Risk of systemic adverse events similar after bevacizumab, ranibizumab, aflibercept

The risk of acute myocardial infarction (MI), cardiovascular disease (CVD), major bleeding, or all-cause hospitalization is comparable following treatment with intravitreal bevacizumab, ranibizumab, and aflibercept during routine clinical practice, a retrospective cohort study has shown.

The authors identified adults receiving initial antivascular endothelial growth factor (anti-VEGF) injections for neovascular age-related macular degeneration (nAMD), diabetic renal disease (DRD), and retinal venous occlusive disease (RVO) between 1 January 2007 and 30 June 2018 using a large US administrative claims database of commercially insured and Medicare Advantage enrolees.

Predefined systemic outcomes between anti-VEGF agents occurring within 180 days of treatment initiation were compared using propensity score–weighted Cox proportional hazards models. Patients were censored upon treatment with a different anti-VEGF medication or termination of health plan coverage.

Of the patients, 69,007 received bevacizumab, 10,895 ranibizumab, and 7,942 aflibercept. Postinjection 180-day event rates per 100 patients for MI, CVD, major bleeding, and all-cause hospitalization were similar for bevacizumab (0.64, 0.59, 0.34, and 10.41, respectively), ranibizumab (0.62, 0.53, 0.40, and 9.44, respectively), and aflibercept (0.63, 0.60, 0.20, and 9.88, respectively).

There were also no differences in the risk of MI, CVD, major bleeding, or all-cause hospitalization when comparing the risk-adjusted effect of treatment initiation with bevacizumab vs ranibizumab (hazard ratio [HR], 0.96, 95 percent confidence interval [CI], 0.74–1.25; HR, 1.04, 95 percent CI, 0.78–1.38; HR, 0.85, 95 percent CI, 0.61–1.19; HR, 1.03, 95 percent CI, 0.96–1.10; p>0.05 for all), bevacizumab vs aflibercept (HR, 0.95, 95 percent CI, 0.68–1.33; HR, 0.99, 95 percent CI, 0.71–1.38; HR, 1.02, 95 percent CI, 0.60–1.74; HR, 1.01, 95 percent CI, 0.93–1.10; p>0.05 for all), or aflibercept vs ranibizumab (HR, 0.91, 95 percent CI, 0.62–1.35), HR, 1.12, 95 percent CI, 0.74–1.69; HR, 0.96, 95 percent CI, 0.53–1.73; HR, 1.02, 95 percent CI, 0.92–1.13; p>0.05).

“Intravitreal anti-VEGF pharmacotherapy plays a central role in the management of nAMD, DRD, and RVO,” the authors said. “Within clinical trials, rates of systemic serious adverse events after anti-VEGF treatment have been low.”