Investigating Risk of Stroke with Anti-VEGF in the Management of Neovascular AMD

Abstract

Purpose : This study aims to expand existing knowledge on the risk of hemorrhagic stroke with anti-vascular endothelial growth factor (anti-VEGF) treatment of neovascular age-related macular degeneration (nAMD) outside of clinical trials. By analyzing outcomes of patients with nAMD over a 5-year period from a single institution, we assess the real-world risk of stroke in nAMD patients undergoing anti-VEGF therapy.

Methods : This single-center retrospective study comparing nAMD to those with nonexudative AMD and the presence of geographic atrophy (GA) patients identified 2923 patient charts with an ICD-10 diagnosis of either condition prior to January 2019. After exclusions, there were 808 patients diagnosed with nAMD receiving anti-VEGF injections with a control group of 316 patients diagnosed with nonexudative AMD and GA. Patients with prior history of stroke or myocardial infarction were excluded. Baseline characteristics between the two groups were 1:1 propensity score matched using a greedy matching with replacement algorithm across age, sex, BMI, race/ethnicity, and past medical history including diabetes, myocardial infarction, and tobacco use.

Results : After matching, there were 808 patients in each group and baseline characteristics were not significantly different between the two groups. The nAMD with injection group post-match had average age of 78.8 years old, 64% female, 94% white, 49% former tobacco users, 46% never tobacco user, and 20% with diabetes Average follow-up time was 29.47 months. Risk for hemorrhagic stroke in nAMD patients receiving anti-VEGF was not significantly different from the control group with an adjusted risk ratio of 0.76 (95% CI, 0.48–1.21).

Conclusions : The results from this study may potentially support the safety profile of anti-VEGF injections in the management of nAMD based on the real-world findings that anti-VEGF injections do not show significant difference in risk of hemorrhagic stroke in patients with nAMD.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.