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Brian L VanderBeek, J. Clay Bavinger, Yinxi Yu; The Comparative Incidence of Endophthalmitis Following Intravitreal Injection with Bevacizumab, Ranibizumab and Aflibercept. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6189.
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Differences in how anti-vascular endothelial growth factor (anti-VEGF) agents are loaded into syringes has caused concerns since reports of large endophthalmitis outbreaks occurred due to bevacizumab being contaminated during repackaging. The purpose of this study is to determine if a difference exists between anti-VEGF agents in the risk of endophthalmitis after intravitreal injection.
This is a retrospective cohort study using medical claims data from a large, national U.S. insurer. Cohorts were created using intravitreal injections of bevacizumab, ranibizumab and aflibercept from 2005-2016. Any individual having an intravitreal injection of an anti-VEGF injection with at least 6 months of data prior to and 1 month after the injection was eligible. Exclusion criteria consisted of any previous diagnosis of endophthalmitis, multiple injected drugs on the day of injection, or intraocular surgery within 15 days of the injection or between an injection and a diagnosis of endophthalmitis. The main outcome was the odds of a new endophthalmitis diagnosis after intravitreal injection for each of individual anti-VEGF agents. Demographic information and treatment indication were covariates.
700,146 injections of bevacizumab were given to 107,052 patients, 209,634 injections of ranibizumab were given to 24,130 patients, and 178,018 injections of aflibercept were given to 24,130 patients. A total of 374 cases of endophthalmitis (224, 83 and 67 in the bevacizumab, ranibizumab and aflibercept cohorts, respectively) were seen for an endophthalmitis rate of 0.032% (CI:0.029-0.037, 1/3126 injections) for bevacizumab, 0.040% (CI:0.033-0.050, 1/2526) for ranibizumab and 0.038% (CI:0.029-0.047, 1/2657) for aflibercept. After controlling for age, race, gender, injection-related diagnosis, and year of injection, ranibizumab (OR=1.25, 95% CI:0.97-1.61, p=0.09) was not associated with an increased odds of of endophthalmitis, but aflibercept was (OR=1.37, 95% CI:1.02-1.84, p=0.04).
This study suggests the odds of endophthalmitis is lower with bevacizumab compared to aflibercept and possibly ranibizumab. These results argue that there is a safety advantage to sterile loading of syringes with anti-VEGF agents.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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