Jaeb Center for Health Research Tampa, Florida, United States.
Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States.
Invest Ophthalmol Vis Sci. 2018 Mar 1;59(3):1199-1205. doi: 10.1167/iovs.17-22853.
To compare blood pressure and urine albumin-creatinine ratio over time for participants receiving aflibercept, bevacizumab, or ranibizumab.
Preplanned secondary analyses from a randomized trial comparing aflibercept, bevacizumab, and ranibizumab for diabetic macular edema (DME). The Diabetic Retinopathy Clinical Research Network (DRCR.net) enrolled 660 participants with DME and visual acuity 20/32 or worse in at least one eye. Eyes received intravitreous injections of 2.0 mg aflibercept, 1.25 mg bevacizumab, or 0.3 mg ranibizumab based on a structured retreatment protocol over 2 years. Main outcome measures were (1) a change in blood pressure at 2 years, and (2) a change in urine albumin-creatinine ratio (UACR) at 1 year.
At baseline, 95 participants (14%) had normal blood pressure, 220 (33%) had borderline blood pressure elevation, 206 (31%) had mild blood pressure elevation, and 139 (21%) had moderate blood pressure elevation. Average change in mean arterial pressure from baseline to 2 years was -1.2 ± 15, -1.8 ± 13.5, -2.6 ± 14.4 mm Hg in the aflibercept, bevacizumab, and ranibizumab groups, respectively (global P = 0.69). At baseline 247 participants (38%) had no albuminuria (<30 mg/g), 195 (30%) had microalbuminuria (30-300 mg/g), and 212 (32%) had macroalbuminuria (>300 mg/g). Changes in UACR category were not different among treatment groups at the 52-week visit (global P = 0.29).
There do not appear to be treatment group differences for changes in blood pressure or UACR as a reflection of kidney function in patients with DME treated with aflibercept, bevacizumab, or ranibizumab.
比较接受阿柏西普、贝伐珠单抗或雷珠单抗治疗的患者的血压和尿白蛋白/肌酐比值随时间的变化。
这是一项比较糖尿病黄斑水肿（DME）中阿柏西普、贝伐珠单抗和雷珠单抗疗效的随机试验的预先计划的二次分析。DRCR.net 共纳入了 660 例患有 DME 且至少一眼视力在 20/32 或更差的患者。根据 2 年的结构化再治疗方案，这些眼分别接受玻璃体腔内注射 2.0mg 阿柏西普、1.25mg 贝伐珠单抗或 0.3mg 雷珠单抗。主要观察指标为：（1）2 年时血压的变化；（2）1 年时尿白蛋白/肌酐比值（UACR）的变化。
在基线时，95 例（14%）患者血压正常，220 例（33%）患者血压边缘升高，206 例（31%）患者血压轻度升高，139 例（21%）患者血压中度升高。从基线到 2 年时平均动脉压的平均变化分别为：阿柏西普、贝伐珠单抗和雷珠单抗组分别为-1.2±15、-1.8±13.5、-2.6±14.4mmHg（总体 P=0.69）。在基线时，247 例（38%）患者无白蛋白尿（<30mg/g），195 例（30%）患者微量白蛋白尿（30-300mg/g），212 例（32%）患者大量白蛋白尿（>300mg/g）。在 52 周时，各组之间 UACR 类别的变化无差异（总体 P=0.29）。
在接受阿柏西普、贝伐珠单抗或雷珠单抗治疗的 DME 患者中，血压或 UACR 的变化似乎没有治疗组差异，这反映了肾功能的变化。
