No single anti-VEGF regimen linked to superior vision outcomes in wet AMD
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Different anti-VEGF regimens may not result in superior vision benefits compared with ranibizumab for neovascular age-related macular degeneration, according to a meta-analysis presented at the virtual American Society of Retina Specialists meeting.
“Although some studies have compared the efficacies of different anti-VEGF therapies for wet AMD, no single trial can draw comparison between every anti-VEGF agent and dosing regimen available,” Diana V. Do, MD, of Byers Eye Institute at Stanford University, said in her presentation.
Using a network meta-analysis approach, Do and colleagues investigated how outcomes compare between different anti-VEGF regimens for wet AMD across clinical trials.
The researchers conducted a systematic literature review to determine randomized controlled trials of anti-VEGF therapy for wet AMD and defined interventions by drug, dose and regimen (fixed Q4W, Q8W, Q12W, as-needed or treat-and-extend). They evaluated more than 20 anatomic, vision and safety outcomes to establish whether they were reported with consistency across studies to be included in the feasibility analysis.
Based on the feasibility analysis, the outcomes that could be compared using a network meta-analysis approach were three BCVA outcomes: mean change from baseline at month 12 and month 24, and patients who gained at least 15 ETDRS letters at month 12. However, many outcomes could not be compared – especially anatomical outcomes related to fluid measurements – because of data heterogeneity or lack of data.
Investigators included 21 randomized controlled trials that reported BCVA change at month 12, the most commonly reported outcome. Across all trials, baseline visual acuity varied from 52 to 65 letters.
Do and colleagued used ranibizumab every 4 weeks and as-needed as reference cases because they were the most commonly compared treatment regimens across studies. The analysis yielded no statistically significant differences in any of the evaluable outcomes compared with ranibizumab in these dosing regimens.
“Our network meta-analysis found that vision gains over 24 months and the odds of gaining 15 or more letters at month 12 were generally comparable between anti-VEF treatment regimens for wet AMD,” Do said. “These data suggest that no single anti-VEGF regimen is associated with superior vision outcomes for patients with wet AMD and that achieving further vision gains may require a different approach to treatment, such as a different drug delivery paradigm or drugs with an alternative mechanism of action.”
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Do DV, et al. Comparative Efficacy of Different Anti-VEGF Treatment Regimens in Patients With nAMD: A Network Meta-Analysis. Presented at: American Society of Retina Specialists annual meeting; July 24-26, 2020 (virtual meeting).
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