A large, claims-based study found patients with diabetic retinopathy who received intravitreal anti-VEGF therapy had similar rates of adverse cardiovascular events (MI or stroke) compared to patients who received steroid or laser treatment. However, there may be a greater risk for all-cause mortality after 1 year in patients treated with anti-VEGF.
Study design
This population-based cohort study utilized Medicare claims and two additional commercial insurance claims databases to assess the rate of adverse cardiovascular events (MI or stroke) and all-cause mortality at 6 months and 1 year after initiation of intravitreal anti-VEGF injection, intravitreal steroid injection, or a laser procedure for the treatment of diabetic retinopathy in patients aged 18 years or older. The study covered a period from January 2009 to December 2017. Outcomes were compared between patients who received anti-VEGF injections and those who received steroid or laser treatment
Outcomes
Analysis of 61,508 patients 6 months after treatment initiation revealed similar rates of MI, stroke, and all-cause mortality between patients who received anti-VEGF treatment and those who received steroid or laser treatment. At 1 year, however, all-cause mortality was higher in those who received anti-VEGF injection (hazard ratio: 1.35, 95% confidence interval, 1.14–1.60). Additional subgroup analysis revealed higher risk of cardiovascular events in those with prior history of cardiovascular events.
Limitations
Limitations of the study include the reliance on claims data, which may be subject to error. In addition, patient groups were organized by treatment at initiation for any manifestation of diabetic retinopathy and were not classified by a more specific reason for initial treatment (diabetic macular edema vs proliferative diabetic retinopathy). Patients may have had a combination of treatments during the study period.
Clinical significance
Study results suggest that the risk of cardiovascular events was similar in patients initially treated with intravitreal anti-VEGF injections for manifestations of diabetic retinopathy compared to alternatives, namely steroid and/or laser. However, as the risk of all-cause mortality was higher in patients treated with anti-VEGF after 1 year, additional studies to further refine this risk profile are warranted, particularly in patients with prior history of cardiovascular events.
Financial Disclosures: Dr. M. Ali Khan discloses financial relationships with Allergan, Apellis Pharmaceuticals, Genentech (Consultant/Advisor); Regeneron Pharmaceuticals (Grant Support).