Abstract
Purpose :
Limited findings regarding the risk of stroke or myocardial infarction (MI) with anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) exist outside of the context of clinical trials. This study utilizes a large national database to assess the risk of stroke, MI, and all-cause mortality (ACM) in American individuals with nAMD receiving anti-VEGF therapy in a real-world setting.
Methods :
This population-based study queried the TriNetX US Collaborative Network, a HIPAA-compliant national database, for individuals diagnosed with nAMD after January 1, 2004 who had at least one CPT code for intravitreal injection (CPT 67028; n=26,280). 1:1 propensity score matching established three control groups matched across age, sex, and past medical factors including diabetes and coronary artery disease. The controls were patients with nAMD diagnosed prior to January 1, 2004 who were not treated with anti-VEGF because this was in the pre-anti-VEGF era, patients with dry AMD diagnosed after January 1, 2004 and no history of injections, and patients with an eye exam after January 1, 2004 but no diagnosis of AMD. Risk ratios for hemorrhagic and ischemic stroke, MI, and ACM were calculated.
Results :
26,280 nAMD patients receiving anti-VEGF injections, 7,315 patients with nAMD without injections, 117,072 patients with dry AMD without injections, and 388,259 patients without AMD were included. Risk ratios show patients receiving anti-VEGF had lower risk of ACM relative to individuals with nAMD not receiving anti-VEGF (RR: 0.62; 95% CI: 0.50-0.75). They had a significantly higher risk of ischemic stroke relative to those with nAMD in the pre-anti-VEGF era (RR: 1.93; 95% CI: 1.13-3.29), and significantly higher risk of ACM relative to those without AMD (RR: 1.21; 95% CI: 1.15-1.28). There were no significant differences in the rates of MI, stroke, or ACM relative to those with dry AMD (Table 1).
Conclusions :
The results demonstrate that anti-VEGF therapy does not increase the risk of adverse cardiovascular outcomes in patients with nAMD over 5 years. While these individuals had mildly higher rates of ACM relative to those without AMD, their similar rate of ACM relative to those with dry AMD suggest that this may be secondary to confounding baseline differences.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.