OBJECTIVES: It is a challenge for clinicians to determine the optimal treatment regimen for neovascular age-related macular degeneration (nAMD) given the variety of anti–vascular endothelial growth factor (anti-VEGF) regimens available. We conducted a network meta-analysis (NMA) to explore differential visual outcomes between treat and extend (T&E) and as-needed (pro re nata [PRN]) regimens and compared their burden in clinical practice.

METHODS: Medline, Embase, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database, Wanfang, China National Knowledge Infrastructure, and VIP databases were searched for published randomized controlled trials (RCTs) in January 2021. We included RCTs of anti-VEGF drugs (intravitreal aflibercept [IVT-AFL], intravitreal ranibizumab [IVR], and intravitreal conbercept [IVC]) using a T&E or PRN regimen for patients with nAMD. We performed a random-effects NMA with a Bayesian framework (registration: PROSPERO CRD42022333024).

RESULTS: We identified 29 RCTs involving 8,402 participants, of which 20 RCTs with 5,372 participants were included in this NMA, which focused on best-corrected visual acuity (BCVA) gains and the number of injections. At a 1-year follow-up, results indicated that there were no clear differences in BCVA improvements between the included anti-VEGF regimens. The mean number of injections for IVT-AFL T&E was less than that for T&E and PRN ranibizumab regimens (IVT-AFL extended by 2-week vs IVR T&E: mean difference [MD], -2.80; 95% credible intervals [CrIs], -3.43 to -1.90; IVT-AFL extended by 4-week vs IVR T&E: MD, -3.10; 95%CrIs, -3.94 to -2.00; IVT-AFL extended by 4-week vs IVR PRN: MD, -1.10; 95%CrIs, -1.93 to -0.08). Although the mean number of injections was less for IVT-AFL T&E extended by 4-week than IVC PRN, statistical significance was not reached (MD, -0.64; 95%CrIs, -1.75 to 0.65).

CONCLUSIONS: Different anti-VEGF regimens may provide similar visual benefits following 1 year of treatment, whereas IVT-AFL T&E (with either 2- or 4-week adjustments) may reduce injection burden for patients with nAMD.