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Retina

Study finds similar risk of kidney failure across intravitreal anti-VEGF medications

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A comprehensive retrospective cohort study across multiple databases found no substantial difference in the risk of kidney failure among patients receiving intravitreal anti-VEGF medications, namely ranibizumab, aflibercept, or bevacizumab. Despite variations in incidence rates, the study’s meta-analysis did not show significant disparities in the risk of kidney failure between these medications.

The study included adult patients who had received at least 3 monthly intravitreal anti-VEGF medications for blinding diseases such as diabetic retinopathy, diabetic macular edema, exudative age-related macular degeneration, or retinal vein occlusion.

Cox proportional hazards models were employed to estimate the risk of kidney failure while on treatment, and a random-effects meta-analysis was performed to combine hazard ratio (HR) estimates from each database into a single network-wide estimate.

The study included a total of 6.1 million patients with blinding diseases, of which 37,189 received ranibizumab, 39,447 received aflibercept, and 163,611 received bevacizumab. The total treatment exposure time amounted to 161,724 person-years. Results showed that the average standardized incidence proportion of kidney failure was 678 per 100,000 persons, with an incidence rate of 743 per 100,000 person-years.

Upon comparison, the meta-analysis HR of kidney failure showed no substantial difference between patients treated with aflibercept compared to ranibizumab (HR 1.01, 95% CI 0.70 to 1.47), ranibizumab compared to bevacizumab (HR 0.95, 95% CI 0.68 to 1.32), and aflibercept compared to bevacizumab (HR 0.95, 95% CI 0.65 to 1.39).

The study found no significant variance in the relative risk of kidney failure among patients receiving ranibizumab, aflibercept, or bevacizumab. The findings suggest that ophthalmologists and nephrologists should be aware of the risk of kidney failure in patients receiving intravitreal anti-VEGF medications, and there is little empirical evidence to preferentially choose among the specific agents.

Reference
Cai CX, Nishimura A, Bowring MG, et al. Similar risk of kidney failure among patients with blinding diseases who receive ranibizumab, aflibercept, and bevacizumab: an OHDSI Network Study. Ophthalmol Retina. 2024;S2468-6530(24)00118-0. doi: 10.1016/j.oret.2024.03.014. Epub ahead of print. PMID: 38519026.

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