Comparative Efficacy of Anti-Vascular Endothelial Growth Factor (ANTI-VEGF) Agents for Treatment of Neovascular Age-Related Macular Degeneration (NAMD): A Systematic Review and Network Meta-Analysis
Author(s)
Danyliv A1, Skelly A1, Dennis N2, Willms K3, Quenéchdu A2
1Novartis Pharma AG, Basel, Switzerland, 2Amaris, Paris, France, 3Amaris Consulting Inc., Toronto, ON, Canada
Presentation Documents
OBJECTIVES: We conducted a systematic literature review (SLR) and network meta-analysis (NMA) comparing efficacy, safety and injection frequency of brolucizumab relative to other approved and marketed anti-VEGFs in nAMD patients. METHODS: SLR identifying randomized-controlled trials (RCTs) published before May-2020 was followed by Bayesian NMA to compare brolucizumab (6mg) against sham and all reported licensed regimens of aflibercept and ranibizumab. Heterogeneity was assessed using Cochran’s Q test and I2 statistic. Mean injection frequency, serious adverse ocular events (SAOEs), and discontinuation rates were estimated by treatment regimen. RESULTS: 15 RCTs were included in NMA base-case analysis. Brolucizumab (6mg q12w/q8w) with loading-phase (LP) demonstrated superior best-corrected visual acuity (BCVA) gains than sham both at year 1 (Y1) (mean difference (MD): 16.9 letters [95%CrI: 13.38, 20.42]) and year 2 (Y2) (MD: 21.23 letters [95%CrI: 17.43, 24.97]) and was comparable to other anti-VEGFs. Brolucizumab (6mg q12w/q8w LP) showed superior retinal thickness reduction than most of comparators including ranibizumab (0.5mg PRN; Y1 MD: -75.54 µm [95%CrI: -111.36, -39.46]; Y2 MD: -69.05 µm [95%CrI: -111.21, -26.65]) and aflibercept (2mg q4w; Y1 MD: -40.26 µm [95%CrI: -60.82, -19.71]; Y2 MD: -39.62 µm [95%CrI: -61.14, -18.51]). Brolucizumab (6mg q12w/q8w LP) was comparable to other anti-VEGFs for treatment discontinuation and SAOEs (both years). Mean intraocular inflammation rates at Y2 were 0.01, 0.00, 0.00 for brolucizumab, aflibercept and ranibizumab, respectively. Y2 annualized injection frequency was lowest for brolucizumab (6mg q12w/q8w LP) and highest for ranibizumab (0.5mg q4w) at 5.7 and 11.5 injections, respectively. CONCLUSIONS: Brolucizumab has comparable BCVA gains, safety and discontinuation to other licensed anti-VEGF treatments and is superior in terms of retinal thickness reduction to most treatments. It also required fewer injections to achieve these results during two years of treatment.
Conference/Value in Health Info
2021-11, ISPOR Europe 2021, Copenhagen, Denmark
Value in Health, Volume 24, Issue 12, S2 (December 2021)
Code
POSA3
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Geriatrics