title: Ranibizumab for age-related macular degeneration: a meta-analysis of dose effects and comparison with no anti-VEGF treatment and bevacizumab.
abstract: OBJECTIVE
  Ranibizumab is used monthly or as-needed (PRN) for the treatment of age-related macular degeneration. However, which treatment regimen is more effective remains unknown. The objectives of this study are to: (i) compare the efficacy of monthly versus as-needed quarterly treatment; and (ii) compare the efficacy of ranibizumab 0·5 mg treatment with: (a) no anti-vascular endothelial growth factor (VEGF); (b) ranibizumab 0·3 mg; and (c) bevacizumab.
  
  
  METHODS
  This is a systematic meta-analytic review of randomized-controlled clinical trials of ranibizumab in neovascular AMD. Weighted multiple regression analyses were used to compare the monthly vs. PRN/quarterly treatment.
  
  
  RESULTS
  Eight randomized controlled trials met our inclusion criteria. Patients on the monthly ranibizumab treatment had higher visual acuity letter gains (β = 0·441, P < 0·05) compared with patients on as-needed/quarterly treatment. More patients on the monthly treatment gained ≥15 letters than as-needed/quarterly treatment (β = 0·582, P < 0·05). Ranibizumab produced significantly higher improvement in visual acuity (d = 1·20, z = 7·14, P < 0·05) and led to a higher proportion of patients gaining ≥15 letters (OR: 6·67; 95% CI 3·16-14·06; P < 0·05) when compared with non-anti-VEGF. Ranibizumab did not show any advantage in visual acuity compared with bevacizumab. No significant differences were found between ranibizumab 0·3 mg and 0·5 mg.
  
  
  CONCLUSIONS
  This is the first meta-analysis to systematically evaluate the efficacy of different treatment regimens for anti-VEGF therapy. Ranibizumab 0·3 or 0·5 mg monthly treatment was more effective for neovascular AMD than non-anti-VEGF treatments but is no better than bevacizumab.
authors.affiliation: College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Jiang
authors.forename: C
authors.initials: C
authors.lastname: Park
authors.forename: J C
authors.initials: JC
authors.lastname: Barner
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D000068258:Bevacizumab; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab
keywords: anti-VEGF; as-needed; bevacizumab; clinical trials; monthly