Visual Abstract
While intravenous anti-VEGF agents are known to contribute to arterial thromboembolic events, the cardiovascular (CV) safety of intravitreal anti-VEGF inhibitors remain unclear. Using Medicare and 2 U.S. commercial claims datasets (1/2009-12/2017), we identified 1:1 propensity score matched patients aged ≥18 years with DR initiating treatment with (1) intravitreal anti-VEGF injections or (2) laser procedure or intravitreal steroid injections (30,681 matched pairs). We assessed a composite CV outcome [myocardial infarction (MI) or stroke], its individual components, and mortality, using an intention-to-treat (ITT) scheme censoring at 180 days and 365 days of follow-up. We estimated pooled HRs and 95% CIs adjusting for 85 baseline covariates. Compared to laser or steroid treatment, intravitreal anti-VEGF injections were associated with a similar risk of the composite CV outcome [HR:0.91 (95% CI:078, 1.06)], MI [0.91 (0.74, 1.11)], stroke [0.92 (0.74, 1.15)], or risk of mortality [1.14 (0.87, 1.51)] at 6 months of follow up. Results were consistent in an ITT analysis censoring at 365 days (Table). Intravitreal anti-VEGF injections, compared to laser or steroid treatment, had similar risk of CV events and mortality in patients with DR.
M. Roh: None. H. Tesfaye: None. L. P. Aiello: Consultant; Self; KalVista Pharmaceuticals, Novo Nordisk, Regeneron Pharmaceuticals Inc., Stock/Shareholder; Self; KalVista Pharmaceuticals. S. C. Kim: Research Support; Self; AbbVie Inc., Bristol-Myers Squibb Company, Pfizer Inc., Roche Pharma. E. Patorno: Research Support; Self; Boehringer Ingelheim International GmbH, National Institutes of Health.
