(043) Renal Adverse Events in Patients with Diabetic Macular Edema Receiving Intravitreal Vascular Endothelial Growth Factors Inhibitors

Publication Number: 380

Background: New evidence of nephrotoxicity after intravitreal anti-VEGFs was reported. Among diabetes patients, they have been known as a vulnerable group to develop adverse renal events. The mainstay of intravitreal VEGF inhibitors for treating DME patients might lead to adverse renal events after repeated intravitreal injections.

Objectives: To assess and compare the risk of renal adverse events among patients with diabetic macular edema (DME) who were treated with either ranibizumab or aflibercept in Taiwan.

Methods: This is a population-based retrospective cohort study. We included patients aged 20 years and older diagnosed with DME newly receiving intravitreal aflibercept or ranibizumab from Taiwan’s National Health Insurance Database (NHID) from 2011 to 2018. To make the comparisons more homogenous, we applied propensity score matching and weighted cohorts to adjust patients’ characteristics, including co-morbidities and co-medications. We primarily compared the incidence rate of composite outcome for the incident acute kidney injury, renal dialysis, or hospitalization due to renal events from the initiations of intravitreal aflibercept or ranibizumab to December 31, 2018. The secondary outcomes were the individual outcome from the primary analyses. Comparative hazards and 95% confidence interval between aflibercept and ranibizumab were calculated.

Results: We identified 6330 and 1258 DME patients newly receiving ranibizumab (mean age: 61.60, SD: 10.37; female:45.38%) and aflibercept (mean age:64.54, SD: 11.14; female: 43.74%) in this study, respectively. The crude incidence of renal events was 102.22 and 138.67 per 1000 person-years for ranibizumab and aflibercept respectively. With adjustment of propensity score, compared to ranibizumab users, aflibercept was associated with higher risk of composite renal events (adjusted hazard ratio [HR], 1.42; 95% CI, 1.24-1.63), and acute kidney injury (adjusted HR, 1.32; 95% CI, 1.08-1.63) and hospitalization due to renal events (adjusted HR, 1.43; 95% CI, 1.25-1.64).

Conclusions: In comparison to ranibizumab, the use of aflibercept was associated with a greater risk of adverse renal events. These findings provide a solid foundation for future studies to validate these results further.