Worsening of renal function and uncontrolled hypertension from intravitreal bevacizumab injections

Ahmed, Moeed; Alouch, Neil; Ahmed, Arslan; Jagadesh, Sunil

doi:10.1080/08998280.2021.1885285

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…This increase possibly suggests that the general condition of the patients receiving bevacizumab was worse than in the other groups, and this assumption could be affirmed by the higher rate of chronic kidney disease in the bevacizumab group compared to the others. In addition to the baseline difference, it has been previously noted that systemic exposure is higher for bevacizumab when compared to ranibizumab and aflibercept, and that systemic use of anti-VEGFs is associated with adverse effects such as exacerbating renal failure and proteinuria [ 29 , 30 ]. While the literature suggests that IVI with bevacizumab does not affect diabetic patients, those with preexisting renal dysfunction may be at risk of worsening albuminuria, and a recent case study reported worsening renal function in a diabetic patient treated with IVI bevacizumab [ 29 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

The Association of Intravitreal Injections of Different Anti-Vascular Endothelial Growth Factor with Systemic Outcomes in Diabetic Patients

Kang

Lin

Wang

et al. 2023

JPM

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This retrospective cohort study aimed to assess the systemic effects of three commonly available anti-vascular endothelial growth factor intravitreal injections in patients with diabetes, using data taken from a multi-institutional database in Taiwan. Patient data were sourced from the multi-institutional Chang Gung Research Database. Participants were divided into groups based on treatment with bevacizumab, ranibizumab, or aflibercept. Baseline characteristics were matched among the groups by the inverse probability of treatment weighting. The incidence rate of outcome events was calculated as the number of events divided by 100 person-years of follow-up. The cumulative incidence function was used to estimate the incidence rate of the outcome events among groups. The incidence of ischemic stroke was higher in the ranibizumab group than the bevacizumab and aflibercept groups (1.65, 0.92, and 0.61 per 100 person-years, respectively). The incidence of major adverse lower-limb events was higher in the bevacizumab group (2.95), followed by ranibizumab (2.00) and aflibercept (0.74). Major bleeding was relatively higher in bevacizumab (12.1) compared to ranibizumab (4.3) and aflibercept (3.8). All-cause death was higher for both bevacizumab (3.26) and aflibercept (2.61) when compared to ranibizumab (0.55), and all-cause admission was found to be highest with bevacizumab (58.6), followed by aflibercept (30.2), and ranibizumab (27.6). The bevacizumab group demonstrated a greater decrease in glycated hemoglobin compared to the baseline level (−0.33%). However, a few differences in the clinical condition between the groups were still observed after matching. In conclusion, this study suggests that different anti-vascular endothelial growth factor agents may be associated with various and differing systemic adverse events. The differences might also be attributed to differences in patient characteristics and clinical status.

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Section: Discussionmentioning

confidence: 99%

The Association of Intravitreal Injections of Different Anti-Vascular Endothelial Growth Factor with Systemic Outcomes in Diabetic Patients

Kang

Lin

Wang

et al. 2023

JPM

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“…In the absence of guidelines to test and monitor for cardiorenal side effects after introducing intravitreal VEGFi, it may be difficult to distinguish whether new or worsened cardiorenal effects are related to progression of diabetic complications, or whether they could have been exacerbated by intravitreal treatments. There are numerous published case reports of de novo renal sequelae after intravitreal VEGFi -particularly bevacizumab and aflibercept -including proteinuria, hypertension, heart failure and progressive renal injury (7,(32)(33)(34)(35). Ranibizumab is similarly absorbed, but cleared far more quickly due to its structure and size.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of the effect of intravitreal VEGF inhibitors on cardiorenal outcomes

