Document Detail


Risks of mortality, myocardial infarction, bleeding, and stroke associated with therapies for age-related macular degeneration.
MedLine Citation:
PMID:  20937996     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To examine associations between therapies for age-related macular degeneration and risks of all-cause mortality, incident myocardial infarction, bleeding, and incident stroke.
METHODS: We conducted a retrospective cohort study of 146,942 Medicare beneficiaries 65 years or older with a claim for age-related macular degeneration between January 1, 2005, and December 31, 2006. On the basis of claims for the initial treatment, we assigned beneficiaries to 1 of 4 groups. The active control group included patients who received photodynamic therapy. The other groups included patients who received intravitreous pegaptanib octasodium, bevacizumab, or ranibizumab. We censored data from patients when they received a therapy different from the initial therapy. The main outcome measures were associations between photodynamic, pegaptanib, bevacizumab, and ranibizumab therapies and the risks of all-cause mortality, incident myocardial infarction, bleeding, and incident stroke.
RESULTS: After adjustment for baseline characteristics and comorbid conditions, we found significant differences in the rates of mortality and myocardial infarction by treatment group. Specifically, the hazard of mortality was significantly lower with ranibizumab therapy than with photodynamic therapy (hazard ratio, 0.85; 99% confidence interval, 0.75-0.95) or pegaptanib use (0.84; 0.74-0.95), and the hazard of myocardial infarction was significantly lower with ranibizumab use than with photodynamic therapy (0.73; 0.58-0.92). There were no significant differences in the hazard of mortality or myocardial infarction between bevacizumab use and the other therapies. We found no statistically significant relationship between treatment group and bleeding events or stroke.
CONCLUSION: Bevacizumab and ranibizumab use was not associated with increased risks of mortality, myocardial infarction, bleeding, or stroke compared with photodynamic therapy or pegaptanib use.
Authors:
Lesley H Curtis; Bradley G Hammill; Kevin A Schulman; Scott W Cousins
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of ophthalmology     Volume:  128     ISSN:  1538-3601     ISO Abbreviation:  Arch. Ophthalmol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-12     Completed Date:  2010-10-27     Revised Date:  2012-09-14    
Medline Journal Info:
Nlm Unique ID:  7706534     Medline TA:  Arch Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1273-9     Citation Subset:  AIM; IM    
Affiliation:
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina 27715, USA. lesley.curtis@duke.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angiogenesis Inhibitors / therapeutic use*
Cause of Death
Databases, Factual
Female
Hemorrhage / etiology,  mortality*
Humans
Macular Degeneration / drug therapy*,  mortality*
Male
Medicare / statistics & numerical data
Myocardial Infarction / etiology,  mortality*
Photochemotherapy*
Proportional Hazards Models
Retrospective Studies
Risk Factors
Stroke / etiology,  mortality*
United States / epidemiology
Vascular Endothelial Growth Factor A / antagonists & inhibitors
Chemical
Reg. No./Substance:
0/Angiogenesis Inhibitors; 0/Vascular Endothelial Growth Factor A
Comments/Corrections
Comment In:
Arch Ophthalmol. 2012 Jan;130(1):124-5; author reply 125-6   [PMID:  22232487 ]
Arch Ophthalmol. 2012 Jun;130(6):806-7; author reply 807   [PMID:  22801854 ]
Erratum In:
Arch Ophthalmol. 2010 Dec;128(12):1623

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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