Ranibizumab for age-related macular degeneration: a meta-analysis of dose effects and comparison with no anti-VEGF treatment and bevacizumab

What is known and objectives Ranibizumab is used monthly or as-needed (PRN) for the treatment of age-related macular degeneration. However, which treatment regimen is more effective remains unknown. The objectives of this study are to: (i) compare the efficacy of monthly versus as-needed quarterly treatment; and (ii) compare the efficacy of ranibizumab 0 center dot 5mg treatment with: (a) no anti-vascular endothelial growth factor (VEGF); (b) ranibizumab 0 center dot 3mg; and (c) bevacizumab. Method This is a systematic meta-analytic review of randomized-controlled clinical trials of ranibizumab in neovascular AMD. Weighted multiple regression analyses were used to compare the monthly vs. PRN/quarterly treatment. Results Eight randomized controlled trials met our inclusion criteria. Patients on the monthly ranibizumab treatment had higher visual acuity letter gains (beta=0 center dot 441, P<0 center dot 05) compared with patients on as-needed/quarterly treatment. More patients on the monthly treatment gained >= 15 letters than as-needed/quarterly treatment (beta=0 center dot 582, P<0 center dot 05). Ranibizumab produced significantly higher improvement in visual acuity (d=1 center dot 20, z=7 center dot 14, P<0 center dot 05) and led to a higher proportion of patients gaining >= 15 letters (OR: 6 center dot 67; 95% CI 3 center dot 16-14 center dot 06; P<0 center dot 05) when compared with non-anti-VEGF. Ranibizumab did not show any advantage in visual acuity compared with bevacizumab. No significant differences were found between ranibizumab 0 center dot 3mg and 0 center dot 5mg. What is new and conclusion This is the first meta-analysis to systematically evaluate the efficacy of different treatment regimens for anti-VEGF therapy. Ranibizumab 0 center dot 3 or 0 center dot 5mg monthly treatment was more effective for neovascular AMD than non-anti-VEGF treatments but is no better than bevacizumab.