The Clinical Effectiveness of Ranibizumab Treat and Extend Regimen in nAMD: Systematic Review and Network Meta-Analysis

Abstract

IntroductionNeovascular age-related macular degeneration (nAMD) is a chronic eye condition that causes severe deterioration of vision and ultimately blindness. Two vascular endothelial growth factor inhibitors are approved for nAMD treatment in Europe: ranibizumab and aflibercept. The European license for ranibizumab was updated with an individualized “treat and extend” (T&E) regimen, which involves more proactive treatment based on changes in best corrected visual acuity (BCVA) and/or anatomical outcomes. The aim of this publication is to compare the efficacy of the ranibizumab T&E regimen with other approved dosing regimens for nAMD on the basis of outcomes identified from a systematic review and subsequent NMA.MethodsFollowing a systematic search of publications, to identify relevant studies, a repeated-measures network meta-analysis (NMA) was performed to estimate the relative effectiveness of ranibizumab T&E versus approved dosing regimens of ranibizumab and aflibercept. The analysis focused on licensed treatment regimens for nAMD. We examined mean change from baseline in BCVA on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart.ResultsThe systematic literature review identified 22,949 records, of which 23 studies were included in the NMA. At 12 months, the ranibizumab T&E dosing regimen vs ranibizumab pro re nata (PRN) was associated with small differences in change in BCVA, between 1.86 letter gain at 12 months and 2.35 letter gain at 24 months. A similar difference was observed in the aflibercept dosing regimen versus ranibizumab T&E ; 1.94 letter gain at 12 months and 3.31 letter gain at 24 months. All doses of ranibizumab and aflibercept showed similar effectiveness, and the differences between treatment options were not significant.ConclusionThis study used novel repeated-measures NMA to synthesize efficacy results when treatment effects were reported at multiple follow-up times. This repeated-measures NMA suggests that treating patients with the ranibizumab T&E regimen yields similar effectiveness compared to other approved ranibizumab and aflibercept dosing regimens for nAMD treatment. Funding: Novartis Pharmaceuticals UK Ltd, Surrey, UK.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0484-0) contains supplementary material, which is available to authorized users.

Efficacy and Treatment Burden of Intravitreal Aflibercept Versus Intravitreal Ranibizumab Treat-and-Extend Regimens at 2 Years: Network Meta-Analysis Incorporating Individual Patient Data Meta-Regression and Matching-Adjusted Indirect Comparison

“…Clinical data comparing the efficacy and treatment burden of IVT-AFL and RBZ in a longer perspective are limited. Results of an NMA reported by Danyliv et al did not demonstrate significant differences between IVT-AFL fixed regimens versus various RBZ regimens regarding visual outcomes [30]. The estimates presented by Danyliv et al were based on the two large RCTs (VIEW 1 and 2) designed to compare IVT-AFL versus RBZ [27,31].…”

Five‐year outcomes of a personalized pro re nata treatment regimen with anti‐vascular endothelial growth factor for neovascular age‐related macular degeneration

“…Our adopted methodthough reactive in treatment modalityis somewhat between monthly PRN and proactive treat and extend. Only a few comparative reviews have been published until today with short-term efficacy outcomes (Chin-Yee et al 2016;Danyliv et al 2017).…”

Seven-Year Visual and Anatomical Outcomes of Intravitreal Vascular Endothelial Growth Factor Inhibition for Neovascular Age-Related Macular Degeneration

“…Considering the excessive costs for health care systems, restricted capacity in clinical practice and risk for patients, alternative approaches like treatment as needed (pro re nata; PRN), or certain retreatment while extending intervals (treat and extend; TAE) have been explored [8][9][10][11]. Short-term clinical trials have shown similar visual outcomes for all applied strategies [12][13][14][15][16][17]. A few prolonged studies have been published in the past years with varying results [18][19][20].…”