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Intravitreal anti-VEGF therapy in DME does not increase risk of systemic serious adverse events

20 Jul 2019

Use of intravitreal antivascular endothelial growth factor (anti-VEGF) therapy in patients with diabetic macular oedema (DME) in routine clinical practice does not escalate the hazard of cerebrovascular disease, myocardial infarction or major bleeding within 6 months after treatment, reports a study.

Of the 23,348 patients who were treated for DME, 13,365 received macular laser, 9,219 received intravitreal anti-VEGF and 764 received intravitreal corticosteroid as initial treatment.

Anti-VEGF pharmacotherapy did not correlate with a higher risk of cerebrovascular disease (hazard ratio [HR], 0.96, 95 percent CI, 0.65–1.41; p=0.83), major bleeding (HR, 1.23, 0.76–1.99; p=0.41) or myocardial infarction (HR, 1.03, 0.73–1.44; p=0.88) when compared with macular laser for DME. However, an increased risk of post-treatment all-cause hospital admission (HR, 1.17, 1.05–1.30; p=0.01) was seen.

Furthermore, there were comparable rates of all primary systemic serious adverse events after treatment with anti-VEGF vs corticosteroid (p>0.05 for all).

“A potential difference in all-cause hospitalization may merit further investigation,” the authors said.

This retrospective cohort study used a large US insurance database to identify patients aged 18 years treated with anti-VEGF for DME between 1 January 2006 and 31 December 2015, as well as control patients receiving macular laser or corticosteroid. Patients with 1 year of medical coverage before initial DME treatment were included.

The authors used Cox proportional hazards regression to examine the associations between treatment modalities and predefined systemic outcomes and performed two separate comparison, one between anti-VEGF and macular laser and one between anti-VEGF and corticosteroid.

Inverse propensity score weighting was used for the first comparison to account for treatment selection bias, and 2:1 propensity score matching on demographic, year and baseline comorbidities for the second due to the smaller number of corticosteroid-treated patients.

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