open access publication

Article, 2024

Cardiovascular Outcomes with Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in Patients with Diabetes: A Real-World Data Analysis

Diabetes Therapy, ISSN 1869-6953, 1869-6961, Volume 15, 4, Pages 833-842, 10.1007/s13300-024-01544-3

Contributors

Lai, Jonathan Y M [1] [2] Riley, David R 0000-0002-0905-6524 [1] [2] Anson, Matthew 0000-0001-9991-7369 [1] [2] Henney, Alex E 0000-0002-8066-9470 [1] [2] Cuthbertson, Daniel James 0000-0002-6128-0822 [1] [2] Hernadez, Gema [3] Austin, Philip J 0000-0002-8855-220X [3] Lip, Gregory Yoke Hong [2] [4] Zhao, Sizheng Steven 0000-0002-3558-7353 [5] Jackson, Timothy L [6] Nabrdalik, Katarzyna 0000-0002-0777-8048 [2] [7] Alam, Uazman 0000-0002-3190-1122 (Corresponding author) [1] [2] [8]

Affiliations

  1. [1] Aintree University Hospital
    2. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  2. [2] University of Liverpool
    3. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  3. [3] TriNetX (United States)
    4. [NORA names: United States; America, North; OECD];
  4. [4] Aalborg University
    5. [NORA names: AAU Aalborg University; University; Denmark; Europe, EU; Nordic; OECD];
  5. [5] University of Manchester
    6. [NORA names: United Kingdom; Europe, Non-EU; OECD];

Abstract

BackgroundAnti-vascular endothelial growth factor (anti-VEGF) therapy is commonly used intravitreally for diabetic proliferative retinopathy, but when used systemically for treating cancers, an excess of cardiovascular disease (CVD) events has been noted. The latter is of concern for people with diabetes, who are at higher risk of CVD. This study aims to explore the relationship between incident CVD and intravitreal anti-VEGF therapy in patients with diabetes, compared to other therapies, using a large real-world global federated dataset.MethodsData were analysed using TriNetX, a global electronic medical real-world ecosystem. The study included adults with diabetes and excluded those with a history of CVD prior to the time window of data extraction. Patients were categorised into two cohorts: anti-VEGF therapy or control cohort (laser or steroid therapies). The cohorts were 1:1 propensity score-matched for age, sex, ethnicity, body mass index, systolic blood pressure, HbA1c, and cardiovascular medications. Outcomes analysed at 1, 6 and 12 months were: (1) mortality; (2) acute myocardial infarction (MI); (3) cerebral infarction; and (4) heart failure. Relative risk analyses were performed using the built-in R statistical computing platform on TriNetX.ResultsIn patients with diabetes (n = 2205; mean age 58.8 ± 15.8, Std diff 0.05; 56% male), anti-VEGF therapy was associated with a numerical but non-statistically significant increased CVD risk over 1, 6, and 12 months: Mortality over 1 month (RR 1; 95% CI 0.42, 2.40), 6 months (RR 1.46; 95% CI 0.72, 2.95) and 12 months (RR 1.41; 95% CI 0.88, 2.27). There was no excess of acute MI over 1 (RR n/a: not applicable; 0/0: 0 events in the anti-VEGF group/0 events in the control group), 6 and 12 months (RR n/a; 0/10 events); cerebral infarction over 1, 6 months (RR n/a; 0/0 events), and 12 months (RR n/a; 0/10); and heart failure over 1 month (RR n/a; 0/0 events), 6 months (RR 1; 95% CI 0.42, 2.40) and 12 months (RR 1; 95% CI 0.42, 2.34).ConclusionsThere was no statistically significant risk of cardiovascular-related events in the short or medium term in patients with diabetes who received intravitreal anti-VEGF therapy, despite a small increase in the number of CVD events. Our study supports the real-world safety of intravitreal anti-VEGF therapy in patients with diabetes free of baseline CVD.

Keywords

BackgroundAnti-vascular endothelial growth factor, CVD risk, Cardiovascular, ConclusionsThere, HbA1c, MethodsData, R statistical computing platform, Real-world data analysis, ResultsIn patients, TriNetX, TriNetX., acute MI, acute myocardial infarction, adults, age, analysis, anti-VEGF, anti-VEGF therapy, anti-vascular endothelial growth factor therapy, baseline cardiovascular disease, blood pressure, body, body mass index, cancer, cardiovascular disease, cardiovascular disease events, cardiovascular medications, cardiovascular outcomes, cardiovascular-related events, cerebral infarction, cohort, computing platform, control, control cohort, data analysis, data extraction, diabetes, diabetic proliferative retinopathy, disease, ecosystem, endothelial growth factor, ethnicity, events, excess, excess of cardiovascular disease, extraction, factor therapy, factors, failure, free of baseline cardiovascular disease, growth factor, growth factor therapy, heart, heart failure, history, history of cardiovascular disease, incidence, incident cardiovascular disease, increase, increased CVD risk, index, infarction, intravitreal, intravitreal anti-VEGF therapy, intravitreal anti-vascular endothelial growth factor therapy, mass index, medication, months, mortality, myocardial infarction, outcomes, patients, people, platform, pressure, proliferative retinopathy, real world, real-world ecosystems, relationship, relative risk analysis, retinopathy, risk, risk analysis, risk of cardiovascular disease, safety, score matching, sex, statistically, statistically significant risk, study, systolic blood pressure, therapy, time, time window, treat cancer

Funders

  • Department of Health and Social Care

Data Provider: Digital Science

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