番茄社区

A presentation during the recent American Society of Retina Specialists (ASRS) annual meeting confirmed a recent report linking anti-vascular endothelial growth factor (VEGF) drugs to an increased risk of systemic adverse events (AEs) in diabetic patients with eye disease. Treatment with VEGF inhibitors almost doubled the likelihood of any prespecified systemic event and significantly increased the risk of myocardial infarction, cerebrovascular disease, and kidney disease, reported Roomasa Channa, MD, of the University of Wisconsin in Madison.

In this exclusive 番茄社区 video, Channa explains the study design and clinical significance of the results.

Following is a transcript of her remarks:

The background and the reason for doing this study was basically that we use anti-VEGF injections, which are intravitreal injections into the eyeball for patients with diabetes, and other conditions too. But my research was focused predominantly on patients with diabetes, because they're already at risk of complications such as kidney disease, heart disease, as well as strokes.

And so we focused on that group of patients to try and understand what happens when we are using these injections over a long period of time in these patients. What is their risk of adverse -- well, what is the likelihood of an adverse event happening versus the patients with diabetes who never get these injections?

So the results showed us that patients who received injections were more likely to have any one of the following three systemic adverse event groups: so, acute kidney disease; acute heart disease, which was myocardial infarction; and acute cerebrovascular disease, which was stroke.

And we also, in our analysis, adjusted for some factors that can be confounders such as age, sex, ethnicity, race, severity of diabetic retinopathy, overall comorbidity, disease burden. So people who are just generally sick are more likely to have adverse events. So we adjusted for that factor too. And so after adjusting for all these factors, we still found that the likelihood of these adverse events was higher in patients who got injections versus those who did not.

Then the second part of our analysis, what we did was we said, OK, for patients who are getting injections, who are those patients who are more likely to get adverse events? So we found independent factors that were associated with the higher likelihood was patients who had the highest severity of disease. So for example, proliferative diabetic retinopathy [PDR] versus severe or other forms of diabetic retinopathy. And the other risk factor that was the main factor that we found, other than PDR, was smoking. So smoking was the other thing.

Our main thing is for physicians to take home, that I thought was, try to think of alternatives for patients with diabetes. So unlike patients who have macular degeneration, we don't have alternative medications or alternative treatments. But for diabetic retinopathy, we do have panretinal photocoagulation, we do have focal laser. Thinking about those. Thinking about using steroids would be another thing.

And the third thing is that sometimes patients have achieved disease stability and trying to think about if we pause the injection and follow them, what's going to happen? And I think that's especially important because data such as the Protocol W from DRCR [Diabetic Retinopathy Clinical Research Network] are showing that using these injections, even in patients with severe NPDR [non-proliferative diabetic retinopathy] and without edema, can be helpful.

And so if you're going to increase the injection burden over time, I think we also want to think about what can we do to decrease that injection burden in terms of following some of these patients or alternative treatments.

Comment