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Evidence on different risk rates among anti-VEGF agents not significant at present
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COPENHAGEN, Denmark — At present, there is not sufficient data to prove that the three anti-VEGF agents currently used to treat wet age-related macular degeneration have different risks of systemic side effects, and more evidence needs to be provided by clinical trials, according to a speaker.
Although a slightly higher proportion of systemic adverse events was found with Avastin (bevacizumab, Genentech) in the CATT and IVAN trials, significance is not strong enough to draw conclusions, Tien Y. Wong, MD, said at the meeting of the European Society of Ophthalmology.
Tien Y. Wong
The HARBOR study also showed different dosing regimens have no impact on risk rate.
"Surprisingly, a lower risk rate was found with monthly ranibizumab than with PRN, suggesting that the occurrence of adverse events is not dose-dependent," Wong said.
The VIEW study showed no difference in risk rate between Lucentis (ranibizumab, Genentech) and Eylea (aflibercept, Regeneron), although in a subgroup analysis, there was a suggestion that aflibercept might have a higher risk of events in older patients.
"Even though pharmacological differences exist between anti-VEGF agents, we have found no significant differences in clinical safety data. This is reassuring for those of us who use different agents," Wong said.
In a real-world setting, an observational analysis of U.S. Medicare data found that bevacizumab had a higher rate of stroke and death, and other smaller studies also suggested a higher risk of events with the same agent.
"However, these are only observational data. Factors that might contribute to a potentially higher risk rate of bevacizumab are related to the various different formulations and pharmacies preparing the drug for intraocular use," Wong said.
Disclosure: Wong is a consultant to Bayer, Novartis and Roche.