title: Intravitreal Bevacizumab Versus Ranibizumab for Treatment of Neovascular Age-Related Macular Degeneration: Findings from a Cochrane Systematic Review.
abstract: OBJECTIVE
  To summarize the relative effects of bevacizumab (Avastin; Genentech, Inc, South San Francisco, CA) and ranibizumab (Lucentis; Genentech, Inc.), using findings from a Cochrane Eyes and Vision Group systematic review.
  
  
  CONCLUSIONS
  Neovascular age-related macular degeneration (NVAMD) is the most common cause of uncorrectable vision loss among the elderly in developed countries. Bevacizumab and ranibizumab are the most frequently used anti-vascular endothelial growth factor (VEGF) agents injected intravitreally to treat NVAMD.
  
  
  METHODS
  For this systematic review, we included only randomized controlled trials in which the 2 anti-VEGF agents had been compared directly. The primary outcome was 1-year gain in best-corrected visual acuity (BCVA) of ≥15 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).
  
  
  RESULTS
  We identified 6 eligible randomized controlled trials with 2809 participants. The proportion of eyes that gained ≥15 letters of BCVA by 1 year was similar for the 2 agents when the same regimens were compared (RR, 0.90; 95% CI, 0.73-1.11). 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 2 agents. One-year treatment cost with ranibizumab was 5.1 and 25.5 times the cost for bevacizumab in the 2 largest trials. Ocular adverse events were uncommon (<1%), and rates were similar for the 2 agents.
  
  
  CONCLUSIONS
  We found no important difference in effectiveness or safety between bevacizumab and ranibizumab for NVAMD treatment, but there was a large cost difference.
authors.affiliation: Wilmer Eye Institute, School of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Kristina B
authors.initials: KB
authors.lastname: Lindsley
authors.affiliation: Retina Service, Massachusetts Eye and Ear Infirmary, Providence, Rhode Island.
authors.forename: Magdalena G
authors.initials: MG
authors.lastname: Krzystolik
authors.affiliation: The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Satyanarayana S
authors.initials: SS
authors.lastname: Vedula
authors.affiliation: Wilmer Eye Institute, School of Medicine, The Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland. Electronic address: bhawkins@jhmi.edu.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Hawkins
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab / Q000008:administration & dosage*; D015861:Retinal Neovascularization / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab; D000069579:Ranibizumab