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Meta-Analysis
. 2008 Apr 16:(2):CD005139.
doi: 10.1002/14651858.CD005139.pub2.

Antiangiogenic therapy with anti-vascular endothelial growth factor modalities for neovascular age-related macular degeneration

S S Vedula, M G Krzystolik
Meta-Analysis

Antiangiogenic therapy with anti-vascular endothelial growth factor modalities for neovascular age-related macular degeneration

S S Vedula et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Age-related macular degeneration (AMD) is a common cause of severe vision loss in people 55 years and older.

Objectives: The objective of this review was to investigate the effects of anti-VEGF (vascular endothelial growth factor) modalities for treating neovascular AMD.

Search strategy: We searched CENTRAL, MEDLINE, EMBASE and LILACS. We handsearched ARVO abstracts for 2006, 2007 for ongoing trials.

Selection criteria: We included randomized controlled trials (RCTs).

Data collection and analysis: Two review authors independently extracted data. We contacted trial authors for additional data. We summarized outcomes as relative risks (RR), number needed to treat (NNT) and weighted mean differences.

Main results: We included five RCTs of good methodological quality. All five trials were conducted by pharmaceutical companies. An intention-to-treat analysis using the last observation carried forward method was done in most trials. Two trials compared pegaptanib versus sham. One trial compared ranibizumab versus sham, another compared ranibizumab/sham verteporfin PDT versus verteporfin PDT/sham ranibizumab, and the final trial compared ranibizumab plus verteporfin PDT versus verteporfin PDT alone. Fewer patients treated with pegaptanib lost 15 or more letters of visual acuity at one year follow-up compared to sham (pooled relative risk (RR) 0.71; 95% confidence interval (CI) 0.61 to 0.84). The NNT was 6.67 (95% CI 4.35 to 14.28) for 0.3 mg pegaptanib, 6.25 (95% CI 4.17 to 12.5) for 1 mg pegaptanib and 14.28 (95% CI 6.67 to 100) for 3 mg pegaptanib. In a trial of ranibizumab versus sham, RR for loss of 15 or more letters visual acuity at one year was 0.14 (95% CI 0.1 to 0.22) in favour of ranibizumab. The NNT was 3.13 (95% CI 2.56 to 3.84) for 0.3 mg ranibizumab and 3.13 (95% CI 2.56 to 3.84) for 0.5 mg ranibizumab. In a trial of ranibizumab versus verteporfin PDT, RR for loss of 15 or more letters at one year was 0.13 (95% CI 0.07 to 0.23) favouring ranibizumab. The NNT was 3.33 (95% CI 2.56 to 4.76) for 0.3 mg ranibizumab and 3.12 (95% CI 2.43 to 4.17) for 0.5 mg ranibizumab. In another trial of combined ranibizumab plus verteporfin PDT versus verteporfin PDT, RR for loss of 15 or more letters at one year favoured combined therapy (RR 0.3 (95% CI 0.15 to 0.60). The NNT was 4.35 (95% CI 2.78 to 11.11). Pooled RR for gain of 15 or more letters visual acuity at one year was 5.81 (95% CI 3.29 to 10.26) for ranibizumab versus sham, 6.79 (95% CI 3.41 to 13.54) for ranibizumab/sham verteporfin PDT versus verteporfin PDT/sham ranibizumab, and 4.44 (95% CI 1.40 to 14.08) for ranibizumab plus verteporfin PDT versus verteporfin PDT. Frequency of endophthalmitis in included studies was between 0.7% to 4.7% with ranibizumab and 1.3% with pegaptanib. Improvement in vision-specific quality of life was reported for both treatments.

Authors' conclusions: Pegaptanib and ranibizumab reduce the risk of visual acuity loss in patients with neovascular AMD. Ranibizumab causes gains in visual acuity in many eyes. Quality of life and cost will be important for treatment decisions. Other agents blocking VEGF are being tested in ongoing trials.

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Conflict of interest statement

Declarations of Interest: None.

References

References to studies included in this review

    1. Bressler NM, Dolan CM, Fine J, Marceau C, Chang TS. [accessed 14 October 2007];Vision-specific quality of life at 12 months in predominantly classic neovascular AMD in ANCHOR: a phase III trial of ranibizumab and verteporfin PDT. http://www.evrs.org/pages/2006/Scientifis%20Sessions_abstracts/Sunday/51....
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References to studies excluded from this review

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References to studies awaiting assessment

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References to ongoing studies

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    1. [accessed 30 November 2007];Comparison of Age-related macular degeneration Treatment Trials. http://www.med.upenn.edu/cpob/studies/documents/CATTEligibilityCriteria.pdf.
    1. A randomised controlled trial of alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularisation. http://www.ivan-trial.co.uk/Default.aspx. - PubMed
    1. Abraham P, Yue H, Shams N. PIER: Year 1 results of a phase IIIb study of ranibizumab efficacy and safety in choroidal neovascularization due to age-related macular degeneration. Program & Abstracts. Sixth EVRS Congress (Joint with ASRS) -Cannes, France. 2006 Sep 9–13; Abstract # 506.
    1. A Study to Evaluate Ranibizumab in Subjects With Choroidal Neovascularization (CNV) Secondary to Age-Related Macular Degeneration (AMD) [accessed 15 Octomber 2007];NCT identifier: NCT00251459. http://clinicaltrials.gov/ct/show/NCT00251459?order=1.

Additional references

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