Abstract
Purpose :
Several anti-VEGF agents are now used as primary therapy for ROP. Their relative efficacy in different subgroups of ROP is unclear while head-to-head clinical trials would be impractical due to the large sample sizes required. Incorporating recent FIREFLEYE trial data, we present an updated network meta-analysis comparing bevacizumab, ranibizumab, aflibercept and laser treatment for ROP in terms of retreatment rate.
Methods :
We included randomized controlled trials and comparative studies up to January 2023 that used bevacizumab, ranibizumab, aflibercept or laser as primary therapy for ROP. Studies were evaluated by the GRADE framework and those with biased case selection, nonrandomized case-control or lack of control group were excluded. Primary retreatment rate of each modality was determined by frequentist meta-analyses while all pairs of modalities were compared by Bayesian network meta-analyses for type 1 and Zone I ROP (Fig.1).
Results :
4678 eyes (30 studies) were included. For type 1 ROP, single treatment success rates were 88.8% (95% CI:83–94%; n=1548) for laser, 87.0% (79–94%; n=2081) for bevacizumab, 76.9% (60–90%; n=322) for aflibercept, and 74.0% (63–84%; n=727) for ranibizumab. Mean time to secondary treatment was 11.36±0.54 (SEM) weeks following primary bevacizumab, 11.12±0.69 for aflibercept, and 9.29±0.43 for ranibizumab. For Zone I ROP, single treatment success rates were 64.7% (43–84%; n=171) for laser, 91.2% (84–97%; n=231) for bevacizumab, 53.3% (35-71%; n=30) for aflibercept, and 78.3% (61–92%; n=100) for ranibizumab.
Conclusions :
Consistent with our previously published network meta-analysis, laser is associated with a significant 62% (95% CrI:18–83%) reduction in retreatment rate compared with ranibizumab in type 1 ROP (Zones I and II combined), while no significant difference was found among other pairwise comparisons. In contrast, for Zone I ROP, bevacizumab is associated with a significant 67% (11-89%) reduction in retreatment risk compared with laser. With inclusion of updated FIREFLEYE data, bevacizumab (p=9×10−3) but not aflibercept (p=0.06) demonstrates longer time to secondary treatment than ranibizumab.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.