title: Comparative efficacy and safety of approved treatments for macular oedema secondary to branch retinal vein occlusion: a network meta-analysis.
abstract: OBJECTIVE
  To compare the efficacy and safety of approved treatments for macular oedema secondary to branch retinal vein occlusion (BRVO).
  
  
  METHODS
  Randomised controlled trials (RCTs) evaluating the efficacy and safety of approved treatments for macular oedema secondary to BRVO were identified from an updated systematic review.
  
  
  METHODS
  A Bayesian network meta-analysis of RCTs of treatments for macular oedema secondary to BRVO.
  
  
  METHODS
  Ranibizumab 0.5 mg pro re nata, aflibercept 2 mg monthly (2q4), dexamethasone 0.7 mg implant, laser photocoagulation, ranibizumab+laser, or sham intervention. Bevacizumab and triamcinolone were excluded.
  
  
  METHODS
  Efficacy outcomes were mean change in best corrected visual acuity (Early Treatment Diabetic Retinopathy Study scale) and the percentage of patients gaining ≥ 15 letters. Safety outcome was the percentage of patients with increased intraocular pressure (IOP)/ocular hypertension (OH).
  
  
  RESULTS
  8 RCTs were identified for inclusion with 1743 adult patients. The probability of being the most efficacious treatment at month 6 or 12 based on letters gained was 54% for ranibizumab monotherapy, 30% for aflibercept, 16% for ranibizumab plus laser (adjunctive or prompt), and 0% for dexamethasone implant, laser or sham. The probability of being the most efficacious treatment for patients gaining ≥ 15 letters was 39% for aflibercept, 35% for ranibizumab monotherapy, 24% for ranibizumab plus laser, 2% for dexamethasone implant, and less than 1% for laser or sham. There was no statistical difference between ranibizumab monotherapy and aflibercept for letters gained (+1.4 letters for ranibizumab vs aflibercept with 95% credible interval (CrI) of -5.2 to +8.5 letters) or the OR for gaining ≥ 15 letters: 1.06 (95% CrI 0.16 to 8.94)). Dexamethasone implant was associated with significantly higher IOP/OH than antivascular endothelial growth factor agents (OR 13.1 (95% CrI 1.7 to 116.9)).
  
  
  CONCLUSIONS
  There was no statistically significant difference between ranibizumab and aflibercept.
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Stephane A
authors.initials: SA
authors.lastname: Regnier
authors.affiliation: Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Larsen
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Bezlyak
authors.affiliation: Novartis Pharmaceuticals UK Ltd., Frimley, Camberley, Surrey, UK.
authors.forename: Felicity
authors.initials: F
authors.lastname: Allen
mesh_terms: D000328:Adult; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods; D008269:Macular Edema / Q000209:etiology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab / Q000008:administration & dosage / Q000009:adverse effects; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage / Q000009:adverse effects; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012170:Retinal Vein Occlusion / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D011993:Recombinant Fusion Proteins; C533178:aflibercept; D003907:Dexamethasone; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: OPHTHALMOLOGY