TY - JOUR
T1 - Mortality associated with bevacizumab intravitreal injections in age-related macular degeneration patients after acute myocardial infarct
T2 - a retrospective population-based survival analysis
AU - Hanhart, Joel
AU - Comaneshter, Doron S.
AU - Freier-Dror, Yossi
AU - Vinker, Shlomo
N1 - Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Background: Intraocular injections of antivascular endothelial growth factor (VEGF) agents are currently the main therapy in age-related macular degeneration (AMD). The safety of bevacizumab, an anti-VEGF compound frequently delivered off label, is debated, particularly for high-group risks. We aim to analyze the mortality associated with intravitreal injections of bevacizumab for AMD in patients previously diagnosed with acute myocardial infarct (MI). Methods: In a national database, we identified bevacizumab-treated AMD patients with a diagnosis of MI prior to their first bevacizumab injection, delivered between September 2008 and October 2014 (n = 2100). We then generated sub-groups of patients treated within 3 months (n = 11), 6 months (n = 24), 12 months (n = 52), and 24 months (n = 124) after MI. Those patients were compared to age- and gender-matched members that had a MI at the same time and had never been exposed to anti-VEGF. Survival analysis was performed using propensity score-adjusted Cox regression. Results: Bevacizumab-treated patients were slightly and insignificantly older than controls (mean age 83.25 vs 83.19 year, P =.75). Gender distribution was similar. In a Cox regression adjusted with propensity score, the following differences in mortality were found: within 3 months between MI and initiation of bevacizumab treatment, OR = 6.22 (95% C.I 1.08–35.97, P <.05); within 6 months, OR = 2.37 (95% C.I 0.93–6.02, P =.071); within 12 months, OR = 3.00 (95% C.I 1.44–6.28, P <.01); within 24 months after MI, OR = 2.24 (95% C.I 1.35–3.70, P <.01); and MI any time prior to first bevacizumab injection, OR = 1.71 (95% C.I 1.53–1.92, P <.001). Conclusions: We report increased mortality associated with the use of intravitreal bevacizumab in AMD patients after MI, compared to age- and gender-matched post-MI patients with no exposure to any anti-VEGF agent. Caution should be taken while offering bevacizumab to AMD patients after MI.
AB - Background: Intraocular injections of antivascular endothelial growth factor (VEGF) agents are currently the main therapy in age-related macular degeneration (AMD). The safety of bevacizumab, an anti-VEGF compound frequently delivered off label, is debated, particularly for high-group risks. We aim to analyze the mortality associated with intravitreal injections of bevacizumab for AMD in patients previously diagnosed with acute myocardial infarct (MI). Methods: In a national database, we identified bevacizumab-treated AMD patients with a diagnosis of MI prior to their first bevacizumab injection, delivered between September 2008 and October 2014 (n = 2100). We then generated sub-groups of patients treated within 3 months (n = 11), 6 months (n = 24), 12 months (n = 52), and 24 months (n = 124) after MI. Those patients were compared to age- and gender-matched members that had a MI at the same time and had never been exposed to anti-VEGF. Survival analysis was performed using propensity score-adjusted Cox regression. Results: Bevacizumab-treated patients were slightly and insignificantly older than controls (mean age 83.25 vs 83.19 year, P =.75). Gender distribution was similar. In a Cox regression adjusted with propensity score, the following differences in mortality were found: within 3 months between MI and initiation of bevacizumab treatment, OR = 6.22 (95% C.I 1.08–35.97, P <.05); within 6 months, OR = 2.37 (95% C.I 0.93–6.02, P =.071); within 12 months, OR = 3.00 (95% C.I 1.44–6.28, P <.01); within 24 months after MI, OR = 2.24 (95% C.I 1.35–3.70, P <.01); and MI any time prior to first bevacizumab injection, OR = 1.71 (95% C.I 1.53–1.92, P <.001). Conclusions: We report increased mortality associated with the use of intravitreal bevacizumab in AMD patients after MI, compared to age- and gender-matched post-MI patients with no exposure to any anti-VEGF agent. Caution should be taken while offering bevacizumab to AMD patients after MI.
KW - Anti-VEGF
KW - Bevacizumab
KW - Ischemic heart disease
KW - Mortality
KW - Myocardial infarct
KW - Neovascular AMD
KW - Safety
UR - http://www.scopus.com/inward/record.url?scp=85041916122&partnerID=8YFLogxK
U2 - 10.1007/s00417-018-3917-9
DO - 10.1007/s00417-018-3917-9
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C2 - 29429131
AN - SCOPUS:85041916122
SN - 0721-832X
VL - 256
SP - 651
EP - 663
JO - Graefe's Archive for Clinical and Experimental Ophthalmology
JF - Graefe's Archive for Clinical and Experimental Ophthalmology
IS - 4
ER -
