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Retreatment and Reactivation Rates Following Bevacizumab, Ranibizumab, Aflibercept, and Laser for Retinopathy of
Arwa Alghamdi1, Faisal Alasmari1, Tala Aletani1
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Insights
Laser therapy for retinopathy of prematurity (ROP) shows lower retreatment and reactivation rates than anti-VEGF agents like ranibizumab and aflibercept. Bevacizumab, however, demonstrated superior outcomes compared to laser therapy for ROP.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of vision impairment in preterm infants.
- Laser photocoagulation has been the historical standard treatment for ROP.
- Anti-vascular endothelial growth factor (anti-VEGF) agents are increasingly used for ROP management.
Purpose of the Study:
- To systematically review and meta-analyze retreatment and reactivation rates for ROP treatments.
- To compare laser therapy with anti-VEGF agents (bevacizumab, ranibizumab, aflibercept) in ROP.
- To evaluate the comparative efficacy of different anti-VEGF agents in ROP treatment.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched Medline, Scopus, Clinical Trial, and Cochrane Library databases.
- Assessed risk of bias using Critical Appraisal Skills Programme (CASP) criteria; meta-analysis performed using Review Manager (RevMan).
Main Results:
- Laser therapy had significantly lower retreatment rates than anti-VEGF medications (RR = 2.11).
- Laser therapy also showed significantly lower reactivation rates compared to anti-VEGF agents (RR = 2.00).
- Bevacizumab demonstrated lower retreatment and reactivation rates compared to laser therapy, outperforming ranibizumab and aflibercept.
Conclusions:
- Laser therapy generally shows reduced retreatment and reactivation risks compared to ranibizumab and aflibercept for ROP.
- Bevacizumab appears to be more effective than laser therapy, with lower retreatment and reactivation rates.
- Further research may be needed to establish optimal treatment strategies for ROP based on these findings.
Abstract:
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that affects preterm newborns. Although laser therapy has been the standard of care for ROP for decades, the use of anti-VEGF agents for ROP has recently become widespread. This systematic review and meta-analysis measures and compares the retreatment and reactivation rates following laser therapy versus anti-vascular endothelial growth factor (VEGF) agents and laser for ROP. We searched Medline, Scopus, Clinical Trial, and Cochrane Library databases for all randomized controlled trials (RCTs) that have used bevacizumab, ranibizumab, aflibercept, or laser therapy for ROP. We assessed studies for risk of bias by the Critical Appraisal Skills Programme (CASP) criteria. Review Manager (RevMan) (2014) Version 5.3 was utilized to carry out the meta-analysis for our study. Five studies were included in this review. The meta-analysis has revealed that laser treatment is associated with a significantly lower risk of retreatment than anti-VEGF medications (RR = 2.11, 95% CI 1.46-3.05, p < 0.0001, I² = 92%). In the subgroup analysis conducted based on the type of anti-VEGF medication used, studies using Aflibercept and Ranibizumab reported higher retreatment rates than studies with Bevacizumab. Similarly, there was a significant difference in terms of the reactivation rates, with patients who underwent laser therapy exhibiting lower reactivation rates than the anti-VEGF groups (RR = 2.00, 95% CI: 1.47 to 2.72, p < 0.0001, I² = 93%). The subgroup analysis comparing types of anti-VEGF agents has also displayed both ranibizumab and aflibercept to have higher reactivation rates than bevacizumab. This meta-analysis demonstrates that laser therapy generally presents a notably reduced risk of retreatment and reactivation compared to ranibizumab and aflibercept, in line with prior research. Conversely, the study reveals that bevacizumab outperforms laser therapy, exhibiting lower rates of retreatment and reactivation.
