BEVACIZUMAB VERSUS RANIBIZUMAB FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION A Meta-analysis of Randomized Controlled Trials

Purpose: To evaluate the relative efficacy and safety of bevacizumab versus ranibizumab for the treatment of the neovascular form of age-related macular degeneration. Methods: A comprehensive literature search using the Cochrane Methodology Register to identify randomized controlled trials comparing bevacizumab with ranibizumab in patients with neovascular age-related macular degeneration. Efficacy estimates were determined by comparing weighted mean differences in the change of best-corrected visual acuity and central macular thickness from baseline. Safety estimates were determined by calculating the risk ratio for rates of death, arteriothrombotic events, venous thrombotic events, and at least 1 serious systemic adverse event. Statistical analysis was performed using the RevMan 5.1 software. Results: A total of 6 randomized controlled trials were selected for this meta-analysis, including 2,612 patients (1,292 patients in the bevacizumab group and 1,320 patients in the ranibizumab group). There were no significant differences between bevacizumab and ranibizumab in best-corrected visual acuity mean change at 1 year or 2 years (weighted mean difference = -0.40, 95% confidence interval [CI], -1.48 to 0.69, P = 0.47 and weighted mean difference = -1.16, 95% CI, -2.82 to 0.51, P = 0.17, respectively). Ranibizumab was found to be more efficacious in reducing central macular thickness at 1 year (weighted mean difference = 4.35, 95% CI, 0.92-7.78, P = 0.01). The pooled risk ratios comparing the rates of serious systemic adverse events at 1 year and 2 years were slightly in favor of ranibizumab (risk ratio = 1.24, 95% CI, 1.04-1.48, P = 0.02 and risk ratio = 1.20, 95% CI, 1.05-1.37, P = 0.008, respectively), whereas the rates of death, arteriothrombotic events, and venous thrombotic events did not differ statistically. Conclusion: Bevacizumab and ranibizumab had equivalent efficacy for best-corrected visual acuity in the treatment of neovascular age-related macular degeneration. Ranibizumab tended to have a better anatomical outcome. There were no differences between drugs in rates of death, arteriothrombotic events or venous thrombotic events, and differences in rates of serious systemic adverse events that require further study.