Top risk factors for ROP reactivation after IVI anti-VEGF injection

All anti-vascular endothelial growth factor (anti-VEGF) agents carry a risk of retinopathy of prematurity (ROP) reactivation, with a higher risk with ranibizumab 0.25 mg than with bevacizumab 0.625 mg, according to findings from a recent study.  Reactivation of ROP needs to be assessed vigilantly, especially in those infants with increased risks, said the researchers who noted future research is needed to determine the optimal anti-VEGF selection and dosage in high-risk infants.

The study, which was designed to assess the rate and risk factors for reactivation of ROP after intravitreal injection (IVI) of anti-VEGF agents, included infants who received IVI therapy between 2017 and 2022. They were divided into 2 groups: those with and without ROP reactivation. Data on ROP variables and patient variables were analyzed using multivariable logistic regression.

A total of 114 infants (223 eyes) were enrolled. The ROP reactivation rate was 11.4% of infants (9.9% of eyes). The mean duration of reactivation was 84 ± 45 days. Among the 223 eyes treated with IVI, reactivation rates were 6% for bevacizumab, 13.9% for aflibercept, and 22.2% for ranibizumab. A multivariable regression model showed that ranibizumab was an independent risk factor (OR: 11.4, P = 0.008) for reactivation. Additional risk factors were infants with periventricular leukomalacia (OR: 13.8, P = 0.003), patent ductus arteriosus ligation (OR: 10.7, P = 0.032), and infants who still required invasive mechanical ventilation on the day of IVI therapy (OR: 7.0, P = 0.018).

Reference
Lee CC, Chiang MC, Chu SM, et al. Clinical risk factors for retinopathy of prematurity reactivation after intravitreal anti-vascular endothelial growth factor injection. J Pediatr. 2024 Jan 11:113913. doi:10.1016/j.jpeds.2024.113913