Summary of findings 2. Summary of findings: bevacizumab versus ranibizumab.
| Bevacizumab versus ranibizumab 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 bevacizumab Comparison: intravitreal injections of ranibizumab | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Ranibizumab | Bevacizumab | |||||
| Gain of 15 or more letters visual acuity at 1 year | 252 per 1000 | 239 per 1000 (204 to 282) | RR 0.95 (0.81 to 1.12) | 3144 (8) | ⊕⊕⊕⊕ High | |
| Loss of fewer than 15 letters visual acuity at 1 year | 944 per 1000 | 944 per 1000 (926 to 963) | RR 1.00 (0.98 to 1.02) | 3144 (8) | ⊕⊕⊕⊕ High | |
| Mean change in visual acuity at 1 year (number of letters) | Mean change across ranibizumab groups ranged from gains of 3 to 8 letters | Mean change in visual acuity in bevacizumab groups was on average 0.58 fewer letters gained (95% CI 1.55 fewer letters to 0.40 more letters) | MD ‐0.6 (‐1.6 to 0.4) | 3190 (9) | ⊕⊕⊕⊕ High | |
| Reduction in central retinal thickness at 1 year | Mean reduction in central retinal thickness across ranibizumab groups ranged from 30 to 182 μm | Mean reduction in central retinal thickness in bevacizumab groups was on average 11.61 μm less (95% CI 21.55 less to 1.66 less) | MD ‐11.6 (‐21.6 to ‐1.7) | 2693 (6) | ⊕⊕⊕⊕ High | Three additional trials reported no differences between groups for this outcome; however, these data were not reported in formats that could be included in meta‐analysis |
| No problems in quality of life domains at 1 year | Range of 591 per 1000 to 861 per 1000 across 5 quality of life domains | Range of 608 per 1000 to 828 per 1000 across 5 quality of life domains | Range of RR 0.96 (0.90 to 1.04) to 1.02 (0.89 to 1.17) | 548 (1) | ⊕⊕⊕⊝ Moderatea | Quality of life domains included mobility, self‐care, usual activities, pain/discomfort, anxiety/depression |
| Serious systemic adverse events at 1 yearb | 156 per 1000 with at least 1 serious systemic adverse event | 179 per 1000 (154 to 209) | RR 1.15 (0.99 to 1.34) | 3365 (6) | ⊕⊕⊕⊝ Moderatea | |
| Serious ocular adverse events at 1 year | < 5 per 1000 | < 5 per 1000 | Range of RR 0.51 (0.05 to 5.62) to 7.05 (0.36 to 136.28) | Range 1670 to 2280 (2 to 3) | ⊕⊕⊕⊝ Moderatea | Studies reported different ocular adverse events. One study reported only that there was no difference between treatment arms |
| *The basis for the assumed risk is estimated by the proportion with the event in the ranibizumab 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). CI: confidence interval; MD: mean difference; 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. | ||||||
aQuality of life and adverse event outcomes downgraded to moderate quality as not all eligible trials reported these outcomes, and numbers of some adverse events were small (< 1%). bA Cochrane review on systemic safety of bevacizumab versus ranibizumab includes more complete data for this finding (Moja 2014). Please refer to Moja 2014 for the most complete information on systemic safety for bevacizumab versus ranibizumab.