June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Comparative efficacy of anti-vascular endothelial growth factor (VEGF) treatment regimens for neovascular age-related macular degeneration (nAMD): A network meta-analysis
Author Affiliations & Notes
  • Vincent Garmo
    Genentech, South San Francisco, California, United States
  • Ivo Stoilov
    Genentech, South San Francisco, California, United States
  • Caroline Solon
    Genentech, South San Francisco, California, United States
  • Ferhina S Ali
    Genentech, South San Francisco, California, United States
  • Jennifer Uyei
    IQVIA, San Francisco, California, United States
  • Pinar Bilir
    IQVIA, San Francisco, California, United States
  • Andreas Karabis
    IQVIA, Amsterdam, Netherlands
  • Rajpal Singh
    IQVIA, Mumbai, India
  • Yilin Jiang
    IQVIA, Amsterdam, Netherlands
  • Diana V Do
    Byers Eye Institute, Stanford University, Palo Alto, California, United States
  • Footnotes
    Commercial Relationships   Vincent Garmo, Genentech, Inc (E); Ivo Stoilov, Genentech, Inc (E); Caroline Solon, Genentech, Inc (E); Ferhina Ali, Genentech, Inc (E); Jennifer Uyei, IQVIA (E); Pinar Bilir, IQVIA (E); Andreas Karabis, IQVIA (E); Rajpal Singh, IQVIA (E); Yilin Jiang, IQVIA (E); Diana Do, Aerie (C), Aerie (R), Genentech, Inc (C), Genentech, Inc (R), Gilead (R), Graybug (C), Graybug (R), Kodiak (C), Novartis (C), Novartis (R), Regeneron (C), Ribomic (C), Ribomic (R), Santen (C), Santen (R)
  • Footnotes
    Support  Genentech, Inc., South San Francisco, CA, provided support for the study and participated in the study design; conducting the study; and data collection, management, and interpretation
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 4228. doi:
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      Vincent Garmo, Ivo Stoilov, Caroline Solon, Ferhina S Ali, Jennifer Uyei, Pinar Bilir, Andreas Karabis, Rajpal Singh, Yilin Jiang, Diana V Do; Comparative efficacy of anti-vascular endothelial growth factor (VEGF) treatment regimens for neovascular age-related macular degeneration (nAMD): A network meta-analysis. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4228.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Numerous clinical trials have compared anti-VEGF agents, dosing, and/or injection frequencies, but no single trial can compare all available treatment regimens. We used a network meta-analysis (NMA), which includes only those studies that have a comparator in common, to evaluate outcomes between anti-VEGF regimens for nAMD across clinical trials.

Methods : A systematic literature review identified randomized controlled trials (RCTs) of anti-VEGF therapy for nAMD (Table). Interventions were defined by drug, dose, and regimen (fixed Q4W, Q8W, Q12W, pro re nata [PRN], or treat-and-extend [T&E]). Over 20 outcomes were assessed to determine if they were reported with sufficient consistency to allow inclusion in the NMA (feasibility analysis). The literature and expert opinion were consulted to assess whether differences in specific baseline characteristics between studies would impact the outcomes included; if so, that impact was factored into the NMA.

Results : Feasibility analysis determined that the outcomes that could be compared using NMA were 3 best-corrected visual acuity (BCVA) outcomes (measured in Early Treatment Diabetic Retinopathy Study letters): mean change from baseline at month (M)12 and M24 and patients (%) gaining ≥15 letters at M12. All studies reported similar baseline characteristics, with few exceptions; no effect modification. For BCVA change at M12, 21 RCTs were included (Table). Baseline VA varied from 52−65 letters across all trials. Ranibizumab (RAN) Q4W and PRN (the most commonly compared treatment regimens) were used as reference cases. The NMA found no statistically significant differences in any of the evaluable outcomes in any pairwise comparison with RAN Q4W or PRN (comparisons with RAN PRN shown in Figure).

Conclusions : This NMA suggests that the different regimens evaluated have not resulted in superior vision benefits compared with RAN PRN or Q4W. If confirmed, these results suggest that greater visual acuity improvements may require a different approach to treatment, such as a different drug delivery paradigm or the development of drugs with different or multiple mechanisms of action.

This is a 2020 ARVO Annual Meeting abstract.

 

Table. Randomized controlled trials included in network meta-analysis (N=21)

Table. Randomized controlled trials included in network meta-analysis (N=21)

 

Figure: Forest plot comparing mean change from baseline in BCVA at month 12 with RAN PRN versus other treatment regimens.

Figure: Forest plot comparing mean change from baseline in BCVA at month 12 with RAN PRN versus other treatment regimens.

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