Intravitreal Bevacizumab Versus Ranibizumab for Treatment of Neovascular Age-Related Macular Degeneration: Findings from a Cochrane Systematic Review.
Intravitreal Bevacizumab Versus Ranibizumab for Treatment of Neovascular Age-Related Macular Degeneration: Findings from a Cochrane Systematic Review.
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DOI：
10.1016/j.ophtha.2015.09.002
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发表时间：
2016-01
期刊：
影响因子：
13.7
通讯作者：
Hawkins BS
中科院分区：
文献类型：
--
作者：
Solomon SD;Lindsley KB;Krzystolik MG;Vedula SS;Hawkins BS
使用 Cochrane 眼睛和视觉小组系统评价的结果来总结贝伐珠单抗（Avastin®，Genentech, Inc.）和雷珠单抗（Lucentis®，Genentech, Inc.）的相对效果。新生血管性年龄相关性黄斑变性（NVAMD）是发达国家老年人无法矫正视力丧失的最常见原因。贝伐单抗和雷珠单抗是最常用的玻璃体内注射治疗 NVAMD 的抗 VEGF 药物，我们仅纳入了直接比较两种抗 VEGF 药物的随机对照试验 (RCT)。主要结局是 1 年最佳矫正视力 (BCVA) 增加 15 个或更多 logMAR 字母。我们遵循 Cochrane 方法进行试验选择、数据提取和数据分析。贝伐珠单抗与雷珠单抗的相对效应以估计风险比 (RR) 和平均差 (MD) 和 95% 置信区间 (CI) 表示。我们确定了 6 项符合条件的随机对照试验，共有 2809 名参与者。当比较相同的治疗方案时，两种药物在一年内获得 15 个或更多 BCVA 字母的眼睛比例相似：RR=0.90，95% CI：0.73 至 1.11。 BCVA 相对于基线的平均变化也相似：MD=-0.5 个字母； 95% CI：-1.6 至 +0.6。两种药物的其他 BCVA 和生活质量结果相似。在两项最大的试验中，雷珠单抗一年的治疗费用是贝伐单抗费用的 5.1 和 25.5 倍。眼部不良事件并不常见（<1%）；两位代理人的比率相似。我们发现贝伐单抗和雷珠单抗治疗 NVAMD 的有效性或安全性没有显着差异，但成本差异很大。
To summarize the relative effects of bevacizumab (Avastin®, Genentech, Inc.) and ranibizumab (Lucentis®, Genentech, Inc.), using findings from a Cochrane Eyes and Vision Group systematic review . Neovascular age-related macular degeneration (NVAMD) is the most common cause of uncorrectable vision loss in the elderly in developed countries. Bevacizumab and ranibizumab are the most frequently-used anti-VEGF agents injected intravitreally to treat NVAMD We included only randomized controlled trials (RCTs) in which the two anti-VEGF agents had been compared directly. The primary outcome was 1-year gain in best-corrected visual acuity (BCVA) of 15 or more logMAR letters. We followed Cochrane methods for trial selection, data extraction, and data analyses. Relative effects of bevacizumab versus ranibizumab are presented as estimated risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We identified 6 eligible RCTs with 2809 participants. The proportion of eyes that gained 15 or more letters of BCVA by 1 year was similar for the two agents when the same regimens were compared: RR=0.90, 95% CI: 0.73 to 1.11. The mean change in BCVA from baseline also was similar: MD=−0.5 letter; 95% CI: −1.6 to +0.6. Other BCVA and quality-of-life outcomes were similar for the two agents. One-year treatment cost with ranibizumab was 5.1 and 25.5 times the cost for bevacizumab in the two largest trials. Ocular adverse events were uncommon (<1%); rates were similar for the two agents. We found no important difference in effectiveness or safety between bevacizumab and ranibizumab for NVAMD treatment but a large cost difference.