(Q) Effect Modification by Indications to The Risks of Major Thromboembolic Adverse Events in Patients Receiving Intravitreal Anti-Vascular Endothelial Growth Factor Treatment – a Population-Based Retrospective Cohort Study

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 307

Presenting Author(s)

Wan-Ju Annabelle Annabelle Lee, MD. PhD.
– Dr., Department of Ophthalmology, Chi Mei Medical Center, Tainan, Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Tainan, Taiwan (Republic of China)

Co-Author(s)

Shih-Chieh Shao, PhD candidate
– Pharmacist, Keelung Chang Gung Memorial Hospital, Tainan, Tainan, Taiwan (Republic of China)
Tzu-Chi Liao
– School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)
Swu-Jane Lin
– Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA., United States
Chi-Chun Lai
– Superintendent, Keelung Chang Gung Memorial Hospital, Taiwan (Republic of China)
Edward Lai, PhD
– Associate Professor, National Cheng Kung University, National Cheng Kung University, Tainan City, Tainan, Taiwan (Republic of China)

Background: The association between intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment and the risk of major thromboembolic adverse events (TAEs) remains under debate.

Objectives: To examine associated risks of TAEs in patients receiving intravitreal anti-VEGF treatment, and effect modification by different indications.

Methods: This retrospective cohort study analyzed Taiwan’s National Health Insurance Database during 2011-2017 to identify neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME) patients newly receiving intravitreal aflibercept or ranibizumab. We followed up patients for two years, or until the occurrence of TAEs, including ischemic heart disease, ischemic stroke, transient ischemic attack, deep vein thrombosis, and pulmonary embolism, death, or the end of the study period (i.e., 2018/12/31). We compared the risk of TAEs between patients with aflibercept and ranibizumab using Cox-proportional hazard models. We examined statistical interaction between the anti-VEGF treatment (i.e., ranibizumab and aflibercept) and indications (i.e., nAMD and DME) with regard to the outcome of TAEs.

Results: We included 12215 nAMD and 7532 DME patients. Among nAMD patients, those receiving aflibercept had lower risk of TAEs (adjusted hazard ratio, HR: 0.85; 95% CI: 0.77-0.94) compared to those receiving ranibizumab. However, among DME patients, those receiving aflibercept had no differences in the risk of TAEs (1.14; 0.97-1.35), compared to those receiving ranibizumab. Among patients treated with ranibizumab, the DME group had higher risk of TAEs than the nAMD group (HR: 1.15; 95% CI, 1.03-1.28); similar results were observed in patients treated with aflibercept (HR: 1.53; 95% CI: 1.27-1.85). When DME patients were treated with aflibercept, the risk of TAEs was 31% higher than when nAMD patients were treated with ranibizumab (HR: 1.31; 95% CI: 1.09-1.56, p < 0.05). The p-value for statistical interaction between the anti-VEGF treatment and indications was 0.0033.

Conclusions: Patients treated with aflibercept or ranibizumab for different indications may be associated with varying risk of TAEs. The findings provide evidence to support treatment selection, taking indications and TAEs risk into consideration.