Abstract
Purpose :
Vascular endothelial growth factors (VEGF) may play a neuroprotective role in aging. Intravitreal anti-VEGF injections for neovascular age-related macular degeneration (nAMD) have been shown to have systemic penetration. While AMD is associated with increased dementia risks, the impact of anti-VEGF use on dementia risks is unknown. We analyzed data from the Taiwan National Health Insurance Research Database (NHIRD) for dementia outcomes in nAMD patients who received documented anti-VEGF versus those who did not.
Methods :
Patients in NHIRD with a new diagnosis of nAMD between 2011-2015 were followed until occurrence of all-cause dementia, Alzheimer’s disease (AD), death, or Dec. 31, 2018, whichever came first. Diagnoses were based on ICD-9/10 codes. Patients <50 years and those with preexisting dementia or AD were excluded. Intravitreal aflibercept or ranibizumab use was identified using Anatomical Therapeutic Chemical codes. Off-label use of bevacizumab was not available. 1:1 propensity score matching (PSM) between anti-VEGF and no-anti-VEGF groups was performed on the following: age, income, occupation, urbanization of residence, and Charlson comorbidity index. A cause-specific hazard model accounting for competing risk of death was performed to examine anti-VEGF use on dementia outcomes.
Results :
Of the included 13,350 nAMD patients, 3311 (24.8%) received anti-VEGF. After PSM, 3,275 patients were included in the anti-VEGF and control groups. (Table 1) Overall incidence (per 1000 person-years) of dementia in the anti-VEGF cohort was 13.83 (95% confidence interval (CI): 11.96, 15.70) versus 16.77 (14.67, 18.86) in the non-anti-VEGF group. After accounting for competing risk of death, the subdistribution hazard ratios of dementia and AD were not significantly different between anti-VEGF (0.84 [0.70, 1.01]) and non-anti-VEGF (0.99 [0.58, 1.71]) cohorts. Two-year moving average incidences of dementia and AD were similar between cohorts.(Fig. 1)
Conclusions :
Anti-VEGF medication use was not associated with different risk of dementia or AD in patients with nAMD, using the Taiwan NHIRD.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.