title: A systematic review of the efficacy and safety outcomes of anti-VEGF agents used for treating neovascular age-related macular degeneration: comparison of ranibizumab and bevacizumab.
abstract: OBJECTIVE
  To systematically review ocular and systemic events in treatment of wet age-related macular degeneration (AMD) with anti-vascular endothelial growth factor antibodies, ranibizumab and bevacizumab, and to provide a detailed perspective of their differences on clinical use, efficacy and safety.
  
  
  METHODS
  This review was based on a 2010 PubMed literature search performed using two separate terms: 'lucentis' OR 'ranibizumab' AND 'age-related macular degeneration' OR 'AMD' or 'avastin' OR 'bevacizumab' AND 'age-related macular degeneration' OR 'AMD'. A clinical diagnosis of wet AMD was defined by the authors of the trial reports. Clinical studies that met Level I or Level II evidence criteria were considered for review.
  
  
  RESULTS
  Eight large, randomized, controlled trials of ranibizumab (Level I) included 1,485 patients (range 162-716) and four open-label studies of ranibizumab (Level II) included 4,484 patients (range 32-4,300). Six studies (one Level I, five Level II) of bevacizumab included 424 patients (range 28-165). All demonstrated improvements in visual acuity. Only one study (Level II) compared the efficacy of ranibizumab and bevacizumab. Adverse ocular and systemic safety events occurring during the study were prospectively recorded for ranibizumab, irrespective of their suspected relationship to study treatments. Only three of six bevacizumab studies reported details of adverse ocular or systemic events. There was extensive Level I and Level II evidence to support both the efficacy and safety of ranibizumab in wet AMD. Data suggest that bevacizumab provides efficacy in wet AMD, but the safety profile of intravitreal bevacizumab remains to be established.
  
  
  CONCLUSIONS
  In contrast to ranibizumab, current safety data for bevacizumab are incomplete and not yet robust. If the medical community remains committed to using intravitreal bevacizumab, it is critical to establish that it has an acceptable safety profile, supported by evidence-based medicine. Considerable further research is warranted to achieve this.
authors.affiliation: Department of Ophthalmology, University of Sydney, Sydney, Australia. paul.mitchell@sydney.edu.au
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000465:Algorithms; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D009389:Neovascularization, Pathologic / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D000069579:Ranibizumab; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab