Bevacizumab and ranibizumab treatments carry a higher risk of increased intraocular pressure (IOP) compared with aflibercept, according to research published in the American Journal of Ophthalmology.
Researchers conducted a retrospective cohort study of 6585 participants (mean age, 73.6 years; 60% women) undergoing anti-vascular endothelial growth factor (VEGF) treatment with aflibercept (n=1749), bevacizumab (n=1112) or ranibizumab (n=3724) who received their first injection between 2011 and 2020. Patient IOP increase was defined by a recorded ICD-9 code 365 or the dispensation of 2 glaucoma medications within 180 days of each other.
A total of 544 cases of increased IOP were noted in the intention-to-treat analysis. Patients treated with bevacizumab (hazard ratio [HR], 2.20; 95% CI, 1.64-2.95) and ranibizumab (HR, 1.88; 95% CI, 1.46-2.42) had a higher risk for IOP increase compared with individuals treated with aflibercept. The as-treated analysis confirms these elevated risks for bevacizumab (HR, 3.76; 95% CI, 2.30-6.17) and ranibizumab (HR, 2.49; 95% CI, 1.62-3.82), the report shows.
“Repeated intravitreal injections of ranibizumab and bevacizumab may promote an inflammatory response due to increased [placental growth factor] levels in the eye: this could lead treated eyes to a higher risk of inflammatory-related increases in IOP than aflibercept,” the researchers suggest.
A lack of data on glaucoma location (right vs left eye) and the indicated use for anti-VEGF treatments are acknowledged limitations to the study.
Spini A, Giometto S, Donnini S, et al. Risk of intraocular pressure increase with intravitreal injections of vascular endothelial growth factor inhibitors: a cohort study. Am J Ophthalmol. Published online November 17, 2022. doi:10.1016/j.ajo.2022.11.015