• Retina/Vitreous

    Using data from 5 multicenter randomized trials, investigators compared the risk of systemic adverse events (SAE) associated with ranibizumab and bevacizumab for treatment of neovascular AMD.

    Study design

    While previous meta-analyses have assessed risk using aggregate data, this study used individual patient data adjusted for baseline factors such as smoking status and diabetes. The primary outcome measure was development of one or more SAE; secondary outcome measures were death, arteriothrombotic events and events associated or not associated with systemic anti-VEGF therapy.

    Outcomes

    The authors found the relative risk of experiencing at least one SAE while on ranibizumab was not significantly different than that for bevacizumab, providing further evidence that large differences in risk between these two anti-VEGF agents are unlikely.

    Limitations

    The available studies are not large enough or adequately powered to prove safety of rare events. Also, patients with neovascular AMD tend to be older and more prone to SAEs.

    Clinical significance

    Although the current evidence is imperfect, the findings suggests that if a difference exists, it is likely to be small. This is important as ranibizumab is more expensive than bevacizumab, and savings to the healthcare system can be tremendous, especially with patients needing monthly injections for an extended period of time.