Systemic safety of anti-VEGF drugs: a commentary

Abstract

Introduction: VEGF is a mediator of angiogenesis. Thus, concerns have been expressed following the use of VEGF inhibitors for the treatment of neovascular age-related macular degeneration (nAMD). Ranibizumab, and more recently aflibercept, are VEGF inhibitors licensed for the treatment of nAMD. Bevacizumab is also used but unlicensed for this application.

Areas covered: A non-systematic review of nAMD trials was undertaken to investigate four outcomes: all-cause mortality, all systemic serious adverse events (SSAEs), arteriothrombotic events (ATEs) and gastrointestinal (GI) complications. Differences in event rates with injections of ranibizumab compared to bevacizumab, aflibercept, photodynamic therapy (PDT) and sham were explored and quantified using fixed-effect meta-analyses.

Expert opinion: Anti-VEGF agents can influence vascular health; however, the data suggest no difference in the risk of an ATE or death between anti-VEGF agents. Clinical trials are limited in their size and eligibility criteria and databases of patients treated in routine practice should also be scrutinized.

Keywords:

• aflibercept
• anti-VEGF drug safety
• bevacizumab
• ranibizumab
• systemic serious adverse events
• VEGF

Declaration of interest

This work was supported by the National Institute for Health Research (NIHR) and the British Heart Foundation (BHF). CA Rogers has received financial support from Novartis. U Chakravarthy has received institutional support from Novartis and institutional and consultant support from Bayer and Roche. BC Reeves has received financial support from Janssen-Cilag. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Notes

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