A Prospective Randomized Trial of Intravitreal Bevacizumab Versus Ranibizumab for the Management of Diabetic Macular Edema

Nepomuceno, Antonio Brunno; Takaki, Erika; Almeida, Felipe P.; Peroni, Renato; Cardillo, J.A.; Siqueira, Rubens Camargo; Messias, André; Jorge, Rodrigo

doi:10.1016/j.ajo.2013.04.026

Cited by 76 publications

(49 citation statements)

References 28 publications

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“…Nine independent RCT studies enrolled 2,289 individuals, including 1,162 patients assigned to the ranibizumab arm and 1,127 patients assigned to the bevacizumab arm [14]–[22]. All qualified articles were published between March 2010 and November 2013, and all were in the English language.…”

Section: Resultsmentioning

confidence: 99%

“…To determine whether bevacizumab is as effective and safe as ranibizumab, numerous randomised, controlled clinical trials (RCTs) and retrospective studies have been performed over the past five years, such as the Comparison of Age-related macular degeneration Treatments Trials (CATT), the Alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularization (IVAN), the Multicenter Anti-VEGF Trial in Austria (MANTA), and the Groupe d'Etude Français Avastin versus Lucentis dans la DMLA néovasculaire (GEFAL) [14]–[22]. Although the results of these studies indicated the two drugs to be both effective and safe, subtle differences in their comparative efficacy and safety profiles still exist, as suggested by the different trends of improved visual acuity with ranibizumab in the CATT and GEFAL studies, which should be further assessed.…”

Section: Introductionmentioning

confidence: 99%

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Ranibizumab versus Bevacizumab for Ophthalmic Diseases Related to Neovascularisation: A Meta-Analysis of Randomised Controlled Trials

Liu

et al. 2014

PLoS ONE

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BackgroundBevacizumab is believed to be as effective and safe as ranibizumab for ophthalmic diseases; however, its magnitude of effectiveness and safety profile remain controversial. Thus, a meta-analysis and systematic review appears necessary.MethodsPubMed and EMBASE were systematically searched with no restrictions. All relevant citations comparing ranibizumab and bevacizumab were considered for inclusion. Pooled effect estimates were obtained using a fixed- and random-effects meta-analysis.ResultsNine independent randomised-controlled clinical trials (RCTs) involving 2,289 participants were identified. Compared with bevacizumab, the overall combined weighted mean difference (WMD) of the mean change in visual acuity for ranibizumab was 0.52 letters (95% CI −0.11–1.14). The odds ratios (ORs) of gaining ≥15, gaining 5–14, losing 5–14 and losing ≤15 letters were 1.10 (95% CI 0.90–1.33), 0.93 (95% CI 0.77–1.11), 0.89 (95% CI 0.65–1.22) and 0.95 (95% CI 0.73–1.25), respectively. The risk of serious systemic events increased by 17% (95% CI 6%–27%, p = 0.0042) for bevacizumab treatment in comparison with ranibizumab. No statistically significant differences between the two treatments were found for the nonfatal arterial thrombotic events, ocular serious adverse, death from vascular and all causes events.ConclusionsBevacizumab is not inferior to ranibizumab as a treatment for achieving visual acuity. The use of bevacizumab was associated with an increased risk of developing serious systemic events. Weighing the costs and health outcomes is necessary when selecting between bevacizumab and ranibizumab for ophthalmic diseases. Due to the limitations of the available data, further research is needed.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ranibizumab versus Bevacizumab for Ophthalmic Diseases Related to Neovascularisation: A Meta-Analysis of Randomised Controlled Trials

Liu

et al. 2014

PLoS ONE

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“…In addition, a delay in the initiation of ranibizumab therapy resulted in limited improvement in BCVA in the 36-month results [64]. Bevacizumab is frequently used off-label to treat DME as well and has demonstrated efficacy in several clinical trials [70, 71]. BOLT (Bevacizumab or Laser Therapy) compared intravitreal bevacizumab to laser therapy alone and found mean BCVA to be significantly better in the bevacizumab group versus laser therapy alone [70].…”

Section: Treatment Optionsmentioning

confidence: 99%

Diabetic Retinopathy and Diabetic Macular Edema

Cohen

Gardner²

2015

Developments in Ophthalmology

101

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Diabetic retinopathy and diabetic macular edema result from chronic damage to the neurovascular structures of the retina. The pathophysiology of retinal damage remains uncertain but includes metabolic and neuroinflammatory insults. These mechanisms are addressed by intensive metabolic control of the systemic disease and by the use of ocular anti-inflammatory agents, including vascular endothelial growth factor inhibitors and corticosteroids. Improved understanding of the ocular and systemic mechanisms that underlie diabetic retinopathy will lead to improved means to diagnose and treat retinopathy and better maintain vision.

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“…A small clinical trial recently compared the efficacy between ranibizumab and bevacizumab in treating DME. While demonstrating similar efficacy in reducing DME based on optical coherence tomography findings (primary outcome), results on visual outcome in this study were considered inconclusive due to inadequate power (21).…”

Section: Efficacymentioning

confidence: 93%

Ocular Anti-VEGF Therapy for Diabetic Retinopathy: Overview of Clinical Efficacy and Evolving Applications

2014

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Ocular anti-vascular endothelial growth factor (VEGF) therapy represents one of the most significant advances in modern medicine. The introduction and widespread use of ocular anti-VEGF therapy for age-related macular degeneration heralded a new era in the treatment of vascular and exudative diseases of the retina. Its expanding indications now include diabetic macular edema and proliferative diabetic retinopathy, two vision-threatening forms of diabetic retinopathy. It is widely anticipated that ocular anti-VEGF therapy could spark a dramatic shift in the treatment paradigm for diabetic retinopathy. However, despite its clear efficacy shown in clinical trials, the dynamic landscape of evolving medical, ethical, and economic issues related to this new treatment suggests significant challenges ahead. In this article, we provide a discussion of this topic as part of this two-part Bench to Clinic narrative. Here, our Clinic contribution provides an overview of the current evidence from clinical trials on anti-VEGF therapy for diabetic retinopathy, and highlights the hopes and fears of this new treatment from clinical and public health standpoints. In the Bench narrative that precedes this contribution, Simó et al. provide an overview of the role of VEGF in the pathogenesis of diabetic retinopathy.

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A Prospective Randomized Trial of Intravitreal Bevacizumab Versus Ranibizumab for the Management of Diabetic Macular Edema

Cited by 76 publications

References 28 publications

Ranibizumab versus Bevacizumab for Ophthalmic Diseases Related to Neovascularisation: A Meta-Analysis of Randomised Controlled Trials

Ranibizumab versus Bevacizumab for Ophthalmic Diseases Related to Neovascularisation: A Meta-Analysis of Randomised Controlled Trials

Diabetic Retinopathy and Diabetic Macular Edema

Ocular Anti-VEGF Therapy for Diabetic Retinopathy: Overview of Clinical Efficacy and Evolving Applications

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