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 0·5 mg treatment with: (a) no anti-vascular endothelial growth factor (VEGF); (b) ranibizumab 0·3 mg; 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 (β = 0·441, P < 0·05) compared with patients on as-needed/quarterly treatment. More patients on the monthly treatment gained ≥15 letters than as-needed/quarterly treatment (β = 0·582, P < 0·05). Ranibizumab produced significantly higher improvement in visual acuity (d = 1·20, z = 7·14, P < 0·05) and led to a higher proportion of patients gaining ≥15 letters (OR: 6·67; 95% CI 3·16-14·06; P < 0·05) 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 0·3 mg and 0·5 mg. 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 0·3 or 0·5 mg monthly treatment was more effective for neovascular AMD than non-anti-VEGF treatments but is no better than bevacizumab.