Abstract
Purpose :
While factors correlating to incomplete response to anti-vascular endothelial growth factor (anti-VEGF) agents in diabetic retinopathy or macular edema (DR or DME) have been reported, correlation between anti-VEGF incomplete response and risk of major adverse cardiovascular events (MACEs) has not been investigated. The purpose of the study is to analyze differences in baseline characteristics and risk of MACEs in responders vs incomplete responders to anti-VEGF treatment for diabetic eye disease.
Methods :
Retrospective cohort study. Inclusion criteria is adult patients treated with anti-VEGF for DR or DME between 1/1/2010 - 7/1/2022. Exclusion criteria included those patients with a MACE prior to anti-VEGF treatment. The following baseline characteristics were assessed: BUN, creatinine, HbA1C, rates of obstructive sleep apnea, requirement of dialysis, and Medicaid vs. other insurance. Incomplete responders to anti-VEGF therapy were defined as patients receiving six or more injections in any eye. Responders were patients receiving less than six injections and with improvement of DR/DME. Rates of patients in each group who had at least one MACE in the first year after initiation of anti-VEGF treatment were assessed. MACE was defined as ischemic stroke, myocardial infarction, unstable angina, or coronary revascularization procedure.
Results :
444 patients satisfied criteria: 313 patients (70%) were identified as incomplete responders and 131 as responders. Mean baseline BUN and creatinine were lower in incomplete responders than in responders (BUN: 25.19 mg/dL vs 31.44 mg/dL; p = 0.0046; t-test of log-transformed data; creatinine: 25.4 mg/dL vs 32.3 mg/dL; p = 0.0035; t-test). No other baseline characteristics were significantly different between groups (p>0.05). No differences were found in the total proportion of patients in each group experiencing MACEs during or after treatment (incomplete responders 14.0%, responders 14.4%; p = 0.68; chi-squared test).
Conclusions :
Other than lower initial BUN and creatinine levels, incomplete responders had no significant difference in HbA1c or rates of sleep apnea, dialysis, or future MACEs.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.