First Author: J.Hanhart ISRAEL
Co Author(s): D. Comaneshter S. Vinker
Back to previous
To analyze the mortality associated with intravitreal injections of bevacizumab for age-related macular degeneration (AMD) in patients previously diagnosed with acute myocardial infarct (MI).
We conducted a retrospective observational study, on the whole population affiliated to Clalit Health Services, the largest health maintenance organization (HMO) in Israel. This retrospective, population-based analysis used the electronic medical records of all patients having received intravitreal injections of bevacizumab between September 2008 and October 2014.
In a national database, we identified bevacizumab-treated AMD patients with a diagnosis of MI prior to their first bevacizumab injection, delivered between September 2008 and October 2014 (n=2,100). We then generated sub-groups of patients treated within 3 (n=11), 6 (n=24), 12 (n=52) and 24 months (n=124) after MI. Those patients were compared to age and gender-matched members that had a MI at the same time and had never been exposed to anti-VEGF Survival analysis was performed using adjusted Cox regression.
bevacizumab-treated patients were slightly and insignificantly older than controls (mean age: 83.25 vs 83.19 year, P=.75). Gender distribution was similar. At several intervals between MI and initiation of bevacizumab treatment, we found the following differences of adjusted mortality between the groups: within 3 months after MI, OR = 17.49 (95% C.I 0.63–481.03, P = .09); within 6 months, OR = 3.25, (95% C.I 0.98 – 10.74), P = .054); within 12 months, OR = 3.82, (95% C.I 1.70 – 8.56, P < .001); within 24 months after MI, OR = 2.55, (95% C.I 1.49 – 4.38, P < .001).
We report increased mortality associated with the use of intravitreal bevacizumab in AMD patients after MI, compared to age and gender-matched post-MI patients with no exposure to any anti-VEGF agent. Caution should be taken while offering bevacizumab to AMD patients after MI.