Arterial Thromboembolic Events in Patients with Exudative Age-Related Macular Degeneration Treated with Intravitreal Bevacizumab or Ranibizumab

Abstract

Background/Aims: To compare retrospectively the incidence of arterial thromboembolic events (ATEs) in patients treated with bevacizumab or ranibizumab for exudative age-related macular degeneration. Methods: Charts of 378 patients treated with at least 1 intravitreal injection of ranibizumab or bevacizumab were reviewed to calculate the incidence of ATEs. Only patients under monotherapy were analyzed. Results: ATEs occurred in 15 patients: 12 (12/97) with bevacizumab (12.4%) and 3 (3/219) with ranibizumab (1.4%) – odds ratio 10.16; 95% confidence interval 2.80–36.93; p < 0.0001. ATEs in the bevacizumab and ranibizumab cohorts included stroke, myocardial infarction, angina pectoris, peripheral thromboembolic disease, transient ischemic attack, sudden death and lethal stroke. Conclusion: In this series, bevacizumab raised the risk of ATEs when compared to ranibizumab. In an elderly population with multiple cardiovascular risk factors, the new ATEs may not be attributed exclusively to the intravitreal bevacizumab administration. These findings raise an issue that must be confirmed in randomized clinical trials.

Vascular endothelial growth factor plasma levels before and after treatment of neovascular age‐related macular degeneration with bevacizumab or ranibizumab

“…The sustained reduction in VEGF plasma levels in an old population with multiple co-morbidities and high cardiovascular risk such as patients with exudative AMD can increase the risk of thromboembolic events in those receiving anti-VEGF therapies (Alexander et al 2007;Csaky & Do 2009;Carneiro et al 2011).…”

Incidence of Myocardial Infarction, Stroke, and Death in Patients With Age-Related Macular Degeneration Treated With Intravitreal Anti–Vascular Endothelial Growth Factor Therapy

“…Multiple clinical studies have shown conflicting results with regard to the safety profile of bevacizumab. 6,12,14,16,[41][42][43] In the CATT study, more serious adverse events were reported in the bevacizumab group than in the ranibizumab group. 42 Campbell and associates in another study looked into hospitalizations for ischemic stroke secondary to anti-VEGF administration and found no significant difference between bevacizumab and ranibizumab.…”

Cardiac Issues of Noncardiac Drugs: The Rising Story of Avastin in Age-Related Macular Degeneration

“…Finally, a smaller retrospective analysis of 378 patients treated with either Lucentis or Avastin for at least 1 year also revealed a significantly higher incidence of atherothrombotic events in patients treated with Avastin compared to those receiving Lucentis: 12.4% (12/97) versus 1.4% (3/219); p < 0.0001 [13 ](table 1). …”