Intravitreal anti-VEGF injections increase adverse events in diabetics: JAMA

Among patients with diabetes, intravitreal anti-VEGF injections were independently linked to a greater risk of systemic adverse effects, says an article published in JAMA Ophthalmology.

Currently, the majority of treatment for diabetic retinopathy (DR) is anti-vascular endothelial growth factor (VEGF) medications. Although effective, evidence on their systemic safety are still lacking, especially in patient populations at high risk. In order to investigate the systemic safety of intravitreal anti-VEGF medicines among patients with diabetes, Sidra Zafar and colleagues undertook this study.

This study examined the Corporate Data Warehouse, a sizable patient database housed inside the US Veteran Health Affairs, retrospectively and longitudinally. Between January 1, 2011, and December 31, 2012, all patients with type 2 diabetes who were 18 years of age or older and seen at any Veterans Affairs medical facility in the US were recorded. On incident systemic adverse events that occurred in this patient group between January 1, 2013, and December 31, 2017, data were then retrieved. Both those with diabetes who had anti-VEGF injections and those who did not were included. Patients who got an intravitreal injection between January 1, 2011, and December 31, 2012, as well as those with a history of past systemic adverse effects, were excluded. Data were examined between October 2023 and March of 2019.

At 1-, 3-, and 5-year follow-up, the percentage of patients who experienced any incident systemic adverse event, acute myocardial infarction, cardiovascular disease, or renal disease.

The key findings of this study were:

1. Type 2 diabetes patients numbered 1 731 782 in total. 476 013 (27.5%) of patients had DR, while 14 022 (0.8%) got anti-VEGF injections.

2. Between 2013 and 2017, 321 940 individuals with type 2 diabetes (18.6%) experienced systemic adverse events.

3. In the injection group, the cumulative incidence of any systemic adverse event over the course of five years was 37.0% (5187/14 022) compared to 18.4% (316 753/1 717 760) in the noninjection group (P .001).

4. When taking into account factors such as age, race, sex, ethnicity, smoking, the severity of DR, the Deyo-Charlson Comorbidity Index score, the mean HbA1c, the total number of injections, and statin use, anti-VEGF injections were found to be independently related with a greater risk of experiencing any type of systemic adverse event.

Reference:

Zafar, S., Walder, A., Virani, S., Biggerstaff, K., Orengo-Nania, S., Chang, J., & Channa, R. (2023). Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti–Vascular Endothelial Growth Factor Injections. In JAMA Ophthalmology. American Medical Association (AMA). https://doi.org/10.1001/jamaophthalmol.2023.2098