Meta-analysis shows anti-VEGF agents comparable in efficacy

All anti-vascular endothelial growth factor (VEGF) agents improve visual acuity compared with laser photocoagulation, but there is insufficient evidence to distinguish the performance of any single anti-VEGF agent over another, according to results from a recently-conducted meta-analysis from researchers at the Institute for Clinical and Economic Review. The safety of bevacizumab also remains uncertain.

These researchers included reports of treatment of diabetic macular oedema with aflibercept, bevacizumab, pegaptanib or ranibizumab published between January 2000 and June 30, 2012, with comparisons to laser photocoagulation, sham injections, or other controls. Fifteen randomized controlled trials and eight observational studies were included. No direct comparative studies could be found. Efficacy measures were based on best-corrected visual acuity (BCVA) in terms of letters gained. Direct meta-analyses were conducted on BCVA for each anti-VEGF agent, and indirect comparisons were also done for each anti-VEGF pairing.

All agents improved visual acuity compared with control, with a range of improvement of 4 to 9 letters, and outcomes were consistent across multiple time points. There were no statistically significant or consistent differences between any agents in regards to changes in BCVA or the percentage of patients who gained more than 10 letters. No differences in adverse events, including ocular events, myocardial infarction, stroke, other cardiovascular events, or death were seen in comparisons of aflibercept, pegaptanib and ranibizumab; data of adverse events with bevacizumab were under reported.

To view an abstract of this study, click here.