A systematic review of the efficacy and safety outcomes of anti-VEGF agents used for treating neovascular age-related macular degeneration: comparison of ranibizumab and bevacizumab

Abstract

Objective:

To systematically review ocular and systemic events in treatment of wet age-related macular degeneration (AMD) with anti-vascular endothelial growth factor antibodies, ranibizumab and bevacizumab, and to provide a detailed perspective of their differences on clinical use, efficacy and safety.

Research design and methods:

This review was based on a 2010 PubMed literature search performed using two separate terms: ‘lucentis’ OR ‘ranibizumab’ AND ‘age-related macular degeneration’ OR ‘AMD’ or ‘avastin’ OR ‘bevacizumab’ AND ‘age-related macular degeneration’ OR ‘AMD’. A clinical diagnosis of wet AMD was defined by the authors of the trial reports. Clinical studies that met Level I or Level II evidence criteria were considered for review.

Findings:

Eight large, randomized, controlled trials of ranibizumab (Level I) included 1485 patients (range 162–716) and four open-label studies of ranibizumab (Level II) included 4484 patients (range 32–4300). Six studies (one Level I, five Level II) of bevacizumab included 424 patients (range 28–165). All demonstrated improvements in visual acuity. Only one study (Level II) compared the efficacy of ranibizumab and bevacizumab. Adverse ocular and systemic safety events occurring during the study were prospectively recorded for ranibizumab, irrespective of their suspected relationship to study treatments. Only three of six bevacizumab studies reported details of adverse ocular or systemic events. There was extensive Level I and Level II evidence to support both the efficacy and safety of ranibizumab in wet AMD. Data suggest that bevacizumab provides efficacy in wet AMD, but the safety profile of intravitreal bevacizumab remains to be established.

Conclusion:

In contrast to ranibizumab, current safety data for bevacizumab are incomplete and not yet robust. If the medical community remains committed to using intravitreal bevacizumab, it is critical to establish that it has an acceptable safety profile, supported by evidence-based medicine. Considerable further research is warranted to achieve this.

Key words::

• Age-related macular degeneration
• AMD
• Avastin
• Bevacizumab
• Lucentis
• Ranibizumab
• VEGF

Transparency

Declaration of funding

Novartis Pharmaceuticals Corporation has offered to sponsor any necessary fees associated with rapid publication services.

Declaration of financial/other relationships

P.M. has provided expert consultation services to and received speaker honoraria from Novartis Pharmaceuticals Corporation. He has also received honoraria for providing consultation or lecture services to Pfizer, Allergan, Solvay/Abbott and Bayer.

Acknowledgments

Alpha-Plus Medical Communications Ltd provided editorial support in the production of this manuscript; this support was sponsored by Novartis Pharmaceuticals Corporation.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.