IOP increase more likely in patients who receive large number of bevacizumab injections

BALTIMORE — Bevacizumab has a substantially increased risk of clinically relevant IOP increase in patients who have received more than 25 injections compared with ranibizumab or aflibercept, according to a “hot topic” designated study at the Association for Research in Vision and Ophthalmology annual meeting.

“Looking at this in a real-world situation instead of the strict clinical research setting, what we found is a lower rate of clinically significant sustained IOP increase, so only 2% or 3% in patients overall, and it didn’t really vary between drugs except with patients who had over 25 injections,” Elizabeth A. Atchison, MD, surgical retina fellow at Rush University and Illinois Retina Associates, told Healio.com/OSN in an interview.

A total of 23,282 patients with age-related macular degeneration, diabetic macular edema, or branch or central retina vein occlusion with retinal edema from the IRIS Registry were included.

IRIS represents the largest database possible for this type of study, according to Mathew W. MacCumber, MD, PhD, study author and professor and associate chairman for research in the Department of Ophthalmology at Rush University Medical Center in Chicago.

Patients received at least one injection in the right eye with Avastin (bevacizumab, Genentech), Eylea (aflibercept, Regeneron) or Lucentis (ranibizumab, Genentech).

Researchers divided patients into three subgroups: all patients, AMD-only and patients who were treatment-naïve for at least 1 year before the start of the study.

In a generalized linear model, aflibercept and ranibizumab were associated with significantly lower IOP compared with bevacizumab in most groups.

“In the over-25 injection subgroup, bevacizumab has a much higher rate [of clinically significant IOP rise], more like 8% or 9% compared to the 2% or 3% with any number of injections,” Atchison said. – by Abigail Sutton

Reference:

Atchison EA, et al. The real-world effect of anti-VEGF injections on IOP using the IRIS Registry. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 7-11, 2017; Baltimore.

Disclosure: Atchison reports no relevant financial disclosures. MacCumber reports he is a consultant for and receives research funds from Genentech and Regeneron. Please see the abstract for all other authors’ relevant financial disclosures.