Comparison of the efficacy of anti-VEGFs agents in nvAMD
Reviewed by Sofia Rokerya

This retrospective multicentric study conducted in Israel and Canada, compared the efficacy of bevacizumab, aflibercept 2mg and ranibizumab as first-line treatments for neovascular age-related macular degeneration (nvAMD). Included were treatment-naïve nvAMD eyes receiving ≥12 months of treat-and-extend (T&E) anti-VEGF therapy with the above-mentioned drugs. Eyes with prior intravitreal therapy or significant ocular comorbidities were excluded. Primary outcomes were changes in visual acuity (VA) and central retinal thickness (CRT). Secondary outcomes included treatment burden (total injections and final maintained interval), non-response (persistent/worsening exudation or functional decline despite adequate treatment), non-extension (final interval of 4 weeks) and absence of active exudation. Of a total cohort of total of 322 eyes, 174 received bevacizumab, 110 received aflibercept and 38 received ranibizumab over a mean follow-up of 16.75 ±12.66 months. Mean VA improved from 0.77 ±0.47–0.60 ±0.45 logarithm of the minimum angle of resolution following an average of 10.5 ±6.3 injections. Aflibercept produced greater CRT reduction (-51.94μm; p<0.001), fewer injections (-2.35; p=0.001), longer final intervals (+2.14 weeks; p<0.001) and lower odds of non-response (adjusted odds ratio (OR) 0.016; p<0.001) and non-extension (OR 0.128, p<0.001) versus bevacizumab. It showed the largest mean VA gain, just short of significance on multivariable analysis (p=0.059). Ranibizumab showed greater CRT reduction (-44.53μm; p=0.012) and lower non-extension odds (OR 0.079; p=0.001) than bevacizumab but did not significantly reduce treatment burden or improve VA. In this comparison, aflibercept and ranibizumab outperformed bevacizumab in key anatomic and treatment-efficiency outcomes, with aflibercept showing the most consistent advantages. Future prospective, large-scale studies with longer follow-up and broader geographic representation are warranted to provide a durable assessment of the presented outcomes. Strengths: each participating centre consistently used a single and distinct first line agent. No financial barriers existed in the healthcare systems as they were all publicly funded. Limitations: retrospective design with its inherent bias in data capture and follow-up. Structural bias drawn due to different participating centres in two different countries which may have led to unmeasured geographical socioeconomic and cultural factors causing variable adherence and health seeking attitudes. Ethnic variability may have caused differences in response to therapy. Assessment at specific time points and a mean follow-up period of 1.5 years precluded the evaluation of long-term outcomes such as geographic atrophy. Small ranibizumab cohort restricted the statistical power.

Comparative real-world efficacy of anti-vascular endothelial growth factor agents in neovascular age-related macular degeneration: a multicenter retrospective study.
Berco E, Kozlov Y, Ostrovsky M, et al. 
OPHTHALMOLOGICA
2026;249(1):50–60.