Summary of findings for the main comparison. Summary of findings: anti‐VEGF treatment versus control.
| Anti‐VEGF treatment versus control for neovascular age‐related macular degeneration | ||||||
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Participant or population: people with neovascular age‐related macular degeneration Settings: clinical centers Intervention: intravitreal injections of anti‐VEGF agents (pegaptanib, ranibizumab, or bevacizumab) Control: standard therapy at the time of the trial (sham injections, verteporfin photodynamic therapy with or without triamcinolone acetonide, or intravitreal injections of pegaptanib) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Anti‐VEGF treatment | |||||
| Gain of 15 or more letters visual acuity at 1 year | 43 per 1000 | 179 per 1000 (99 to 322) | RR 4.19 (2.32 to 7.55) | 2667 (6) | ⊕⊕⊕⊝ Moderatea | |
| Loss of fewer than 15 letters visual acuity at 1 year | 599 per 1000 | 838 per 1000 (760 to 928) |
RR 1.40 (1.27 to 1.55) |
2667 (6) | ⊕⊕⊕⊕ High | |
| Mean change in visual acuity at 1 year (number of letters) | Mean change across control groups ranged from a loss of 10 to 16 letters | See comment | See comment | 2508 (4) | ⊕⊕⊕⊝ Moderateb | Owing to substantial statistical heterogeneity between pegaptanib and ranibizumab subgroups, we did not combine data across subgroups Mean change in visual acuity in pegaptanib groups was on average 6.72 more letters gained (95% CI 4.43 letters to 9.01 letters); MD 6.72 (95% CI 4.43 to 9.01) Mean change in visual acuity in ranibizumab groups was on average 17.80 more letters gained (95% CI 15.95 letters to 19.65 letters); MD 17.80 (95% CI 15.95 to 19.65) Mean change from baseline in visual acuity was 7.0 letters in bevacizumab group and ‐9.4 letters in control group in 1 study. The second study reported that participants in bevacizumab group gained 8 letters on average and participants in control group lost 3 letters on average |
| Reduction in central retinal thickness at 1 year | See comment | See comment | See comment | See comment | See comment | We were unable to find data on central retinal thickness in reports from the only trial comparing pegaptanib with control and from any of the 3 included trials comparing ranibizumab with control Mean change was ‐91 μm in bevacizumab group and ‐55 μm in control group in one study, and ‐113 μm in bevacizumab group and ‐72 μm in control group in the other study |
| Mean change in vision‐related quality of life | Mean change across control groups in vision‐related quality of life scores ranged from ‐3 to 2 points | Mean change across control groups in vision‐related quality of life scores ranged from 5 to 7 points | MD 6.69 (3.38 to 9.99) | 1134 (2) | ⊕⊕⊕⊝ Moderatea | Use of the NEI‐VFQ questionnaire with a 10‐point difference considered clinically meaningful |
| Serious systemic adverse events at 1 year | Range of 5 to 83 per 1000 for various systemic adverse events | Range of 0 to 55 per 1000 for various systemic adverse events | Range of RR 0.17 (0.01 to 4.24) to 2.08 (0.23 to 18.45) | 2667 (6) | ⊕⊕⊕⊝ Moderatec | |
| Serious ocular adverse events at 1 year | Range of 0 to 68 per 1000 for various ocular adverse events | Range of 3 to 118 per 1000 for various ocular adverse events | Range of RR 0.52 (0.03 to 8.25) to 2.71 (1.36 to 5.42) | 2667 (6) | ⊕⊕⊕⊝ Moderatec | |
| *The basis for the assumed risk is estimated by the proportion with the event in the control group. The corresponding risk (and its 95% CI) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). Anti‐VEGF: anti‐vascular endothelial growth factor; CI: confidence interval; MD: mean difference; NEI‐VFQ: National Eye Institute‐Visual Functioning Questionnaire; RR: risk ratio. | ||||||
| Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group grades of evidence. High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate. | ||||||
aDowngraded (‐1) owing to imprecision in the confidence interval. bDowngraded (‐1) owing to inconsistency in effect between types of anti‐VEGF agents. cAdverse events downgraded to moderate quality as not all eligible trials reported all types of adverse events, and numbers were small (< 1%) for many specific adverse events.