Intravitreal Bevacizumab and Cardiovascular Risk in Patients with Age-Related Macular Degeneration: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies

Mikačić, Ivana; Bosnar, Damir

doi:10.1007/s40264-016-0408-y

Cited by 20 publications

(17 citation statements)

References 72 publications

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“…Mikacic and Bosnar have published a meta-analysis study on intravitreal bevacizumab and cardiovascular risk in wet-AMD patients. Again, in this study, no significant evidence emerged that bevacizumab may increase the cardiovascular risks of patients with AMD [76].…”

Section: Bevacizumabmentioning

confidence: 55%

Systemic thromboembolic adverse events in patients treated with intravitreal anti-VEGF drugs for neovascular age-related macular degeneration: an update

Costagliola

Morescalchi

Duse

et al. 2019

Expert Opinion on Drug Safety

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Introduction: Intravitreal anti-VEGF is the most effective therapy for wet AMD, although systemic effects on the endothelium cannot be excluded. Areas covered: The purpose of this review was to evaluate risk of thromboembolic events associated with intravitreal anti-VEGF. Expert opinion: Current data are insufficient to confirm the safety of these compounds, due to the paucity of specific studies. Thus, pharmacovigilance for all anti-VEGF should be improved to verify the true role of anti-VEGF in the occurrence of systemic adverse events.

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Section: Bevacizumabmentioning

confidence: 55%

Systemic thromboembolic adverse events in patients treated with intravitreal anti-VEGF drugs for neovascular age-related macular degeneration: an update

Costagliola

Morescalchi

Duse

et al. 2019

Expert Opinion on Drug Safety

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“…[ 37 ] Some VEGF isoforms play a positive role in cardiovascular function, but nonselective inhibition of VEGF may be involved in the induction of MI. [ 38 ] Most of these studies investigated patients with AMD [ 18 , 21 , 22 , 27 , 39 ] ; the present study is the first to compare differences in vascular complication according to the type of disease treated with anti-VEGF.…”

Section: Discussionmentioning

confidence: 99%

The association between myocardial infarction and intravitreal bevacizumab injection

Kwon

Jee

2018

Medicine

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To evaluate the risk of myocardial infarction (MI) after receiving intravitreal bevacizumab (IVB) injection. We retrospectively reviewed the charts of patients who had received IVB injection in 2016, and grouped them according to whether they received the injection for age-related macular degeneration (AMD), diabetes-related complications, or retinal vein occlusion (RVO). We then investigated the prevalence of MI within 2 months after IVB injection and analyzed the possible association of IVB with MI. During 2016, 724 patients were enrolled and received a total of 1870 IVB injections. Seven patients were diagnosed with MI within 2 months after receiving an IVB injection. Of 274 patients with AMD, 2 were diagnosed with MI; of 311 patients with diabetes-related complications, 3 were diagnosed with MI; and of 139 patients with RVO, 2 were diagnosed with MI (P = 0.785). All MIs occurred between 3 days and 3 weeks after IVB injection (mean = 14.00 ± 6.45 days). The MIs after receiving IVB were associated with previous history of MI or cerebrovascular infarction in multivariate logistic regression analysis (P = 0.005). There was no significant difference in MI prevalence after IVB injection according to the reason for receiving the injection. However, care should be taken when administering IVB injections, especially to patients with risk factors such as history of MI or cerebrovascular infarction.

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“…5,14 The current literature does not confirm a direct relationship between intravitreal anti-VEGF therapy and cardiac ischemic events. 15,16 Usually, these events are detected when there are overt clinical manifestations. However, subclinical myocardial injury may be a concern in the context of systemic VEGF suppression with intravitreal anti-VEGF therapy.…”

Section: Introductionmentioning

confidence: 99%

“…In this study, we tried to detect potential subclinical cardiac myocyte injury from repeated intravitreal injections of bevacizumab or ranibizumab by measuring systemic high-sensitivity cardiac troponin T (hs-cTnT), a highly sensitive and objective marker for myocardial damage. [15][16][17][18][19] We correlated hs-cTnT levels with changes in free-systemic VEGF levels.…”

Section: Introductionmentioning

confidence: 99%

Change in cardiac troponin T level after intravitreal anti-vascular endothelial growth factor treatment: Prospective pilot study

Rebeiz

Mahfoud

Fattah

et al. 2019

European Journal of Ophthalmology

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Background: Evaluate subclinical myocardial injury associated with intravitreal anti-vascular endothelial growth factor therapy by measuring serum high-sensitivity cardiac troponin T. Methods: This is a prospective pilot comparative study conducted at American University of Beirut Medical Center, Beirut, Lebanon. In total, 40 consecutive patients were randomized to receive either intravitreal bevacizumab or ranibizumab. Patients received three consecutive monthly injections of the assigned drug, then continued treatment as needed. Systemic concentrations of high-sensitivity cardiac troponin T and vascular endothelial growth factor were obtained at baseline, week 9, and week 24. Primary endpoint measure was change in high-sensitivity cardiac troponin T levels compared to baseline. Secondary endpoint measure was change in systemic vascular endothelial growth factor levels. Results: There was no significant difference in high-sensitivity cardiac troponin T levels over time ( p = 0.227) within each treatment group and no significant difference between treatments at any time point ( p = 0.276). There was a significant decrease in plasma vascular endothelial growth factor levels at week 9 ( p = 0.001) and week 24 ( p < 0.001) compared to baseline. In the ranibizumab group, vascular endothelial growth factor levels were not significantly different at weeks 9 and 24 compared to baseline ( p = 0.708 and p = 0.117, respectively). There was a significant association between the number of bevacizumab injections from weeks 8 to 24 and the decrease in vascular endothelial growth factor levels at week 24 ( R = −0.67, p = 0.032). This correlation was not observed in the ranibizumab group ( R = −0.341, p = 0.141). Conclusion: Repeated intravitreal bevacizumab or ranibizumab did not influence serum high-sensitivity cardiac troponin levels. Intravitreal bevacizumab but not ranibizumab lowered free-systemic vascular endothelial growth factor levels, which was observed in this study to be inversely related to the number of bevacizumab injections.

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Intravitreal Bevacizumab and Cardiovascular Risk in Patients with Age-Related Macular Degeneration: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies

Abstract: Published data on IVTB in AMRD provide only a low level of evidence on its cardiovascular safety and do not support any finite conclusions.

Cited by 20 publications

References 72 publications

Systemic thromboembolic adverse events in patients treated with intravitreal anti-VEGF drugs for neovascular age-related macular degeneration: an update

Systemic thromboembolic adverse events in patients treated with intravitreal anti-VEGF drugs for neovascular age-related macular degeneration: an update

The association between myocardial infarction and intravitreal bevacizumab injection

Change in cardiac troponin T level after intravitreal anti-vascular endothelial growth factor treatment: Prospective pilot study

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