The relative clinical effectiveness of ranibizumab and bevacizumab in diabetic macular oedema: an indirect comparison in a systematic review

A comparison of the evidence of effectiveness of ranibizumab and bevacizumab for diabetic macular oedema is important as both these anti-VEGF treatments are being used but are not currently funded in the UK. I am not clear, however, why it was thought justifiable to publish a systematic review on the subject. I appreciate that the subject is of topical interest due to the political issues of using a licensed (ranibizumab) versus an unlicensed (bevacizumab) drug, which is considerably less costly, but there is little evidence to compare. Only 5 studies were found (which ignored the American, licensing, ranibizumab trials, RISE and RIDE) and in these only 80 patients where in a well run bevacizumab trial (Bolt), only half of whom had bevacizumab, compared to over 1000 patients in ranibizumab trials.

I also question the dogma of reciting the methodology of a systematic review without due consideration, ‘databases searched included Medline (1996-September 2011)…’. Bevacizumab was first used in the eye as an intravitreal injection for macular degeneration in 2004, ranibizumab was licensed for use in macular degeneration in 2006 and only started in clinical trials for diabetic macular oedema after that with some 3 year results having just been published.

I would be very keen to use anti-VEGF therapy for diabetic macular oedema but wait to hear final NICE guidance on the issue after funding for ranibizumab was initially not recommended. In my region the North East Treatment Advisory Board has recently advised against bevacizumab funding for DMO due to lack of evidence.