Minimal Differences Between Anti-VEGF Drugs on IOP Over Time

By Lorraine L. Janeczko

June 01, 2017

NEW YORK (Reuters Health) - Patients on anti-VEGF therapy may have a small decrease in intraocular pressure (IOP) over time, but with minimal differences between aflibercept, ranibizumab, and bevacizumab, a new large study suggests.

"The differences in IOP between aflibercept, ranibizumab, and bevacizumab were statistically significant; however, overall they were small, suggesting no clinically relevant difference between these drugs and changes in IOP over time,” the authors said in their abstract.

“In our large real-world study that used American Academy of Ophthalmology IRIS Registry, we found a statistically significant but small decrease in IOP compared to baseline in patients who received intravitreous ranibizumab, aflibercept or bevacizumab injections for longer than one year. However, 1% to 3% of patients receiving each of the three anti-VEGF agents experienced clinically significant sustained IOP elevations,” coauthors Dr. Elizabeth A. Atchison and Dr. Mathew W. MacCumber, both of Rush University in Chicago, said in a joint email.

“Of the three drugs, only bevacizumab was associated with an even higher incidence of IOP elevations in those patients who received 25 or more injections, 9.5%,” they told Reuters Health.

“Clinicians should keep this information in mind when delivering long-term treatment for age-related macular degeneration, diabetic retinopathy or retinal vein occlusion with these drugs," they added.

The researchers examined 23,282 patients in the large IRIS Registry who had neovascular age related macular degeneration (AMD), diabetic macular edema (DME) or branch or central retinal vein occlusion (BRVO/CRVO) with retinal edema and who received at least one injection in the right eye with bevacizumab, aflibercept, or ranibizumab over two years.

They considered three subgroups: all patients, patients with AMD only, and those who were treatment-naive for one year or longer at baseline. They excluded patients who were given two or more kinds of injection.

The authors calculated the change from pre-injection IOP to IOP at final injection at least one year later. They presented their results in a poster May 7 at ARVO 2017, the annual meeting of the Association for Research in Vision and Ophthalmology, in Baltimore, Maryland.

They used generalized linear model repeated measures analysis of longitudinal observational data controlled for possible confounding factors; and in consideration of the possible confounding effects of a glaucoma diagnosis or of cataract surgery during the study, they also evaluated a fourth group that excluded these patients.

All subgroups of patients for all drugs had a small decrease in IOP, between -0.04 mmHg to -045 mmHg. Comparing the three drugs, IOP was higher in bevacizumab treated eyes compared to aflibercept and ranibizumab treated eyes in most cases, though differences were small. These patterns held in the group excluding glaucoma patients and those undergoing cataract surgery during the study period.

Controlling for confounders (age, gender, race, number of anti-VEGF injections, glaucoma history, vitrectomy history, post-injection vitrectomy, post-injection cataract surgery, post-injection pseudophakia and baseline pre-injection IOP), the final IOPs in mmHg, compared to bevacizumab, for aflibercept were: -0.43 (p<0.001) for all patients; -0.40 (p<0.001) for AMD patients; and 0.107 (p<0.01) for treatment-naive patients.

The final IOPs in mmHg, compared to bevacizumab, for ranibizumab were -0.14 for all patients; -0.09 for AMD patients; and 0.12 for treatment-naive patients (p<0.001 for all).

Dr. Mattox has financial relationships with Allergan, Aerie, and Alcon/Transcend; Dr. MacCumber received financial support from Regeneron and Genentech. SOURCE: ARVO 2017.