Photo Credit: Aria sandi Hasim
The following is a summary of “Comparison of Renal Adverse Events Between Intravitreal Anti-Vascular Endothelial Growth Factor Agents: A Meta-Analysis,” published in the December 2024 issue of Ophthalmology by Huang et al.
Researchers conducted a retrospective study to assess the risk of renal adverse events, specifically acute kidney injury (AKI), linked with intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents.
They searched literature on Ovid Medline, Embase, and the Cochrane Library for randomized controlled trials (RCTs) published from January 2005 to February 2024. The trials involved adult patients receiving anti-VEGF intravitreal injections for age-related macular degeneration, diabetic macular edema, and macular edema secondary to retinal vein occlusion. The primary outcome was comparing the risk of AKI between anti-VEGF agents and sham injections. Secondary outcomes included other renal adverse events. Subgroup analyses were performed based on disease indications. A random-effects model was used for meta-analysis to calculate risk ratios (RR) and 95% CI, with statistical significance set at P < 0.05. The risk of bias was estimated with the Cochrane Risk of Bias 2 (ROB2) tool, and evidence certainty was determined using the GRADE framework.
The results showed that 10,031 eyes from 11 RCTs were included. No significant differences in the risk of acute or chronic renal conditions, obstructive uropathies, neoplasia, or infectious processes were found between anti-VEGF agents and sham therapy, AKI occurred in 5.4% (n=10/185) of patients treated with bevacizumab, 1.3% (n=6/456) with sham, 1.0% (n=48/4,724) with aflibercept, 0.8% (n=15/1,929) with faricimab, 0.5% (n=5/1,098) with brolucizumab, and 0.3% (n=5/1,639) with ranibizumab. No significant differences in AKI risk were observed between any of the anti-VEGF agents and sham (P >0.05 for all). However, patient-reported symptoms were more familiar with 1.25mg bevacizumab compared to 2mg aflibercept (RR=3.26, 95% CI=1.07-9.93, P=0.04), primarily due to hematuria: 4.3% (bevacizumab), 0.7% (sham), 0.2% (aflibercept), 0.1% (faricimab), and 0.1% (ranibizumab).
Investigators concluded that FDA-approved intravitreal anti-VEGF agents did not generally increase AKI risk compared to sham injections, variations in patient-reported renal symptoms, specifically hematuria, were observed among different anti-VEGF drugs, potentially due to varying systemic absorption, emphasizing the need for ongoing monitoring and pharmacovigilance.
Source: ajo.com/article/S0002-9394(24)00590-7/fulltext
