A Cochrane review included 12 studies with a total of 5 496 subjects. One trial compared pegaptanib, 3 trials ranibizumab, and 2 trials bevacizumab versus controls; 6 trials compared bevacizumab with ranibizumab. When compared with control treatments, participants who received any of the three anti-VEGF agents were more likely to have gained 15 letters or more of visual acuity, lost fewer than 15 letters of visual acuity, and had vision 20/200 or better after one year of follow up. Visual acuity outcomes after bevacizumab and ranibizumab were similar when the same regimens were compared in the same RCTs, despite the substantially lower cost for bevacizumab compared with ranibizumab. No trial directly compared pegaptanib with other anti-VEGF agents; however, when compared with controls, ranibizumab or bevacizumab yielded larger improvements in visual acuity outcomes than pegaptanib. Participants treated with anti-VEGFs showed improvements in morphologic outcomes (e.g., size of CNV or central retinal thickness) compared with participants not treated with anti-VEGF agents.
Very few patients treated with pegaptanib gained visual acuity. A greater proportion of patients treated with ranibizumab gained 15 of more letters visual acuity at one year compared with sham or verteporfin PDT (RR was 5.81, 95% CI 3.29 to 10.26 for ranibizumab versus sham, 6.79, 95% CI 3.41 to 13.54 for ranibizumab+sham verteporfin PDT versus verteporfin PDT+sham ranibizumab, and 4.44, 95% CI 1.40 to 14.08 for ranibizumab plus verteporfin PDT versus verteporfin PDT).Endophthalmitis was reported in fewer than 1% of anti-VEGF treated participants and in none in the control groups. Data for visual function, quality of life, and economic outcomes were sparsely measured and reported.
In a multicentre randomised double-masked study