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Effect of ranibizumab on retinopathy of prematurity: A meta-analysis
Zhibin Wang1, Zhaobo Zhang2, Yue Wang1
1Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang China.
Insights
Intravitreal ranibizumab injection shows higher efficacy than laser therapy for retinopathy of prematurity (ROP) by promoting retinal neovascularization regression. Adverse events were similar between treatments, warranting further long-term safety and efficacy studies.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Current treatments like laser therapy have limitations, necessitating evaluation of alternative therapies.
- Intravitreal ranibizumab, an anti-vascular endothelial growth factor (anti-VEGF) agent, has emerged as a potential treatment for ROP.
Approach:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Searched multiple databases (MEDLINE, Embase, Cochrane Library, etc.) for RCTs comparing ranibizumab with laser therapy for ROP from 2007 to January 2022.
- Assessed study quality using QUADAS-2 and analyzed data on retinal neovascularization regression and adverse events.
Key Points:
- Intravitreal ranibizumab demonstrated a statistically significant higher rate of retinal neovascularization regression compared to laser therapy (RR = 1.26, 95% CI: 1.18-1.35).
- The incidence of adverse events, including recurrence and complications, did not differ significantly between the ranibizumab and laser groups (RR = 0.73, 95% CI: 0.19-2.80).
- Five RCTs were included in the meta-analysis, focusing on therapeutic effectiveness measured by neovascularization regression.
Conclusions:
- Intravitreal ranibizumab injection appears to be more clinically effective than laser therapy for treating retinopathy of prematurity.
- The safety profile regarding adverse events seems comparable between ranibizumab and laser treatment in the short term.
- Further investigation is required to ascertain the long-term safety and efficacy of ranibizumab in ROP management.
Abstract:
The primary objective of this study was to systematically evaluate the clinical efficacy of intravitreal ranibizumab injection in the treatment for retinopathy of prematurity (ROP) in infants. The MEDLINE (PubMed), Embase, China Biology Medicine disc, Cochrane Library, Web of Science, WanFang Data, CNKI, and CQVIP databases were searched to collect randomized controlled trials (RCTs) comparing the efficacy of ranibizumab with laser treatment in ROP. The retrieval time was from 2007, on which ranibizumab was approved until 12 January 2022. Data were extracted based on predetermined inclusion and exclusion criteria. Two investigators employed QUADAS-2 to independently assess the quality of all eligible original studies. Following quality evaluation, we also performed a meta-analysis using STATA v 15.1 and RevMan v 5.4 and funnel plots were used to detect publication bias. A total of five RCTs were included in the meta-analysis. In this study, the regression rate of retinal neovascularization was used as the index of therapeutic effectiveness. According to the results, the retinal neovascularization regression rate of the intravitreal ranibizumab injection group was statistically higher than that of the laser therapy group [risk ratio (RR) = 1.26, 95% confidence interval (CI): 1.18-1.35]; however, the incidence of adverse events, including recurrence and complications, was not different between them (RR = 0.73, 95%CI: 0.19-2.80). Therefore, intravitreal ranibizumab injection may be more clinically effective than laser therapy in the treatment for ROP. The safety and efficacy of ranibizumab in the long-term treatment for ROP needs further investigation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, CRD42022296387.
