Improvement of treatment outcomes in patients with locally advanced or metastatic urothelial carcinoma represents an important unmet need, since survival remains poor in patients who progressed after first-line treatment. The purpose of this study was to investigate the effects of ramucirumab, a human monoclonal antibody which binds to VEGFR-2, in the treatment of locally advanced or metastatic urothelial carcinoma. A literature search of PubMed and CENTRAL was conducted. Outcomes of interest were overall survival (OS), progression-free survival (PFS) and rate of adverse events. Time-to-event outcomes were combined using the generic inverse-variance method and presented as hazard ratio (HR) with 95% confidence intervals (95%CI), while dichotomous events were combined using the Mantel-Haenszel method and presented as odds ratio (OR) with 95%CI. All analyses were performed in RevMan 5.3. Literature search identified two randomized controlled trials. Addition of ramucirumab to docetaxel resulted in a statistically significant improvement in PFS (HR=0.55, 95%CI 0.31-0.96, p=0.030), while the difference was not significant for OS (HR=0.86, 95%CI 0.71-1.04, p=0.12). Subgroup analysis by sex, age (<65 and ≥65 years), baseline hemoglobin (<10 g/dL and ≥10 g/dL), presence of visceral metastases and presence of liver metastases did not identify a subgroup in which improvement in OS was present. The difference in treatment-related grade≥3 adverse events was not significant (OR=1.47, 95%CI 0.95-2.27, p=0.08). Ramucirumab in addition to docetaxel significantly improved PFS in patients with locally advanced or metastatic urothelial carcinoma. Future studies are necessary to identify a subset of patients who might have a significant improvement in OS.