Erhebung über mögliche kardiovaskuläre Nebenwirkungen nach intravitrealer Injektion der VEGF-Inhibitoren Bevacizumab und Ranibizumab bei altersbedingter Makuladegeneration

Erhebung über mögliche kardiovaskuläre Nebenwirkungen nach intravitrealer Injektion der VEGF-Inhibitoren Bevacizumab und Ranibizumab bei altersbedingter Makuladegeneration

Investigation about possible cardiovascular adverse events after intravitreal application of VEGF-inhibitors bevacizumab and ranibizumab in therapy of age-related maculopathy

Kristine Schäfer

Doctoral thesis

Date of Examination: 2012-04-18

Date of issue: 2012-04-18

Advisor: Hoerauf, Hans Prof. Dr.

Referee: Hoerauf, Hans Prof. Dr.

Referee: Schäfer Prof. Dr.

Referee: Stojanovic, Tomislav PD Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-000D-EF9F-C

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Abstract

English

Background: Age-related macular degeneration is the most common cause of blindness in the western civilisation in patients more than 65 years old. The incidence of AMD will increase in the following years according to increased life expectancy. At this time intravitreous injection of VEGF inhibitors is the first choice in treatment of exsudative amd because of being a low-risk but highly efficiant drug. Nevertheless it is mostly needed to be used continuously for several years. This study's intention was to find out about cardiovascular side effects after 3 doses of intravitreal bevacizumab and ranibizumab. Results: In this study with 111 patients of the university hospital in Göttingen we did not find an elevated risk for cardiovascular side effects after 3 months respectively 3 injections of bevacizumab and ranibizumab. Very few cases of angina pectoris or raising of blood pressure medication occurred of which correlation to the VEGF inhibitors is not securely to be made with this small amount of participants. Compared to incidences from cardiovascular trials they rather seem to be due to normal age-dependent distribution. Data show that even patients with history of cardiovascular diseases did not suffer from events like heart attack, apoplexy, arterial embolism, venous thrombosis or permanent elevated blood pressure during treatment period. Also there was no difference shown between bevacizumab und ranibizumab. Conclusions: There has to be further evaluation of risk factors of cardiovascular diseases in trials including a bigger number of cases to find out how much they are concordant to the risk factors of amd, what role anti-VEGF medication is really having in pathogenesis of the above-mentioned diseases and if there are long-term side effects.

Keywords: ARM; VEGF-Inhibitors; cardiovascular side effects

Other Languages

Hintergrund: Die AMD ist die häufigste Ursache für Erblindung und Verlust der Sehschärfe in der westlichen Welt bei Patienten in einem Alter über 65 Jahre und die Inzidenz wird auch in den kommenden Jahren auf Grund der immer älter werdenden Bevölkerung weiter zunehmen. Derzeit ist die intravitreale Injektion von VEGF-Inhibitoren das Mittel der Wahl in der Therapie der exsudativen AMD, da es ein relativ risikoarmes Verfahren mit verhältnismäßig großem therapeutischen Nutzen darstellt. Allerdings handelt es sich in den meisten Fällen um eine Dauertherapie, die mehrere Injektionen pro Jahr erforderlich macht. Das Ziel der Studie war, die kardiovaskulären Nebenwirkungen nach der Upload-Phase von 3 Injektionen von Bevacizumab und Ranibizumab zu erfassen. Ergebnisse: In der vorliegenden Studie mit 111 Patienten der Universitätsmedizin Göttingen konnte für die VEGF-Inhibitoren Avastin

Schlagwörter: AMD; VEGF-Inhibitoren; Kardiovaskuläre Nebenwirkungen