comparative effectiveness of ranibizumab and bevacizumab in the treatment of diabetic retinopathy: A Systematic Review and Meta-Analysis

Background: Diabetic retinopathy (DR) is a leading cause of vision loss globally. While panretinal photocoagulation has been a long-standing treatment, intravitreal anti-VEGF agents such as ranibizumab have demonstrated superior efficacy, establishing it as a first-line therapy. However, bevacizumab, though off-label, is widely used due to its lower cost and comparable pharmacological profile. This study systematically reviewed and meta-analysed randomized controlled trials (RCTs) published between 2012 and 2021 to compare the therapeutic effectiveness of ranibizumab and bevacizumab in improving visual outcomes among patients with DR. Specific objectives included: (1) rigorous selection and appraisal of eligible RCTs; (2) systematic extraction of trial data; (3) pooled statistical analysis using odds ratios and relative risks; and (4) critical interpretation of findings for clinical practice. Methods: A quantitative approach was employed, using systematic review and meta-analysis in line with PRISMA guidelines. Data were analysed with RevMan 5.4 software, and statistical comparisons were made using odds ratios and relative risk analysis. Results: Pooled analysis of eligible trials demonstrated no heterogeneity (I² = 0%) and revealed a p-value of 0.74, indicating bevacizumab was superior to ranibizumab in improving visual outcomes. Conclusion: Bevacizumab demonstrates greater therapeutic effectiveness than ranibizumab in the treatment of DR. Given its lower cost and accessibility, bevacizumab should be prioritized in clinical practice, particularly in resource-limited settings. Increased awareness and adoption by healthcare professionals are recommended to optimize DR management.