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Retinopathy of Prematurity

Network meta-analysis compares anti-VEGF agents/doses vs laser for ROP

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The findings from a recent network meta-analysis that compared different agents and doses of anti-vascular endothelial growth factors (anti-VEGF) vs laser photocoagulation (LPC) for treatment of retinopathy of prematurity (ROP) suggest that low doses of the drugs retain efficacy and may reduce ocular and systemic undesired events. Further clinical trials comparing different intravitreal doses of anti-VEGF agents are needed, the researchers noted.

LPC and/or intravitreal anti-VEGF injections are the standard treatment for ROP; however, no consensus exists regarding the best anti-VEGF dosage. The study focused on whether a ranking of interventions could be established for different dose levels of intravitreal injection of anti-VEGF agents (aflibercept, bevacizumab, conbercept, and ranibizumab) as primary treatments for ROP vs laser in terms of retreatment rate (primary outcome), and time to retreatment and refractive error (secondary endpoints). Sixty-eight studies (15 randomized control trials; 53 nonrandomized studies) of 12,356 eyes of 6,445 infants were retrieved from databases (January 2005 – June 2023). Studies were evaluated for model fit, risk of bias, and confidence of evidence in Network Meta-Analysis (CINeMA).

Results of the Bayesian network meta-analysis showed that anti-VEGF drugs were not inferior to laser in terms of retreatment rate. For intravitreal bevacizumab (IVB), doses half of the conventional infant dose showed a low risk of retreatment rate. On probability ranking as surface under the cumulative ranking curve (SUCRA) plot, half dose of bevacizumab had a better position than conventional and augmented (1.2-2 times the regular dose) doses. A similar probability trend was observed for half vs conventional doses of aflibercept and ranibizumab. Conventional infant dose of conbercept showed the lowest risk for retreatment.

For secondary endpoints, lower doses of anti-VEGF agents were associated with shorter times to retreatment. The largest changes were noted for the augmented doses of bevacizumab and ranibizumab (0.3 mg) with means of 14.1 weeks and 12.8 weeks, respectively. Finally, network meta-analysis demonstrated better refractive profile for anti-VEGF than laser therapy, especially for the conventional infant doses of bevacizumab and ranibizumab which had a significantly better refractive profile than LPC. In the SUCRA plots, LPC had a markedly different position with a higher probability for myopia.

Reference
Ortiz-Seller A, Martorell P, Barranco H, et al. Comparison of different agents and doses of anti-vascular endothelial growth factors (aflibercept, bevacizumab, conbercept, ranibizumab) versus laser for retinopathy of prematurity: A network meta-analysis. Surv Ophthalmol. March 1, 2024:S0039-6257(24)00008-0. doi:10.1016/j.survophthal.2024.02.005

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