September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
3-month efficacy of anti-VEGFs and vPDT in the treatment of visual impairment due to myopic CNV: An indirect treatment comparison
Author Affiliations & Notes
  • Stephane Regnier
    Novartis AG, Basel, BS, Switzerland
  • Wayne Macfadden
    Novartis AG, Basel, BS, Switzerland
  • Tien Yin Wong
    Singapore National Eye Centre, National University of Singapore, Singapore, Singapore
  • Footnotes
    Commercial Relationships   Stephane Regnier, Novartis AG (E); Wayne Macfadden, Novartis (E); Tien Wong, Allergan (F), Allergan (C), Bayer (F), Bayer (C), Novartis (F), Novartis (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2133. doi:
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      Stephane Regnier, Wayne Macfadden, Tien Yin Wong; 3-month efficacy of anti-VEGFs and vPDT in the treatment of visual impairment due to myopic CNV: An indirect treatment comparison. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2133.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : The objective was to compare the efficacy of approved therapies in the treatment of visual impairment (VI) due to myopic CNV (mCNV).

Methods : A systematic review was conducted to identify relevant randomized clinical trials (RCTs). Studies evaluating the efficacy of at least two of the following interventions: ranibizumab 0.5 mg, aflibercept 2.0 mg, verteporfin photodynamic therapy (vPDT) or sham. The outcome of interest was improvement in best-corrected visual acuity (BCVA) measured in letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale at month 3.
Comparisons of efficacy were made using a Bayesian network meta-analysis with fixed treatment effect.

Results : The analysis included 518 patients from 3 RCTs: RADIANCE (ranibizumab 0.5 mg vs. vPDT), VIP (vPDT vs. sham) and MYRROR (aflibercept 2.0 mg vs. sham). Ranibizumab patients in RADIANCE and aflibercept patients in MYRROR received one injection at baseline and then treatment as needed. Since vPDT patients in RADIANCE could cross over to ranibizumab 0.5 mg at month 3, increase in BCVA was measured and compared across all treatments in these studies from baseline to month 3. MYRROR gains at month 3 were not publically available and were estimated from a published graph with a digitizing software. Ranibizumab patients (guided by either visual acuity stabilization or disease activity) gained, on average, 2.9 (95% credible interval [CrI]: -2.9, 9.4) more letters than aflibercept patients from baseline to month 3. The probability of a treatment to provide the greatest gain in visual acuity was 84% for ranibizumab vs. 16% for aflibercept, 0% for sham and 0% for vPDT. When analyzing RADIANCE results for East-Asian patients only (population studied in MYRROR), ranibizumab patients gained, on average, 4.7 (95% CrI: -1.9, 11.3) more letters than those treated with aflibercept and the probability of ranibizumab being the most effective treatment increased to 92% vs. 8% for aflibercept.

Conclusions : Patients were likely to experience better visual acuity gains after 3 months with ranibizumab compared to aflibercept. This improvement was more marked in East Asian patients. The main limitation was that the conclusions are based on short-term clinical assessment in only three clinical trials; additional data would improve the strength of this finding.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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