Anti-vascular endothelial growth factor for neovascular age-related macular degeneration: a meta-analysis of randomized controlled trials

Abstract

BackgroundTo evaluate the relative efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) agents for the treatment of neovascular age-related macular degeneration (AMD).MethodsSystematic literature review identifying RCTs comparing anti-VEGF agents to another treatment published before June 2016. Efficacy assessed by mean change in best corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline at up to 2 years followup. Safety assessed by proportions of patients with death, arteriothrombotic and venous thrombotic events, and at least one serious systemic adverse event at up to 2 years of followup.ResultsFifteen RCTs selected for meta-analysis (8320 patients). Two trials compared pegaptanib, and three trials compared ranibizumab versus control. Eight trials compared bevacizumab with ranibizumab. Two trials compared aflibercept with ranibizumab. There were no significant differences between bevacizumab and ranibizumab for BCVA at 1 or 2 years (weighted mean difference = − 0.57, 95% CI − 1.55 to 0.41, P = 0.25 and weighted mean difference = − 0.76, 95% CI − 2.25 to 0.73, P = 0.32, respectively). Ranibizumab was more effective in reducing CMT at 1 year (weighted mean difference = 4.49, 95% CI 1.13 to 7.84, P = 0.009). Risk ratios comparing rates of serious systemic adverse events at 1 and 2 years were slightly out of favour for bevacizumab. Aflibercept compared with ranibizumab demonstrated similar mean change in BCVA, reduction in CMT, and safety at 1 year.ConclusionsBevacizumab and ranibizumab had equivalent efficacy for BCVA, while ranibizumab had greater reduction in CMT and less rate of serious systemic adverse events. Aflibercept and ranibizumab had comparable efficacy for BCVA and CMT. This provides information to balance comparable effects on vision and risk of adverse events between anti-VEGF agents.

HTRA1 rs11200638 and ARMS2 rs10490924 gene polymorphisms and response to intravitreal anti-VEGF treatment in patients with exudative age-related macular degeneration

“…Vascular Endothelial Growth Factor -VEGF) (4). Aktualnie standardem postępowania w leczeniu wysiękowej postaci AMD jest terapia podawanymi doszklistkowo przeciwciałami skierowanymi przeciwko czynnikowi VEGF, do których należą ranibizumab, aflibercept oraz stosowany "off-label" bewacyzumab (5)(6)(7). Według doniesień miejscowa terapia anty-angiogenna jednak jest nieskuteczna u 20-35% chorych na AMD (5,7).…”

“…Aktualnie standardem postępowania w leczeniu wysiękowej postaci AMD jest terapia podawanymi doszklistkowo przeciwciałami skierowanymi przeciwko czynnikowi VEGF, do których należą ranibizumab, aflibercept oraz stosowany "off-label" bewacyzumab (5)(6)(7). Według doniesień miejscowa terapia anty-angiogenna jednak jest nieskuteczna u 20-35% chorych na AMD (5,7). W tej grupie pacjentów określanych jako "non-responders" obserwuje się słabą odpowiedź na leczenie lub jej całkowity brak, to wiąże się z dalszą progresją choroby i postępującą utratą widzenia centralnego (5,6).…”

“…Według doniesień miejscowa terapia anty-angiogenna jednak jest nieskuteczna u 20-35% chorych na AMD (5,7). W tej grupie pacjentów określanych jako "non-responders" obserwuje się słabą odpowiedź na leczenie lub jej całkowity brak, to wiąże się z dalszą progresją choroby i postępującą utratą widzenia centralnego (5,6). Uważa się, że słaba reakcja na leczenie lub jej brak są uwarunkowane genetycznie (8)(9)(10)(11).…”

Subretinal Fibrosis Detection Using Polarization Sensitive Optical Coherence Tomography

“…1,2 Recently, new treatments based on drugs suppressing vascular endothelial growth factor (anti-VEGF) have been developed to prevent severe vision loss in these patients. 1,3,4 However, even with anti-VEGF drug treatment, retinal tissue changes such as subretinal fibrosis (SRFib) can still develop in the course of submacular neovascularization, causing irreversible vision loss. [5][6][7] The development and presence of fibrosis is a prognostic factor for the future of visual acuity; therefore, good imaging techniques to monitor the development of SRFib are important for the selection of patients who may respond better (i.e., no fibrosis) or worse (i.e., mostly fibrotic lesions) to treatment.…”

Anti‐ VEGF ‐A/ ANG 2 combotherapy limits pathological angiogenesis in the eye: a replication study

“…However, a subgroup of patients loses initial vision gains due to recurrence of neovascular leakage (Comparison of Age‐related Macular Degeneration Treatments Trials Research Group et al , ). Moreover, the high frequency of intraocular injections and potential side effects of chronic VEGF neutralization may limit the efficacy (Nguyen et al , ). Another aspect currently not addressed by established anti‐VEGF therapies is the chronic retinal immune response (Akhtar‐Schafer et al , ).…”