Ranibizumab treatment in age-related macular degeneration: a meta-analysis of one-year results.
BACKGROUND
Although ranibizumab is widely used in age-related macular degeneration there is no systematic data available on the relation between treatment frequency and functional efficacy within the first 12 months of follow-up.


METHODS
A meta-analysis was performed on available MEDLINE literature. 47 relevant clinical studies (54 case series) could be identified covering 11706 treated eyes. Non-linear and linear regressions were calculated for the relation between treatment frequency and functional outcome (average gain in visual acuity, % of eyes losing less than 15 letters of visual acuity, % of eyes gaining ≥ 15 letters) within the first year of care.


RESULTS
Mean improvement of average visual gain was +4.9 ± 3.6 (mean ± 1 standard deviation) letters (case-weighted: 3.3 letters). The average number of ranibizumab injections until month 12 was 6.3 ± 2.0 (case-weighted: 5.9). 92.4 ± 3.9% of eyes (case-weighted: 91.9%) lost less than three lines of visual acuity and 24.5 ± 8.2% (case-weighted: 23.3) gained more than 3 lines within the first year. Analysis of the relation between the number of injections and functional improvement indicated best fit for non-linear equations. A nearly stepwise improvement of functional gain occurred between 6.8 and 7.2 injections/year. A saturation effect of treatment occurred at higher injection frequency.


CONCLUSIONS
The results of this meta-analysis clearly indicate a non-linear relation between the number of injections and functional gain of ranibizumab within the first 12 months of treatment. Treatment saturation seems to occur at a treatment frequency >7.2 injections within the first 12 months.
Department of Retinology, Klinik Pallas, Olten, Switzerland (Director: Prof. Dr. med. Heinrich Gerding, F. E. B. O.).
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D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D015984:Causality; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D006801:Humans; D058449:Intravitreal Injections; D008137:Longitudinal Studies; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015995:Prevalence; D000069579:Ranibizumab; D020127:Recovery of Function / Q000187:drug effects; D012307:Risk Factors; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D014792:Visual Acuity / Q000187:drug effects*
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab