Serum VEGF Levels and Anti-VEGF Drugs: Results From IVAN
By Jean Shaw
Selected By: Andrew P. Schachat, MD
Ophthalmology Retina, February 2018
Rogers et al. set out to evaluate the potential impact of serum vascular endothelial growth factor (sVEGF) in patients who have neovascular age-related macular degeneration (AMD) and received intravitreal injections of anti-VEGF drugs. In addition, they sought to determine whether there were any associations between sVEGF levels and systemic serious adverse events (SSAEs), notably those of an arteriothrombotic or immunologically mediated nature.
The researchers found that patients who received bevacizumab experienced a greater decrease in sVEGF than did those who received ranibizumab but that this difference was eliminated when treatment ceased for ≥ 3 months. In addition, they found that higher sVEGF levels increased the likelihood that a patient would experience an arte-riothrombotic SSAE, while bevacizumab was more likely to raise the risk of an immunologically mediated SSAE.
For this study, the researchers performed an exploratory analysis of data from the IVAN trial, which was conducted in the United Kingdom.
IVAN (Inhibit VEGF in Age-related choroidal Neovascularization) enrolled 610 patients with wet AMD, who were randomized to receive either bevacizumab or ranibizumab. At month 3, after receiving 3 treatments, they were further randomized to either continuous (monthly) dosing or discontinuous treatment (given on an as-needed basis, with those who restarted treatment mandated to receive 3 consecutive monthly injections). Follow-up extended to 2 years.
Average sVEGF levels were higher in women than in men and in participants who had a history of deep vein thrombosis or pulmonary embolism—and lower in those with a history of myocardial infarction or stroke (including transient ischemic attacks). They did not differ at baseline by age, smoking status, history of heart failure, or diabetes.
On average, sVEGF decreased from a geometric mean of 169 picograms (pg)/mL at baseline to 64 pg/mL at month 24. The decrease was greater in those who received bevacizumab and was apparent by month 1. However, at months 12 and 24, sVEGF levels were similar for the 2 drugs for patients who were 3 months out from treatment.
With regard to SSAEs, 161 of the patients experienced at least 1 SSAE during the trial. Of these, 53 had an arteriothrombotic event and 23 had an immunologically mediated event, and the risk of the latter was higher in those who received bevacizumab. The authors noted that this finding needs to be evaluated in future studies.
The original article can be found here.