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  • Frequency of Anti-VEGF Injections and Mortality Rates

    By Jean Shaw
    Selected by Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, May 2022

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    Reibaldi et al. set out to determine whether an intensive regimen of anti-VEGF injections is associated with a higher risk of mortality. They found no significant link between mortality risk and treatment intensity.

    For this meta-analysis, the researchers evaluated the results of 52 randomized trials with 13,099 and 9,691 patients at 12 and 24 months of follow-up, respectively. The primary outcome of interest was the relationship between the average number of injections in different study arms and the all-cause mortality rate. Separate regression analyses were conducted to investigate this relationship in selected subgroups of studies, including patients with different retinal diseases and receiving different anti-VEGF medications.

    The median number of injections was 7.1 (interquartile range, 3.3-10.1) at 12 months and 11.6 (interquartile range, 5.9-20.6) at 24 months.

    At 12 months, 134 of 13,099 patients (1.02%) in 46 studies had died. At 24 months, 326 deaths (3.36%) had oc­curred among 9,691 participants in 18 studies. Results of univariate regression analysis showed that a greater number of injections was not associated with an increase in mortality risk at 12 months (incidence rate ratio [IRR], 1.16%; 95% confidence interval [CI], .87-1.53; p = .31) or at the 24-month mark (IRR, 1.05; 95% CI, .95-1.15; p = .03). However, in a subgroup analysis of patients with diabetic macular edema, a slightly high­er risk of mortality was observed at 24 months in five studies with 74 deaths (IRR, 1.17; 95% CI, 1.02-1.33, p = .03).

    The researchers noted that most of the studies in this analysis excluded patients with a history of stroke and myocardial infarction; thus, the results “should be interpreted cautiously in pa­tients at high cardiovascular risk,” they said.

    The original article can be found here.