Which anti-VEGF to use for retinopathy of prematurity? A meta-analysis of bevacizumab, ranibizumab and aflibercept

Theme: Paediatric ophthalmology and strabismus
What: Paediatric ophthalmology and strabismus
Part of: Paediatrics III: Retinopathy of Prematurity - Pathophysiology and Best Evidence for Prevention and Treatment / Pédiatrie III: Rétinopathie du prématuré - Pathophysiologie et meilleures données probantes pour la prévention et le traitement
When: 6/2/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 714 A

Abstract

Purpose: Intravitreal anti-VEGF injections are being increasingly used for the treatment of retinopathy of prematurity (ROP). The purpose of this study was to compare the efficacy and safety of intravitreal bevacizumab (IVB), ranibizumab (IVR) and aflibercept (IVA) in the treatment of ROP.

Methods: MEDLINE, EMBASE and Cochrane CENTRAL were used to identify studies comparing IVB to IVR, IVB to IVA, or IVR to IVA. The primary outcome was ROP regression. Secondary outcomes included the likelihood of additional treatment, complete peripheral revascularization, refractive outcomes, and complications such as retinal detachment, cataract, endophthalmitis, macular ectopia, retinal folds, vitreous or retinal hemorrhages. A random effects model was designed.

Results: Overall, 2361 articles were identified. 3966 eyes from 15 comparative studies were included. There was no significant difference in initial regression of ROP between IVB vs. IVR or IVA (p>0.05). However, regression was greater with IVA compared to IVR (risk ratio RR= 1.66, 95% confidence interval CI= [1.14, 2.42], p= 0.008). The likelihood of retreatment was significantly higher with IVR compared to IVB and IVA (RR= 2.11, CI= [1.89, 2.37], p< 0.00001 and RR= 2.76, CI= [1.54, 4.97], p= 0.0007; respectively). However, there was no significant difference in retreatment between IVB and IVA (p= 0.36). Postprocedural complications were rare with no differences between IVB, IVR and IVA. IVB was more likely to be associated with subsequent myopia compared to IVR with a weighted mean difference of 1.11 D (CI= [0.32, 1.89], p= 0.006). Quality of evidence was rated moderate-low.

Conclusion: IVR was associated with a higher risk of retreatment compared to IVB and IVA. Initial regression was similar between IVB vs. IVR or IVA, but IVA was associated with better disease regression compared to IVR. Infants who received IVR had decreased myopia compared to infants who received IVB. With the increasing use of IVB, IVR and IVA for ROP, a randomized, prospective head-to-head comparison of these anti-VEGF agents’ efficacy and safety is needed.

Presenter(s)

Presenting Author: Abed Baiad

Additional Author(s):

Grace Yin, Queen's University

Marko Popovic, University of Toronto

Catherine Sun, McMaster University

Rajeev Muni, University of Toronto

Kamiar Mireskandari, University of Toronto

Peter Kertes, University of Toronto

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