Oral Presentation: Risk of Glaucoma Diagnosis in Patients Who Received Intravitreal Injections of VEGF Inhibitors: A Cohort Study

• Published in: Drug safety Vol. 45; no. 10; pp. 1121 - 1122
• Main Authors: Spinj, A, Giometto, S, Donnini, S, Posarelli, M, Dotta, F, Tosi, G, Girardi, A, Lucenteforte, E, Gini, R, Etminan, M, Virgili, G
• Format: Journal Article
• Language: English
• Published: Auckland Springer Nature B.V 01.10.2022
• Subjects: Anticoagulants; Bevacizumab; Cohort analysis; Comorbidity; Dexamethasone; Diabetes mellitus; Diagnosis; Drugs; Glaucoma; Injection; Intraocular pressure; Medical diagnosis; Monoclonal antibodies; Occlusion; Patients; Retina; Risk analysis; Statistical analysis; Vascular endothelial growth factor
• ISSN: 0114-5916; 1179-1942

Introduction: Intravitreal drugs such as bevacizumab, ranibizumab, and aflibercept are widely used to treat a wide range of retinal diseases. Several studies suggest that repeated injections of these drugs may lead to a sustained rising of intraocular pressure increasing risk for glaucoma. To date, a comparative safety study of these three drugs with respect to the incidence of glaucoma diagnosis has not been done. Objective: The objective of this study was to evaluate the risk of glaucoma diagnosis compared among new users of bevacizumab, ranibizumab, and aflibercept in Tuscany. Methods: A retrospective cohort study using the Tuscan regional administrative database was conducted. Subjects with a first intravitreal injection (index date) between January 2011-June 2020 were identified and followed to the first occurrence of glaucoma diagnosis. Patients with less than a five-year look-back period, those with less than one year of follow-up, and those with previous use of intravitreal dexamethasone, diagnosis of diabetes or glaucoma were excluded. We also excluded patients for whom we could not track the first injection to bevacizumab, ranibizumab or aflibercept. Glaucoma diagnosis was identified from exemptions, diagnosis in hospital discharge records or drug dispensations. An intention-to-treat analysis was conducted to analyze risk of glaucoma diagnosis between the three drugs. A Cox model was constructed to compute hazard ratios adjusting for age, sex comorbidities, corticosteroid use and binocularity. To control for retinal vein occlusion, a potential confounder for this question, a stratification by use of anticoagulants in the six months prior/after cohort entry was performed. Results: A total of 6593 new users were included in the analysis (Aflibercept = 1749, Bevacizumab = 1115, Ranibizumab = 3729). Women made up 60% of the cohort with a mean age of 73 years (± 12.3 years). Overall, the incidence of a glaucoma diagnosis was 2%, 5.3% and 5.9% in the aflibercept, ranibizumab, and bevacizumab group, respectively. The risk of incident glaucoma diagnosis compared to aflibercept was significantly higher among non-anticoagulant users who had received ranibizumab (HR 2.55; CI 95% 1.77-3.66) and bevacizumab (HR 3.07; CI 95% 2.03-4.66). Among anticoagulant users no statistically significant difference was observed. Conclusion: Our study reported an incidence of glaucoma diagnosis of approximately 5% in patients treated with anti-VEGF drugs. Moreover, we found an increase in the risk of glaucoma with ranibizumab and bevacizumab compared to aflibercept among nonanticoagulant users. A time dependent exposure analysis is ongoing to confirm these results.