TY - JOUR
T1 - The 12- and 24-Month Effects of Intravitreal Ranibizumab, Aflibercept, and Bevacizumab on Intraocular Pressure
T2 - A Network Meta-Analysis
AU - Nanji, Keean
AU - Sarohia, Gurkaran S.
AU - Kennedy, Kevin
AU - Ceyhan, Tiandra
AU - McKechnie, Tyler
AU - Phillips, Mark
AU - Devji, Tahira
AU - Thabane, Lehana
AU - Kaiser, Peter
AU - Sarraf, David
AU - Garg, Sunir J.
AU - Sivaprasad, Sobha
AU - Wykoff, Charles C.
AU - Bakri, Sophie J.
AU - Sheidow, Tom
AU - Bhandari, Mohit
AU - Chaudhary, Varun
N1 - Funding Information:
S.J.G.: Consultant – Allergan, Apellis, Bausch & Lomb, Boehringer Ingelheim, Johnson and Johnson, Kanaph; Financial support – American Academy of Ophthalmology, Apellis, Boehringer Ingelheim, NGM Bio, Regeneron D.S.: Consultant – Amgen, Bayer, Genentech, Novartis, Optovue; Financial support – Amgen, Genentech, Heidelberg, Optovue, Regeneron, Topcon S.S.: Financial support – Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim, Optos Plc, Novartis, Bayer; Lecturer – Novartis, Bayer, Optos Plc; Advisory board – Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim, Optos Plz, Oxurion, Ophthea, Apellis, Oculis, Heidelberg Engineering C.C.W.: Consultant – Acuela, Adverum Biotechnologies, Inc., Aerpio, Alimera Sciences, Allegro Ophthalmics, LLC, Allergan, Apellis Pharmaceuticals, Bayer AG, Chengdu Kanghong Pharmaceuticals Group Co., Ltd., Clearside Biomedical, DORC (Dutch Ophthalmic Research Center), EyePoint Pharmaceuticals, Gentech/Roche, GyroscopeTx, IVERIC Bio, Kodiak Sciences, Inc., Novartis AG, ONL Therapeutics, Oxurion NV, PolyPhotonix, Recens Medical, Regeron Pharmaceuticals, Inc., REGENXBIO, Inc., Santen Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited; Financial support – Adverum Biotechnologies, Inc., Aerie Pharmaceuticals, Inc., Aerpio, Alimera Sciences, Allergan, Apellis Pharmaceuticals, Chengdu Kanghong Pharmaceutical Group Co., Ltd., Clearside Biomedical, Gemini Therapeutics, Genentech/Roche, Graybug Vision, Inc., GyroscopeTx, Ionis Pharmaceuticals, IVERIC Bio, Kodiak Sciences, Inc., Neurotech LLC, Novartis AG, Opthea, Outlook Therapeutics, Inc., Recens Medical, Regeneron Pharmaceuticals, Inc., REGENXBIO, Inc., Samsung Pharm Co., Ltd., Santen Pharmaceutical Co., Ltd., Xbrane Biopharma AB T.S.: Scientific advisory panel – Bayer Healthcare, Novartis Pharma AG; Financial support – Bayer Healthcare, Novartis Pharma AG, Roche, Genentech, Apellis, Allergan, Chengdu Kanghong Biotechnology M.B.: Financial support – Pendopharm, Bioventus, Acumed V.C.: Advisory board member – Novartis, Bayer, Roche; Financial support – Novartis, Bayer, Allergan Obtained funding: N/A; Study was performed as part of the authors' regular employment duties. No additional funding was provided.
