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Comparative Risk of Arterial Thromboembolic Events Between Aflibercept and Ranibizumab in Patients with Maculopathy: A Population-Based Retrospective Cohort Study

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Abstract

Background

The increasing numbers of elderly patients and rising incidence of maculopathy raise concerns over arterial thromboembolic events (ATEs) with the use of intravitreal anti-vascular endothelial growth factor (VEGF) medications.

Objectives

This study aimed to compare the risk of ATEs between aflibercept and ranibizumab for maculopathy.

Methods

We conducted a retrospective population-based cohort study analyzing Taiwan’s National Health Insurance Database during 2011–2017 to identify patients with maculopathy receiving intravitreal aflibercept or ranibizumab. The primary outcome was any hospitalization or emergency room visit because of ATEs, including ischemic heart disease (IHD), ischemic stroke (IS), and transient ischemic attack (TIA). The secondary outcome was mortality within 30 days after occurrence of ATE. We employed propensity score methods to generate more homogeneous groups for comparison.

Results

We included 5791 aflibercept users and 14,534 ranibizumab users in this study. Compared with the ranibizumab group, the aflibercept group was associated with a lower risk of ATE (hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.80–0.91), with HRs of 0.86 for IHD (95% CI 0.80–0.93), 0.87 for IS (95% CI 0.76–1.00), and 0.57 for TIA (95% CI 0.46–0.71). The risk of 30-day mortality after ATE (HR 1.39; 95% CI 0.80–2.43) and the risk of all-cause mortality (HR 1.02; 95% CI 0.89–1.17) in the aflibercept group was similar to that in the ranibizumab group.

Conclusion

The use of aflibercept in patients with maculopathy was associated with a lower risk of ATE than was the use of ranibizumab. There was no difference in mortality risk between the two groups. Our study could provide strong grounds for future prospective studies to confirm the findings.

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Acknowledgement

The authors thank the Health Data Science Center, National Cheng Kung University Hospital for providing administrative support.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan

    Wan-Ju Annabelle Lee

  2. School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No. 1, University Road, 701, Tainan, Taiwan

    Wan-Ju Annabelle Lee, Shih-Chieh Shao, Tzu-Chi Liao & Edward Chia-Cheng Lai

  3. Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan

    Wan-Ju Annabelle Lee

  4. Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan

    Shih-Chieh Shao

  5. Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA

    Swu-Jane Lin

  6. Chang Gung University College of Medicine, Taoyüan, Taiwan

    Chi-Chun Lai

  7. Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan

    Chi-Chun Lai

Authors
  1. Wan-Ju Annabelle Lee
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  2. Shih-Chieh Shao
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  3. Tzu-Chi Liao
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  6. Edward Chia-Cheng Lai
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Corresponding author

Correspondence to Edward Chia-Cheng Lai.

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Funding

This study was supported by Taiwan Ministry of Science and Technology (107-2320-B-006-070-MY3). The funding source had no role in the design, analysis, interpretation, or reporting of results, or in the decision to submit the manuscript for publication.

Conflict of interest

Wan-Ju Annabelle Lee, Shih-Chieh Shao, Tzu-Chi Liao, Swu-Jane Lin, Chi-Chun Lai, and Edward Chia-Cheng Lai have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

This study was approved by the Institutional Review Board of National Cheng Kung University Hospital (A-ER-106-501).

Consent

Not applicable.

Availability of Data and Material

Data sharing is not applicable because data analysis and management were only permitted within Taiwan’s Health and Welfare Data Science Center because of data safety and privacy concerns.

Code availability

Not applicable.

Author Contributions

WJAL and ECCL substantially contributed to the study conception and design. TCL substantially contributed to the data acquisition and analysis. All authors substantially contributed to the data interpretation and manuscript writing and gave final approval of the manuscript submission. ECCL is the guarantor for the whole of the study.

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Lee, WJ.A., Shao, SC., Liao, TC. et al. Comparative Risk of Arterial Thromboembolic Events Between Aflibercept and Ranibizumab in Patients with Maculopathy: A Population-Based Retrospective Cohort Study. BioDrugs 35, 579–588 (2021). https://doi.org/10.1007/s40259-021-00497-4

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  • DOI: https://doi.org/10.1007/s40259-021-00497-4

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