Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti–Vascular Endothelial Growth Factor Injections

JAMA Ophthalmology Published online June 1, 2023

中文摘要

此研究探討了糖尿病患者使用玻璃體內抗血管內皮生長因子（anti-VEGF）藥物的全身安全性。作者旨在評估糖尿病患者使用玻璃體內anti-VEGF治療與全身不良事件風險之間的關聯。

該研究納入了1731782名2型糖尿病患者的大型群體。從2013年1月1日至2017年12月31日期間提取了該患者群體中不良全身事件的數據。研究人員在控制年齡、性別、種族、族裔、吸煙習慣、糖尿病視網膜病變（DR）嚴重程度、合併症負擔和其他變量等各種因素的基礎上，評估了玻璃體內anti-VEGF注射與全身不良事件發展之間的關聯。

研究結果顯示，玻璃體內anti-VEGF治療獨立與全身不良事件的風險增加有關，包括急性心肌梗塞、心血管疾病和腎臟疾病。與全身不良事件風險增加相關的其他因素包括年齡較大、男性、吸煙、非白人種族、較高的DR嚴重程度和合併症負擔。

該研究強調了在考慮糖尿病患者使用玻璃體內anti-VEGF藥物時要考慮其全身安全性。雖然先前的研究報告結果不一，但這項大型群體研究提供了來自臨床實踐的寶貴數據。研究結果表明，在臨床決策中，醫生在考慮給糖尿病患者使用anti-VEGF治療時應謹慎，特別是對於那些更容易出現全身不良事件的患者。

值得注意的是，該研究存在一定的限制，包括依賴診斷的計費代碼、編碼可能存在的不準確性以及未對糖尿病持續時間進行控制。需要進一步進行樣本量更大、追蹤時間更長的研究來確認和更好地理解這些結果。

總的來說，該研究對於糖尿病患者使用玻璃體內anti-VEGF治療的全身安全性的現有文獻作出了貢獻，並強調在臨床決策中需要仔細考慮潛在的風險和益處。

English Abstract

The study explores the systemic safety of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents among patients with diabetes. The authors aimed to assess the risk of systemic adverse events associated with intravitreal anti-VEGF therapy in patients with diabetes.

The study included a large cohort of 1,731,782 patients with type 2 diabetes. Data on incident systemic adverse events among this patient cohort were extracted from January 1, 2013, to December 31, 2017. The researchers evaluated the association between intravitreal anti-VEGF injections and the development of systemic adverse events while controlling for various factors such as age, sex, race, ethnicity, tobacco use, severity of diabetic retinopathy (DR), comorbidity burden, and other variables.

The results of the study indicated that intravitreal anti-VEGF therapy was independently associated with a higher likelihood of systemic adverse events, including acute myocardial infarction, cardiovascular disease, and kidney disease. Other factors that were associated with an increased risk of systemic adverse events included older age, male sex, tobacco use, non-White race, higher DR severity, and comorbidity burden.

The study highlights the importance of considering the systemic safety profile of intravitreal anti-VEGF agents in patients with diabetes. While previous studies have reported mixed results, this large cohort study provides valuable data from a clinical practice setting. The findings suggest that clinicians should be cautious when considering anti-VEGF therapy in patients with diabetes, especially those at higher risk for systemic adverse events.

It is important to note that this study has certain limitations, including its reliance on billing codes for diagnoses, potential inaccuracies in coding, and the lack of control for the duration of diabetes. Further research with larger sample sizes and longer follow-up periods is needed to confirm and better understand these findings.

Overall, this study contributes to the existing body of literature on the systemic safety of intravitreal anti-VEGF therapy in patients with diabetes and emphasizes the need for careful consideration of potential risks and benefits in clinical decision-making.