title: Systemic safety of anti-VEGF drugs: a commentary.
abstract: BACKGROUND
  VEGF is a mediator of angiogenesis. Thus, concerns have been expressed following the use of VEGF inhibitors for the treatment of neovascular age-related macular degeneration (nAMD). Ranibizumab, and more recently aflibercept, are VEGF inhibitors licensed for the treatment of nAMD. Bevacizumab is also used but unlicensed for this application.
  
  
  METHODS
  A non-systematic review of nAMD trials was undertaken to investigate four outcomes: all-cause mortality, all systemic serious adverse events (SSAEs), arteriothrombotic events (ATEs) and gastrointestinal (GI) complications. Differences in event rates with injections of ranibizumab compared to bevacizumab, aflibercept, photodynamic therapy (PDT) and sham were explored and quantified using fixed-effect meta-analyses.
  
  
  CONCLUSIONS
  Anti-VEGF agents can influence vascular health; however, the data suggest no difference in the risk of an ATE or death between anti-VEGF agents. Clinical trials are limited in their size and eligibility criteria and databases of patients treated in routine practice should also be scrutinized.
authors.affiliation: University of Bristol, School of Clinical Sciences, Clinical Trials and Evaluation Unit , Level 7, Queen's Building, Bristol Royal Infirmary, Bristol, BS2 8HW , UK.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Scott
authors.forename: Usha
authors.initials: U
authors.lastname: Chakravarthy
authors.forename: Barnaby C
authors.initials: BC
authors.lastname: Reeves
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000494:pharmacology; D000068258:Bevacizumab; D006801:Humans; D009389:Neovascularization, Pathologic / Q000188:drug therapy*; D010778:Photochemotherapy / Q000009:adverse effects; D000069579:Ranibizumab; D040262:Receptors, Vascular Endothelial Growth Factor / Q000009:adverse effects / Q000494:pharmacology; D011993:Recombinant Fusion Proteins / Q000009:adverse effects / Q000494:pharmacology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D057135:Wet Macular Degeneration / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: VEGF; aflibercept; anti-VEGF drug safety; bevacizumab; ranibizumab; systemic serious adverse events