Risk of Myocardial Infarction and Stroke With Single or Repeated Doses of Intravitreal Bevacizumab in Age-Related Macular Degeneration

PurposeTo examine the risk of myocardial infarction and stroke with single and repeated doses of intravitreal bevacizumab in wet age-related macular degeneration (AMD).DesignNested case-control study and retrospective cohort study.Methodssetting: Two patient cohorts from British Columbia, Canada. study population: Patients with wet AMD. intervention: For the cohort study, patients who received the first intravitreal bevacizumab; for the nested case-control study, repeated injections of intravitreal bevacizumab. main outcome measures: Myocardial infarction for the retrospective cohort study; myocardial infarction and stroke for the nested case-control study.ResultsIn the cohort analysis, there were 2564 AMD subjects not on a vascular endothelial growth factor (VEGF) inhibitor and 5644 subjects receiving intravitreal bevacizumab. The rate of myocardial infarction (MI) among bevacizumab users was 11/1000 person-years, compared to 14.9/1000 person-years in nonusers. The adjusted rate ratio (RR) for MI was 0.70 (95% confidence interval [CI]: 0.50–1.00) and 0.74 (0.46–1.20) for the propensity score–adjusted analysis. In the nested case-control analysis there were 7452 new users of VEGF inhibitors, within which there were 313 cases of MI with 3130 matched controls. The adjusted RR for MI among those receiving 3 or more injections compared to those receiving fewer than 3 was 0.71 (95% CI: 0.41–1.22). Also in the nested case-control analysis, the adjusted RR for stroke was 0.81 (95% CI: 0.39–1.65) for those receiving ≥4 injections vs those receiving fewer than 4 injections.ConclusionSingle or repeated doses of intravitreal bevacizumab were not shown to increase the risk of myocardial infarction or stroke in patients with wet AMD.