Publisher Copyright:
© 2021 American Academy of Ophthalmology
PY - 2022/5
Y1 - 2022/5
N2 - Topic: To investigate the effect of anti–vascular endothelial growth factor (VEGF) therapy on intraocular pressure (IOP) 12 and 24 months after initiation. Clinical Relevance: It is unclear whether serial anti-VEGF injections result in sustained IOP increases. Methods: Randomized controlled trials (RCTs) comparing anti-VEGF agents with each other or with controls for the treatment of neovascular age-related macular degeneration, retinal vein occlusions, or diabetic macular edema were included. Pairwise meta-analysis and Bayesian network meta-analysis examined the proportion of patients whose IOP (1) increased 5 mmHg or more from baseline on consecutive visits, (2) increased 10 mmHg or more from baseline at any visit, (3) was 21 mmHg or more on consecutive visits, (4) was 25 mmHg or more at any visit, (5) was 30 mmHg or more at any visit, (6) prompted initiation of IOP-lowering medications, or (7) increased as per the clinicians’ discretion. Grading of Recommendations Assessments, Development, and Evaluations methodology informed the certainty of evidence. Results: Twenty-six RCTs of 12 522 eyes were included. Aflibercept, bevacizumab, ranibizumab (0.3 mg and 0.5 mg), and noninjection controls were analyzed. Eighty-three of 84 network estimates for comparisons between anti-VEGF agents demonstrated no statistically significant difference (low to moderate certainty of evidence). Ranibizumab 0.5 mg showed higher rates than bevacizumab of IOP measurements of 30 mmHg or more at 12 months (low certainty of evidence). Fifty-three of 56 network estimates for comparisons between anti-VEGF agents and controls demonstrated no statistically significant difference (low to moderate certainty of evidence). Ranibizumab 0.5 mg showed higher rates of consecutive IOP increases of 5 mmHg or more at 24 months (low certainty of evidence) and higher rates of IOP increases as per the clinicians’ discretion at 12 and 24 months (low and very low certainty of evidence, respectively). The 95% credible intervals in comparisons without statistically significant effects did not rule out important clinical effects. The certainty of evidence in these comparisons is limited by imprecision. Conclusion: This network meta-analysis does not show any clear difference in IOP increases 12 and 24 months after treatment initiation between anti-VEGF agents and controls. Imprecision precludes definitive conclusions.
AB - Topic: To investigate the effect of anti–vascular endothelial growth factor (VEGF) therapy on intraocular pressure (IOP) 12 and 24 months after initiation. Clinical Relevance: It is unclear whether serial anti-VEGF injections result in sustained IOP increases. Methods: Randomized controlled trials (RCTs) comparing anti-VEGF agents with each other or with controls for the treatment of neovascular age-related macular degeneration, retinal vein occlusions, or diabetic macular edema were included. Pairwise meta-analysis and Bayesian network meta-analysis examined the proportion of patients whose IOP (1) increased 5 mmHg or more from baseline on consecutive visits, (2) increased 10 mmHg or more from baseline at any visit, (3) was 21 mmHg or more on consecutive visits, (4) was 25 mmHg or more at any visit, (5) was 30 mmHg or more at any visit, (6) prompted initiation of IOP-lowering medications, or (7) increased as per the clinicians’ discretion. Grading of Recommendations Assessments, Development, and Evaluations methodology informed the certainty of evidence. Results: Twenty-six RCTs of 12 522 eyes were included. Aflibercept, bevacizumab, ranibizumab (0.3 mg and 0.5 mg), and noninjection controls were analyzed. Eighty-three of 84 network estimates for comparisons between anti-VEGF agents demonstrated no statistically significant difference (low to moderate certainty of evidence). Ranibizumab 0.5 mg showed higher rates than bevacizumab of IOP measurements of 30 mmHg or more at 12 months (low certainty of evidence). Fifty-three of 56 network estimates for comparisons between anti-VEGF agents and controls demonstrated no statistically significant difference (low to moderate certainty of evidence). Ranibizumab 0.5 mg showed higher rates of consecutive IOP increases of 5 mmHg or more at 24 months (low certainty of evidence) and higher rates of IOP increases as per the clinicians’ discretion at 12 and 24 months (low and very low certainty of evidence, respectively). The 95% credible intervals in comparisons without statistically significant effects did not rule out important clinical effects. The certainty of evidence in these comparisons is limited by imprecision. Conclusion: This network meta-analysis does not show any clear difference in IOP increases 12 and 24 months after treatment initiation between anti-VEGF agents and controls. Imprecision precludes definitive conclusions.
KW - Anti-VEGF therapy
KW - Diabetic macular edema
KW - Neovascular age-related macular degeneration
KW - Ocular hypertension
KW - Retinal vein occlusion
UR - http://www.scopus.com/inward/record.url?scp=85122667606&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122667606&partnerID=8YFLogxK
U2 - 10.1016/j.ophtha.2021.11.024
DO - 10.1016/j.ophtha.2021.11.024
M3 - Article
C2 - 34871637
AN - SCOPUS:85122667606
VL - 129
SP - 498
EP - 508
JO - Ophthalmology
JF - Ophthalmology
SN - 0161-6420
IS - 5
ER -