A Cochrane review [Abstract] 1 included 6 studies with a total of 937 subjects comparing outcomes at 6 months to sham injection for 4 anti-vascular endothelial growth factor (anti-VEGF) agents: aflibercept (VEGF Trap-Eye, Eylea), bevacizumab (Avastin), pegaptanib sodium (Macugen) and ranibizumab (Lucentis). Treatment with anti-VEGF agents increased the chance of a significant gain in vision at 6 months compared to sham injections. One study demonstrated sustained benefit at 12 months. The risk of losing significant vision was reduced by 80% in those receiving anti-VEGF therapy compared to those receiving sham treatment. Participants receiving anti-VEGF treatment had a greater reduction in mean central retinal thickness from baseline to 6 months than patients receiving sham, indicating enhanced resolution of macular oedema (table T1). No significant safety concerns were identified at 6 or 12 months, but the available studies did not allow a conclusion about their long-term effectiveness and safety to be drawn.
| Outcome | Relative effect (95% CI) | Assumed risk - Sham injection | Corresponding risk - Anti-VEGF injection (95% CI) | Participants (studies) |
|---|---|---|---|---|
| BCVA gain of 15 letters or more | RR 2.71 (2.10 to 3.49) | 182 per 1000 | 493 per 1000(382 to 635) | 937(6 studies) |
| BCVA loss of 15 letters or more | RR 0.20 (0.12 to 0.34) | 219 per 1000 | 44 per 1000(26 to 74) | 766(5 studies) |
| Mean change from baseline in central retinal thickness | MD -267.4 µm (211.4 to 323.4) | 481(3 studies) | ||
| BCVA = best-corrected visual acuity | ||||
Clinical comments
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