Bevacizumab does not elevate risk of neurodevelopmental impairment in cases of ROP

This is the first meta-analysis evaluating the neurodevelopmental outcomes of bevacizumab therapy for retinopathy of prematurity (ROP).

Study design

Researchers included 8 studies that had an intravitreal bevacizumab treatment group, a control group without bevacizumab, and at least 1 neurodevelopmental outcome. Six studies included infants receiving laser as the control treatment, and 2 studies included ROP cases that did not require treatment as the control. The primary outcome was severe neurodevelopmental impairment. Secondary outcomes included Bayley III scores for cognition, language, and motor skills, and the odds ratio for cerebral palsy.

Outcomes

Treatment with bevacizumab did not increase the risk of severe neurodevelopmental impairment, specifically cognitive and language measures. Babies receiving bevacizumab treatment did exhibit a small but significant decrease in motor scores of Bayley III compared with controls; however, the clinical significance of this observation is unknown.

Limitations

This study was a meta-analysis of 8 studies that had various experimental designs and control groups, different inclusion criteria based on age and weight, and varying outcomes. In most of the studies, the choice of intervention was at the physician's discretion; only 1 study was a randomized trial. As a result, some studies may have weighted the bevacizumab treatment arm to have younger and smaller infants who may have had more severe conditions compared with controls.

Clinical significance

Analysis of data from multiple studies suggest that bevacizumab has minimal effect on the neurodevelopment of infants being treated for ROP. However, the authors note the need for randomized controlled trials to evaluate long-term developmental outcomes and establish high-quality evidence.