Comparative efficacy of intravitreal anti‐VEGF therapy for neovascular age‐related macular degeneration: A systematic review with network meta‐analysis

Abstract

AbstractThe aim of this review was to evaluate the comparative efficacy of intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) therapy for neovascular AMD. We searched 12 literature databases for randomised clinical trials (RCT) on anti‐VEGF therapy for neovascular AMD and extracted data on: change from baseline to 12 months in best‐corrected visual acuity (BCVA) and central retinal thickness (CRT), and cumulative number of injections at 12 months. The reference for comparison was monthly ranibizumab. Comparisons were made using network meta‐analyses. Forty‐nine RCTs including 23 257 eyes of 23 257 patients were included. No anti‐VEGF drug or treatment regimen provided a better BCVA response compared to the reference. For CRT, small but statistically significant improvements over the reference were observed for brolucizumab 3 mg (−27.9 μm) or 6 mg (−38.1 μm) in loading dose (LD) then every 8–12 weeks, aflibercept 8 mg in LD then every 12 (−26.9 μm) or 16 weeks (−32.1 μm), faricimab 6 mg in LD then treat‐and‐extend (−18.1 μm) and aflibercept 2 mg in LD then every 8 weeks (−11.3 μm). For the cumulative number of injections, a range of anti‐VEGF drugs and treatment regimens provided a statistically significant and clinically meaningful reduction compared to the reference. When results are considered simultaneously, faricimab 6.0 mg or aflibercept 8.0 mg in a treatment regimen with an LD followed by either a treat‐and‐extend regimen or a fixed 12‐ or 16‐week regimen appears to provide the optimal balance between visual outcomes, anatomical outcomes and the lowest treatment burden. However, studies of the long‐term efficacy of newer anti‐VEGF drugs are warranted.