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Two-year efficacy and safety of different anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: a network meta-analysis of randomized controlled trials

Eye (2024)Cite this article

Subjects

Abstract

Objectives

To compare the 2-year efficacy and safety of various anti-vascular endothelial growth factor (VEGF) regimens for neovascular age-related macular degeneration (nAMD).

Methods

A comprehensive search was performed on multiple electronic databases up to April 2023 and updated in June 2024, to identify relevant randomized controlled trials (RCTs). Key outcomes included the proportion of patients achieving a vision gain of ≥15 letters and maintaining stable vision (loss of <15 letters) in best-corrected visual acuity (BCVA), changes in mean BCVA from baseline, serious ocular adverse events (SAEs), adverse events leading to treatment discontinuation and any cause of death at 2 years.

Results

Nineteen trials with 12,654 patients and 25 treatment regimens were analyzed in the study. All anti-VEGF regimens showed superior efficacy compared to sham therapy. Specifically, faricimab 6 mg (4+up to Q16W) and ranibizumab 0.5 mg (2-week T&E) displayed top-level effect in vision gain. Bevacizumab 1.25 mg (2-week T&E) and aflibercept 2 mg (2-week T&E) demonstrated the most stable vision outcomes. Bevacizumab 1.25 mg (2-week T&E) and ranibizumab 0.5 mg (2-week T&E) exhibited the most pronounced mean BCVA improvement. Compared to sham therapy, the risk of SAEs was significantly higher for brolucizumab 6 mg (3 + Q12W/ Q8W) (RR = 6.04, 95% CI: 1.30–28.02) and PDS 100 mg/ml (Q24W) (RR = 10.95, 95% CI: 2.14–56.02), but not for other anti-VEGF regimens.

Conclusions

Ranibizumab 0.5 mg (2-week T&E) emerges as a potentially optimal regimen for nAMD over a 2-year period. Future studies need to consider the impact of baseline characteristics on treatment outcomes.

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Fig. 1
Fig. 2: Network plots of studies that assessed each outcome.
Fig. 3: Quality assessment of included studies.
Fig. 4: Ranking of different regimens for each outcome.

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Data availability

All data can be obtained by a reasonable request to corresponding authors.

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Authors and Affiliations

  1. Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China

    Hong Sun, Ling Li, Fengjiao Bu, Xiu Xin, Jingchao Yan & Taomin Huang

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Contributions

HS, JY, and TH designed the protocol. HS, LL, FB, XX, JY, and TH were involved in the acquisition of data. HS performed the statistical analysis. HS wrote the original draft. HS, LL, FB, XX, JY, and TH revised the manuscript. All authors approved the final version to be published.

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Correspondence to Jingchao Yan or Taomin Huang.

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Sun, H., Li, L., Bu, F. et al. Two-year efficacy and safety of different anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: a network meta-analysis of randomized controlled trials. Eye (2024). https://doi.org/10.1038/s41433-024-03327-3

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