Comparison of risks of arterial thromboembolic events and glaucoma with ranibizumab and aflibercept intravitreous injection: A nationwide population-based cohort study

• Published in: PloS one Vol. 17; no. 4; p. e0267088
• Main Authors: Chang, Yin-Hsi, Chien, Li-Nien, Chen, Wan-Ting, Lin, I-Chan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.04.2022; Public Library of Science (PLoS)
• Subjects: Aged; Angiogenesis Inhibitors - therapeutic use; Cardiac arrhythmia; Cardiovascular disease; Cerebral infarction; Cohort analysis; Cohort Studies; Confidence intervals; Coronary artery; Coronary artery disease; Data science; Diabetes; Diabetic retinopathy; Embolism; FDA approval; Glaucoma; Glaucoma - chemically induced; Glaucoma - drug therapy; Glaucoma - epidemiology; Growth factors; Health hazards; Health insurance; Health risks; Heart attacks; Heart diseases; Humans; Hypertension; Injection; Intravitreal Injections; Ischemia; Medical records; Medicine; Medicine and Health Sciences; Monoclonal antibodies; Myocardial infarction; Ophthalmology; Patients; Population studies; Population-based studies; Ranibizumab - adverse effects; Receptors, Vascular Endothelial Growth Factor; Recombinant Fusion Proteins - adverse effects; Regression models; Reimbursement; Research and Analysis Methods; Retrospective Studies; Review boards; Risk; Risk factors; Statistical analysis; Stroke; Subgroups; Thromboembolism; Treatment Outcome; Vascular Endothelial Growth Factor A; Weighting methods; Taiwan; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0267088

To compare intravitreal aflibercept injection with intravitreal ranibizumab injection for the risk of major arterial thromboembolic events (ATEs) and glaucoma. This retrospective, nationwide cohort study investigated 15 611 and 3867 patients aged >50 years with at least one pharmacy claim for intravitreal ranibizumab injection and aflibercept injection between 2011 and 2016, respectively. The inverse probability of treatment weighting method was performed to adjust the baseline difference between the two groups and the hazard risk of adverse events was estimated using the Cox proportional regression model. No significant difference was noted between intravitreal ranibizumab and aflibercept injection for arterial thromboembolic risk, including ischemic stroke and acute myocardial infarction, during a 2-year follow-up (adjusted hazard ratio (HR): 0.87, 95% confidence interval (CI): 0.53-1.42; P = .583). Subgroup analyses revealed that patients age >65 years (adjusted HR: 0.64, 95% CI: 0.45-0.92) and those without coronary artery disease (adjusted HR: 0.59, 95% CI: 0.37-0.95) had significantly lower arterial thromboembolic risk in the aflibercept group than in the ranibizumab group. Additionally, the risk of glaucoma development after intravitreal injection did not significantly differ between the two groups (adjusted HR: 0.63, 95% CI: 0.37-1.06; P = .084). No significant differences in the risk of major ATEs and glaucoma were found between ranibizumab and aflibercept, and aflibercept might be safe for use in elderly patients.