抗血管内皮生长因子药物致眼内注射相关性急性肾损伤：系统评价和随机对照试验的荟萃分析。
Acute Kidney Injury from Intravitreal Anti-vascular Endothelial Growth Factor Drugs: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
机构信息
College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
出版信息
BioDrugs. 2023 Nov;37(6):843-854. doi: 10.1007/s40259-023-00621-6. Epub 2023 Sep 7.
BACKGROUND
Several observational studies have reported acute kidney injury from intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs for retinal diseases. However, systematic reviews and meta-analyses of randomized controlled trials on this critical topic are scant.
OBJECTIVE
To evaluate acute kidney injury risk associated with intravitreal anti-VEGF drugs in patients with retinal diseases.
METHODS
We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials on 12 July, 2023, and included randomized controlled trials reporting acute kidney injury between anti-VEGF drugs (e.g., aflibercept, bevacizumab, brolucizumab, and ranibizumab) and controls for retinal diseases (e.g., age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy/diabetic macular edema, retinal vein occlusion, and myopic choroidal neovascularization). Data were synthesized by a fixed-effects model for pooling odds ratios (ORs) using the Peto method.
RESULTS
We included 13 randomized controlled trials (four and nine trials for aflibercept and ranibizumab, respectively) with a total of 4282 participants. The meta-analysis indicated intravitreal anti-VEGF drugs did not increase the acute kidney injury risk, compared with controls (odds ratio [OR]: 1.00, 95% confidence interval [CI] 0.49-2.04, I: 0%), and no differences in the acute kidney injury risk were observed between different anti-VEGF drugs (OR: 1.10, 95% CI 0.27-4.43, I: 0% for aflibercept; OR: 0.97, 95% CI 0.42-2.22, I: 0% for ranibizumab) and between different retinal diseases (OR: 4.61, 95% CI 0.07-284.13, I: not applicable for age-related macular degeneration; OR: 0.90, 95% CI 0.42-1.93, I: 0% for diabetic retinopathy/diabetic macular edema; OR: 1.57, 95% CI 0.16-15.88, I: 0% for retinal vein occlusion).
CONCLUSIONS
Intravitreal anti-VEGF drugs were not associated with an acute kidney injury risk, regardless of which anti-VEGF drugs (aflibercept or ranibizumab) or retinal diseases (age-related macular degeneration, diabetic retinopathy/diabetic macular edema, or retinal vein occlusion) were involved.
SYSTEMATIC REVIEW PROTOCOL REGISTRATION
PROSPERO CRD42021267854.
背景
几项观察性研究报告了视网膜疾病的玻璃体腔内抗血管内皮生长因子（抗-VEGF）药物引起的急性肾损伤。然而，关于这个关键问题的随机对照试验的系统评价和荟萃分析却很少。
目的
评估玻璃体腔内抗 VEGF 药物治疗视网膜疾病患者发生急性肾损伤的风险。
方法
我们于 2023 年 7 月 12 日检索了 PubMed、Embase 和 Cochrane 对照试验中心注册库，纳入了抗 VEGF 药物（如阿柏西普、贝伐珠单抗、brolucizumab 和雷珠单抗）与对照组（如年龄相关性黄斑变性、息肉样脉络膜血管病变、糖尿病性视网膜病变/糖尿病性黄斑水肿、视网膜静脉阻塞和近视性脉络膜新生血管形成）治疗视网膜疾病的随机对照试验，报告急性肾损伤。使用 Peto 方法的固定效应模型对数据进行综合，以汇总比值比（OR）。
结果
我们纳入了 13 项随机对照试验（分别有 4 项和 9 项试验用于阿柏西普和雷珠单抗），共 4282 名参与者。荟萃分析表明，与对照组相比，玻璃体腔内抗 VEGF 药物并未增加急性肾损伤风险（OR：1.00，95%置信区间 0.49-2.04，I：0%），并且不同的抗 VEGF 药物（OR：1.10，95%置信区间 0.27-4.43，I：0%用于阿柏西普；OR：0.97，95%置信区间 0.42-2.22，I：0%用于雷珠单抗）和不同的视网膜疾病（OR：4.61，95%置信区间 0.07-284.13，I：不适用年龄相关性黄斑变性；OR：0.90，95%置信区间 0.42-1.93，I：0%用于糖尿病性视网膜病变/糖尿病性黄斑水肿；OR：1.57，95%置信区间 0.16-15.88，I：0%用于视网膜静脉阻塞）之间，急性肾损伤风险均无差异。
结论
无论使用哪种抗 VEGF 药物（阿柏西普或雷珠单抗）或哪种视网膜疾病（年龄相关性黄斑变性、糖尿病性视网膜病变/糖尿病性黄斑水肿或视网膜静脉阻塞），玻璃体腔内抗 VEGF 药物均与急性肾损伤风险无关。
系统评价方案注册
PROSPERO CRD42021267854。
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