Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Hospital, and Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland.
Department of Public Health, University of Helsinki, Helsinki, Finland.
Acta Ophthalmol. 2021 Sep;99(6):e893-e898. doi: 10.1111/aos.14717. Epub 2021 Jan 2.
To examine whether real-world clinical patients with macular oedema (MO) receiving intravitreal antivascular endothelial growth factor (VEGF) therapy have a higher mortality compared with a matched reference population.
A population-based, retrospective cohort study of 26 386 patients from Finland, from January 1, 2001, to December 31, 2017. Index patients were identified through the Caring Epidemiology Project database, receiving at least one intravitreal anti-VEGF injection for wet age-related macular degeneration (AMD, n = 2243, 48.61%), diabetic MO (n = 744, 16.12%), MO due to retinal vascular occlusion (n = 589, 12.77%), or other MO (n = 1038, 22.5%). For each individual treated with intravitreal injection (n = 4614), five age- , sex- , calendar year- and hospital district- matched control individuals (n = 21 772) were chosen. Baseline data of chronic conditions were available. All-cause and cause-specific mortality was analysed using Cox´s proportional hazards model.
In general, the anti-VEGF treated patients had a higher prevalence of systemic conditions, including diabetes (60.1% vs. 46.8%, p < 0.001), chronic hypertension (38.4% vs. 34.6%, p < 0.001), in hospital-treated ischaemic heart disease (23.1% vs. 21.5%, p = 0.014), and glaucoma (11.1% vs. 6.3%, p < 0.001) than controls. There was no difference in all-cause mortality between the anti-VEGF treated patients and matched controls (p = 0.62). In unadjusted Kaplan-Meier analysis of wet AMD subgroup, all-cause mortality was lower in anti-VEGF treated patients than matched controls (p = 0.015), but adjusted Cox´s proportional hazards model showed no difference in the risk of all-cause mortality (HR 0.85, 95% CI 0.66-1.09).
Intravitreal anti-VEGF therapy was not associated with an increase in the risk of mortality in patients with MO compared with age- and sex-matched controls.
研究接受玻璃体内抗血管内皮生长因子（VEGF）治疗的黄斑水肿（MO）的真实世界临床患者与匹配的参考人群相比，死亡率是否更高。
这是一项基于人群的回顾性队列研究，研究对象为 2001 年 1 月 1 日至 2017 年 12 月 31 日期间芬兰的 26386 名患者。通过 Caring Epidemiology Project 数据库确定指数患者，他们至少接受过一次玻璃体内抗 VEGF 注射治疗湿性年龄相关性黄斑变性（AMD，n=2243，48.61%）、糖尿病性 MO（n=744，16.12%）、视网膜血管阻塞性 MO（n=589，12.77%）或其他 MO（n=1038，22.5%）。对于每一位接受玻璃体内注射治疗的个体（n=4614），选择了 5 位年龄、性别、日历年份和医院区匹配的对照个体（n=21772）。可用慢性疾病的基线数据。使用 Cox 比例风险模型分析全因和病因特异性死亡率。
一般来说，接受抗 VEGF 治疗的患者患有全身性疾病的患病率较高，包括糖尿病（60.1%比 46.8%，p<0.001）、慢性高血压（38.4%比 34.6%，p<0.001）、住院治疗的缺血性心脏病（23.1%比 21.5%，p=0.014）和青光眼（11.1%比 6.3%，p<0.001）。与对照组相比，接受抗 VEGF 治疗的患者在全因死亡率方面没有差异（p=0.62）。在湿性 AMD 亚组的未经调整的 Kaplan-Meier 分析中，与匹配的对照组相比，接受抗 VEGF 治疗的患者的全因死亡率较低（p=0.015），但调整后的 Cox 比例风险模型显示全因死亡率的风险无差异（HR 0.85，95%CI 0.66-1.09）。
与年龄和性别匹配的对照组相比，玻璃体内抗 VEGF 治疗并未增加 MO 患者的死亡风险。
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