Mortality associated with bevacizumab intravitreal injections in age-related macular degeneration patients after acute myocardial infarct: a retrospective population-based survival analysis

Joel Hanhart, Doron S. Comaneshter, Yossi Freier-Dror, Shlomo Vinker

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)651-663
Number of pages13
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Volume256
Issue number4
DOIs
StatePublished - 1 Apr 2018

Keywords

  • Anti-VEGF
  • Bevacizumab
  • Ischemic heart disease
  • Mortality
  • Myocardial infarct
  • Neovascular AMD
  • Safety

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