16][17][18][19] and seven study arms used a mixed protocol.…”

“…Included study arms used ranibizumab that was dosed at 0.5 mg and bevacizumab that was dosed at 1.25 mg. [12][13][14][16][17][18][20][21][22][23] Aflibercept was dosed at 2.0 mg and brolucizumab was dosed at 6 mg. 8,14,15,24 Dose frequencies for included study arms included single dose, monthly, bimonthly, as needed, treat and extend, and mixed protocols. 8,[12][13][14][15][16][17][18][19][20][21][22][23] Two study arms used single dose, 14 two study arms used monthly, 16 four study arms used bimonthly, 8,15 four study arms used treat and extend, 20,21 13 study arms used as needed, 12,13,[16][17][18][19] and seven study arms used a mixed protocol. 16,22,23 The HAWK and HARRIER trials used a unique dose frequency where patients in the brolucizumab group started with three injections at 0, 4 and 8 weeks, followed by a 12-week interval and possible 8-week intervals if needed.…”