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Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti-Vascular Endothelial Growth

Sidra Zafar1, Annette Walder2, Salim Virani2,3

  • 1Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

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Intravitreal anti-vascular endothelial growth factor (VEGF) injections for diabetic retinopathy (DR) are linked to increased systemic adverse events in patients with diabetes. This finding highlights potential safety concerns in DR treatment.

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Area of Science:

  • Ophthalmology
  • Cardiology
  • Nephrology

Background:

  • Anti-vascular endothelial growth factor (VEGF) agents are standard treatments for diabetic retinopathy (DR).
  • Systemic safety data for anti-VEGF agents, especially in high-risk diabetic patients, require further investigation.

Purpose of the Study:

  • To evaluate the systemic safety profile of intravitreal anti-VEGF agents in patients diagnosed with diabetes.
  • To determine the association between anti-VEGF injections and incident systemic adverse events.

Main Methods:

  • Retrospective, longitudinal population-based analysis using the US Veteran Health Affairs Corporate Data Warehouse.
  • Inclusion of patients aged 18+ with type 2 diabetes from 2011-2012, with systemic adverse event data tracked from 2013-2017.
  • Comparison of systemic adverse event rates between patients who received and did not receive intravitreal anti-VEGF injections.

Main Results:

  • Over 1.7 million patients with type 2 diabetes were analyzed; 0.8% received anti-VEGF injections.
  • Patients receiving anti-VEGF injections had a significantly higher 5-year cumulative incidence of systemic adverse events (37.0%) compared to non-injected patients (18.4%).
  • Anti-VEGF injections were independently associated with an 80% increased likelihood of systemic adverse events (OR, 1.8; 95% CI, 1.7-1.9).

Conclusions:

  • Intravitreal anti-VEGF injections are independently associated with an elevated risk of systemic adverse events in patients with diabetes.
  • The findings suggest a need for careful consideration of systemic safety when prescribing anti-VEGF therapy for diabetic retinopathy.
  • Further research is warranted to elucidate the mechanisms and clinical implications of these systemic risks.