Rate of serious adverse effects in a series of bevacizumab and ranibizumab injections.
OBJECTIVE
To compare the rate of serious ocular and systemic adverse effects of intravitreal bevacizumab and ranibizumab in the treatment of a variety of eye diseases.


METHODS
Retrospective chart review.


METHODS
Consecutive series of intravitreal injections of bevacizumab (n = 693) and ranibizumab (n = 891).


METHODS
Medical records of all patients receiving injections in the series were retrieved. We considered the rate of both serious ocular adverse effects (e.g., acute intraocular inflammation, infectious endophthalmitis, retinal detachment, vitreous hemorrhage) and of arterial thromboembolic events that occurred within 1 month of injection.


RESULTS
Subjects who received bevacizumab were 12 times more likely to develop severe intraocular inflammation following each injection than were those who received ranibizumab (OR = 11.71; 95% CI 1.5-93). The 1 case of acute intraocular inflammation following ranibizumab injection was mild and not associated with vision loss. No other serious ocular complications were noted. A trend was also noted toward an increased risk for arterial thromboembolic events in patients receiving bevacizumab, although the confidence interval was wide (OR = 4.26; 95% CI 0.44-41).


CONCLUSIONS
Significant concern still exists regarding the safety of off-label use of intravitreal bevacizumab. Patients receiving bevacizumab should be counselled regarding a possible increased risk for serious adverse events.
Department of Ophthalmology, Queen's University, Kingston, Ont. sanjay_sharma60@hotmail.com
Sanjay
S
Sharma
Davin
D
Johnson
Marwan
M
Abouammoh
Simon
S
Hollands
Ashley
A
Brissette
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000068258:Bevacizumab; D009877:Endophthalmitis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D012163:Retinal Detachment / Q000453:epidemiology* / Q000209:etiology; D012170:Retinal Vein Occlusion / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014823:Vitreous Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D057135:Wet Macular Degeneration / Q000188:drug therapy
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab