Mortality after a cerebrovascular event in age-related macular degeneration patients treated with bevacizumab ocular injections.

Abstract

To analyse the mortality associated with intravitreal injections of bevacizumab for age-related macular degeneration (AMD) in patients previously diagnosed with stroke or transient ischaemic attack (TIA). We reviewed bevacizumab-treated AMD patients with a diagnosis of stroke or TIA prior to their first bevacizumab injection (n=948). Those patients, naïve to any anti-vascular endothelial growth factor (anti-VEGF) at the time of stroke/TIA, were then compared to age- and gender-matched patients who had a stroke/TIA at the same time and had never been exposed to anti-VEGF. Survival analysis was performed using adjusted Cox regression. The main outcome measure was survival. Adjusted variables were age, smoking, alcohol abuse, hypertension, diabetes mellitus, obesity, ischaemic heart disease, congestive heart failure and liver cancer. Age and gender distribution of bevacizumab-treated patients and controls were similar (mean age: 83.4 versus 83.7years, p=0.3; 51.7% males versus 52.5% males, p=0.7). The adjusted mortality in patients who received bevacizumab within 3months after stroke/TIA was significantly different than in patients non-exposed to bevacizumab (OR=6.92, 95%, CI 1.88-25.43, p<0.01). Within 6months after stroke/TIA, the difference in adjusted mortality showed a strong trend (OR=2.00, 95%, CI 0.96-4.16, p=0.064). Within 12months, it was insignificant (OR=1.30, 95%, CI 0.75-2.26, p=0.348). We found increased mortality within three months after a cerebrovascular event in patients treated with bevacizumab for AMD compared to patients for whom there was no record of a prescription to any anti-VEGF agent.