Difficulty in Assessing the Systemic Adverse Effects of Intravitreal Anti–Vascular Endothelial Growth Factor Therapy


Tags Retina
Journal JAMA Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

JAMA Ophthalmology Published online June 1, 2023





作者建議使用時間更新的生存模型(time-updating survival modeling),確保anti-VEGF劑量與不良效應之間的必要關聯。此外,提出使用糖尿病併發症嚴重程度指數作為評估潛在糖尿病嚴重程度並減少時間混淆的工具。


English Abstract

The author mentions a study conducted by Zafar and colleagues, which used the Veterans Health Administration database to assess systemic adverse events in patients with type 2 diabetes who received intravitreal anti-VEGF therapy. The study found an increased risk of adverse events, such as acute myocardial infarction, cerebrovascular disease, and kidney disease, in patients who received anti-VEGF therapy compared to unexposed patients.

The author acknowledges that adverse effects, including hypertension, proteinuria, and thromboembolic events, have been documented in patients with cancer who received systemic anti-VEGF therapy. However, the debate regarding the potential systemic adverse effects of intravitreal anti-VEGF therapy is ongoing, and evidence both supporting and contradicting these effects exists.

The commentary discusses the challenges in conducting studies to evaluate these adverse effects, including limited sample sizes, the difficulty in finding suitable active comparators, the potential for indication bias, confounding by time, and the need for causal inference.

The author suggests using time-updating survival modeling to ensure the necessary proximity of the anti-VEGF dose to the adverse effect. Additionally, the Diabetes Complications Severity Index is proposed as a tool to assess underlying diabetes severity and reduce confounding by time.

The commentary concludes by highlighting the importance of conducting further research using various study designs to achieve a consensus on the systemic adverse effects of intravitreal anti-VEGF therapy.