Retreatment and recurrence rates following Bevacizumab, Ranibizumab, Aflibercept and Laser for Retinopathy of Prematurity: A Systematic Review and Meta-analysis

Abstract Introduction Retinopathy of prematurity is a vaso-proliferative retinal disorder that affects preterm newborns. For decades, the use of cryotherapy and laser has been the standard of care for retinopathy of prematurity. Recently, the use of anti-VEGF agents for ROP has been widely used. This systematic review measures retreatment rates following certain anti-VEGF agents and laser for ROP. Methods We searched Medline, Scopus, ClinicalTrial.gov, and Cochrane library databases for all RCTs that used bevacizumab, ranibizumab, aflibercept and laser for ROP. Studies were assessed for risk of bias by the CASP criteria. Review Manager (RevMan) (2014) Version 5.3 was utilized to carry out the meta-analysis for our study. Results Analysis revealed that laser treatment is associated with a lower risk of retreatment than anti- VEGF medications. Similarly, in the subgroup analysis of the anti-VEGF medications used, groups using Aflibercept and Ranibizumab reported higher retreatment rates. In contrast, studies using Bevacizumab reported lower retreatment rates than laser therapy. Furthermore, there was a significant difference in the recurrence rate of patients using anti-VEGF and laser therapy. Patients that underwent laser therapy had lower recurrence rates than the anti-VEGF groups in most trials. In the subgroup analysis, both Ranibizumab and Aflibercept reported higher recurrence rates, which favored laser treatment. However, the two trials that included Bevacizumab reported lower recurrence with Bevacizumab than with laser. Discussion Our results suggest that laser treatment for ROP is associated with a lower risk of retreatment and recurrence than Ranibizumab and Aflibercept, which was consistent with similar systematic reviews. On the other hand, this study found that Bevacizumab was superior to laser therapy with lower retreatment and recurrence rates. Conclusion This study showed that laser was superior to both ranibizumab and aflibercept as it had a lower risk of disease reactivation requiring retreatment. However, when reviewing studies that examined bevacizumab compared to laser. Bevacizumab showed a lower retreatment rate.