Anti-VEGF Therapy and Associated Risk of Serious Cardiovascular Events
Dalvin LA, Starr MR, AbouChehade JE, et al. Association of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy with Risk of Stroke, Myocardial Infarction, and Death in Patients with Exudative Age-Related Macular Degeneration. JAMA Ophthalmol. 2019;137(5):483-490.
Ever since intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents became the mainstay of treatment for neovascular age-related macular degeneration (nv-AMD), there has been concern about the possible increased risk of thromboembolic events and death due to treatment. Although numerous studies have examined the issue, contradictory conclusions, low event rates, and confounding factors have prevented definitive conclusions from being made about safety. This study was the first to perform a population-based retrospective cohort study with multiple control groups to answer the question.
Data from 2004-2013 was gathered from the Rochester Epidemiology Project (REP) medical records linkage system, which encompasses nearly all residents of Olmsted County, Minnesota. The injection group included all patients with at least 3 anti-VEGF injections for nv-AMD within the year prior to an event or in the final year of follow-up. Three age- and gender-matched control groups, consisting of 1) patients with exudative AMD who did not receive anti-VEGF treatment, 2) patients with dry AMD, and 3) patients with no AMD diagnosis were also included in the analysis. Most patients were treated predominantly with bevacizumab (74.8%) versus pegaptanib (2.0%), ranibizumab (14.3%), or aflibercept (8.9%).
No difference was found in the 5-year risk of stroke, myocardial infarction (MI), or all-cause mortality in the injection cohort compared with any of the control groups. In the injection cohort, patients had a 7.2% cumulative 5-year risk of stroke, 6.1% risk of MI, and 30.0% risk of death. Overall, the authors concluded that there is no evidence of increased event risk in patients receiving anti-VEGF injections compared to the control cohorts and therefore, anti-VEGF injections are considered safe for patients with exudative AMD.