Ryu Sun Young, Kim Jiwon, Kim Dong Wook, Chung Eun Jee
Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Department of Big Data, National Health Insurance Service, Wonju, Korea.
Korean J Ophthalmol. 2020 Apr;34(2):150-157. doi: 10.3341/kjo.2019.0120.
This study aimed to evaluate the risk of acute myocardial infarction (AMI) associated with intravitreal ranibizumab in age-related macular degeneration (AMD).
This nationwide retrospective case-crossover study using data from the Korean National Health Insurance Service database included patients diagnosed with exudative AMD using the registration code for exudative AMD (V201) from 2009 to 2014. We identified all incident AMI cases among these exudative AMD cases from inpatient claims and defined the index date as the date of hospitalization. For each patient, we defined the case period as one to 60 days and four control periods as 121 to 180, 181 to 240, 241 to 300, and 301 to 361 days, respectively, before the index date. A prescription of ranibizumab was searched for during the case and control periods. We calculated the adjusted odds ratios and their 95% confidence intervals using a conditional logistic regression model.
From a cohort of patients with exudative AMD (n = 41,860), a total of 181 AMI patients with exudative AMD were included. Among all the patients, 11.05% were treated during the 2 months preceding the index date as compared with 8.29% to 9.39% treated during control periods. The adjusted odds ratio of AMI associated with intravitreal ranibizumab during the preceding 2 months was 1.22 (95% confidence interval, 0.673-2.213; = 0.5124). Analyses based on case periods of 15 days and 1 month yielded similar results.
Intravitreal ranibizumab injection does not appear to increase the risk of hospitalization for AMI within 60 days in exudative AMD patients.
本研究旨在评估玻璃体内注射雷珠单抗治疗年龄相关性黄斑变性（AMD）时发生急性心肌梗死（AMI）的风险。
本项全国性回顾性病例交叉研究使用了韩国国民健康保险服务数据库中的数据，纳入了2009年至2014年期间使用渗出性AMD登记代码（V201）诊断为渗出性AMD的患者。我们从住院索赔中识别出这些渗出性AMD病例中的所有新发AMI病例，并将索引日期定义为住院日期。对于每位患者，我们将病例期定义为索引日期前1至60天，将四个对照期分别定义为索引日期前121至180、181至240、241至300和301至361天。在病例期和对照期内搜索雷珠单抗的处方。我们使用条件逻辑回归模型计算调整后的比值比及其95%置信区间。
在一组渗出性AMD患者（n = 41,860）中，共纳入了181例患有渗出性AMD的AMI患者。在所有患者中，11.05%在索引日期前2个月内接受了治疗，而对照期内接受治疗的比例为8.29%至9.39%。前2个月内与玻璃体内注射雷珠单抗相关的AMI调整后比值比为1.22（95%置信区间，0.673 - 2.213；P = 0.5124）。基于15天和1个月病例期的分析得出了相似的结果。
玻璃体内注射雷珠单抗似乎不会增加渗出性AMD患者在60天内因AMI住院的风险。