Lees

Dobbin

Elyan

et al. 2022

Nephrology Dialysis Transplantation

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Background Vascular endothelial growth factor inhibitors (VEGFi) have transformed the treatment of many retinal diseases, including diabetic maculopathy. Increasing evidence supports systemic absorption of intravitreal VEGFi and development of significant cardiorenal side effects. Methods Systematic review and meta-analysis (PROSPERO: CRD42020189037) of randomised controlled trials of intravitreal VEGFi treatments (bevacizumab, ranibizumab and aflibercept) for any eye disease. Outcomes of interest were cardiorenal side effects (hypertension, proteinuria, kidney function decline and heart failure). Fixed-effects meta-analyses were conducted where possible. Results There were 78 trials (81 comparisons; 13 175 participants) that met criteria for inclusion: 47% were trials in diabetic eye disease. Hypertension (29 trials; 8570 participants) was equally common in VEGFi and control groups (7.3 versus 5.4%; RR 1.08 [0.91; 1.28]). New or worsening heart failure (10 trials; 3384 participants) had similar incidence in VEGFi and control groups (RR 1.03 [0.70; 1.51]). Proteinuria (5 trials; 1902 participants) was detectable in some VEGFi-treated participants (0.2%) but not controls (0.0%; RR 4.43 [0.49; 40.0]). Kidney function decline (9 trials; 3471 participants) was similar in VEGFi and control groups. In participants with diabetic eye disease, risk of all-cause mortality was higher in VEGFi-treated participants (RR 1.62 [1.04; 2.46]). Conclusion In trials of intravitreal VEGFi, we did not identify an increased risk of cardiorenal outcomes, though these outcomes were reported in only a minority of cases. There was an increased risk of death in VEGFi-treated participants with diabetic eye disease. Additional scrutiny of post-licensing observational data may improve recognition of safety concerns in VEGFi-treated patients.

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“…In this case, steroid use may have contributed to the development of the scleroderma renal crisis given the known association between steroid use and renal crisis [ 31 ]. The concomitant use of several chemotherapies and a VEGF inhibitor further confounds the ability attribute causality, especially as VEGF inhibition independently has been tied to proteinuria, worsening renal function, and thrombotic microangiopathy [ 32 ].…”

Section: Systemic Sclerosis/sclerodermamentioning

confidence: 99%

Checkpoint Inhibitor-Associated Scleroderma and Scleroderma Mimics

et al. 2023

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Immune checkpoint inhibitors (ICI) are the standard of care for various malignancies and have been associated with a wide spectrum of complications that are phenotypically akin to primary autoimmune diseases. While the literature on these toxicities is growing, there is a paucity of data regarding ICI-associated scleroderma which can carry significant morbidity and limit the ability to continue effective ICI therapy. Our review aimed to analyze the current literature on ICI-associated systemic scleroderma (ICI-SSc) and key scleroderma mimics. Cases of ICI-SSc had notable differences from primary SSc, such as fewer vascular features and less seropositivity (such as scleroderma-specific antibodies and antinuclear antibodies). We found that patients with a diagnosis of SSc prior to the start of ICI can also experience flares of pre-existing disease after ICI treatment used for their cancer. Regarding scleroderma mimics, several cases of ICI-eosinophilic fasciitis have also been described with variable clinical presentations and courses. We found no cases of scleroderma mimics: ICI-scleromyxedema or ICI-scleroedema. There is a critical need for multi-institutional efforts to collaborate on developing a patient database and conducting robust, prospective research on ICI-scleroderma. This will ultimately facilitate more effective clinical evaluations and management for ICI-scleroderma.

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Worsening of renal function and uncontrolled hypertension from intravitreal bevacizumab injections

Cited by 5 publications

References 8 publications

The Association of Intravitreal Injections of Different Anti-Vascular Endothelial Growth Factor with Systemic Outcomes in Diabetic Patients

The Association of Intravitreal Injections of Different Anti-Vascular Endothelial Growth Factor with Systemic Outcomes in Diabetic Patients

A systematic review and meta-analysis of the effect of intravitreal VEGF inhibitors on cardiorenal outcomes

Checkpoint Inhibitor-Associated Scleroderma and Scleroderma Mimics

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