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Akbar M, Avdagic E, Carlos C, Blair M, Yang C, Rodriguez SH. Bevacizumab for Retinopathy of Prematurity is Not Associated With Systemic Hypertension. J Pediatr Ophthalmol Strabismus 2024:1-8. [PMID: 39141771 DOI: 10.3928/01913913-20240620-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
PURPOSE To evaluate for an association between systemic hypertension and intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP) treatment, due to a 2020 case report of a neonate with ROP developing systemic hypertension and posterior reversible encephalopathy syndrome (PRES) after IVB and limited data on long-term safety of IVB. METHODS A retrospective cohort study was conducted using vital signs for 90 days, comparing IVB to laser treatment. The primary outcome was short-term hypertension, recorded for at least 3 consecutive days following treatment. As a secondary outcome, infants treated with IVB were also compared to infants with severe ROP who experienced spontaneous regression without treatment. Rates of long-term hypertension, based on chart diagnoses at discharge, were also reviewed. Neuroimaging was re-reviewed to evaluate for vasogenic edema consistent with PRES. RESULTS Overall, 137 infants with severe ROP were included, of whom 94 required treatment. There were no baseline differences in neonatal comorbidities comparing laser to IVB. There was no difference on unadjusted or adjusted logistic regression comparing odds of short-term hypertension after IVB to laser (adjusted odds ratio: 0.69, 095% CI: 0.25, 1.87). There was no significant difference in the rate of long-term hypertension diagnoses by treatment group. CONCLUSIONS The lack of association between IVB and short-term systemic hypertension is reassuring. Further studies are warranted to confirm this. [J Pediatr Ophthalmol Strabismus. 202X;XX(X):XXX-XXX.].
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Cai CX, Nishimura A, Bowring MG, Westlund E, Tran D, Ng JH, Nagy P, Cook M, McLeggon JA, DuVall SL, Matheny ME, Golozar A, Ostropolets A, Minty E, Desai P, Bu F, Toy B, Hribar M, Falconer T, Zhang L, Lawrence-Archer L, Boland MV, Goetz K, Hall N, Shoaibi A, Reps J, Sena AG, Blacketer C, Swerdel J, Jhaveri KD, Lee E, Gilbert Z, Zeger SL, Crews DC, Suchard MA, Hripcsak G, Ryan PB. Similar Risk of Kidney Failure among Patients with Blinding Diseases Who Receive Ranibizumab, Aflibercept, and Bevacizumab: An Observational Health Data Sciences and Informatics Network Study. Ophthalmol Retina 2024; 8:733-743. [PMID: 38519026 PMCID: PMC11298306 DOI: 10.1016/j.oret.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To characterize the incidence of kidney failure associated with intravitreal anti-VEGF exposure; and compare the risk of kidney failure in patients treated with ranibizumab, aflibercept, or bevacizumab. DESIGN Retrospective cohort study across 12 databases in the Observational Health Data Sciences and Informatics (OHDSI) network. SUBJECTS Subjects aged ≥ 18 years with ≥ 3 monthly intravitreal anti-VEGF medications for a blinding disease (diabetic retinopathy, diabetic macular edema, exudative age-related macular degeneration, or retinal vein occlusion). METHODS The standardized incidence proportions and rates of kidney failure while on treatment with anti-VEGF were calculated. For each comparison (e.g., aflibercept versus ranibizumab), patients from each group were matched 1:1 using propensity scores. Cox proportional hazards models were used to estimate the risk of kidney failure while on treatment. A random effects meta-analysis was performed to combine each database's hazard ratio (HR) estimate into a single network-wide estimate. MAIN OUTCOME MEASURES Incidence of kidney failure while on anti-VEGF treatment, and time from cohort entry to kidney failure. RESULTS Of the 6.1 million patients with blinding diseases, 37 189 who received ranibizumab, 39 447 aflibercept, and 163 611 bevacizumab were included; the total treatment exposure time was 161 724 person-years. The average standardized incidence proportion of kidney failure was 678 per 100 000 persons (range, 0-2389), and incidence rate 742 per 100 000 person-years (range, 0-2661). The meta-analysis HR of kidney failure comparing aflibercept with ranibizumab was 1.01 (95% confidence interval [CI], 0.70-1.47; P = 0.45), ranibizumab with bevacizumab 0.95 (95% CI, 0.68-1.32; P = 0.62), and aflibercept with bevacizumab 0.95 (95% CI, 0.65-1.39; P = 0.60). CONCLUSIONS There was no substantially different relative risk of kidney failure between those who received ranibizumab, bevacizumab, or aflibercept. Practicing ophthalmologists and nephrologists should be aware of the risk of kidney failure among patients receiving intravitreal anti-VEGF medications and that there is little empirical evidence to preferentially choose among the specific intravitreal anti-VEGF agents. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Cindy X Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Akihiko Nishimura
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary G Bowring
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Erik Westlund
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jia H Ng
- Division of Kidney Diseases and Hypertension, Donald and Barbara School of Medicine at Hofstra/Northwell, New York
| | - Paul Nagy
- Department of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Jody-Ann McLeggon
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, Utah; Department of Internal Medicine Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael E Matheny
- VA Informatics and Computing Infrastructure, Tennessee Valley Healthcare System, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Asieh Golozar
- Odysseus Data Services, Inc., Cambridge, Massachusetts; OHDSI Center at the Roux Institute, Northeastern University, Boston, Massachusetts
| | | | - Evan Minty
- O'Brien Center for Public Health, Department of Medicine, University of Calgary, Canada
| | - Priya Desai
- Technology / Digital Solutions, Stanford Health Care and Stanford University School of Medicine, Palo Alto, California
| | - Fan Bu
- Department of Biostatistics, University of California - Los Angeles, Los Angeles, California
| | - Brian Toy
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, California
| | - Michelle Hribar
- National Eye Institute, National Institutes of Health, Bethesda, Maryland; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Linying Zhang
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Laurence Lawrence-Archer
- Odysseus Data Services, Inc., Cambridge, Massachusetts; OHDSI Center at the Roux Institute, Northeastern University, Boston, Massachusetts
| | - Michael V Boland
- Mass Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - Kerry Goetz
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Nathan Hall
- Janssen Research and Development, Titusville, New Jersey
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, New Jersey
| | - Jenna Reps
- Janssen Research and Development, Titusville, New Jersey
| | - Anthony G Sena
- Janssen Research and Development, Titusville, New Jersey; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Joel Swerdel
- Janssen Research and Development, Titusville, New Jersey
| | - Kenar D Jhaveri
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Donald and Barbara School of Medicine at Hofstra/Northwell, New York
| | - Edward Lee
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, California
| | - Zachary Gilbert
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, California
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc A Suchard
- VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, Utah; Department of Biostatistics, University of California - Los Angeles, Los Angeles, California
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Patrick B Ryan
- Janssen Research and Development, Titusville, New Jersey
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Barkmeier AJ. Intravitreal Anti-VEGF Pharmacotherapy and Kidney Failure: Protecting Vision with an Eye on Renal Safety. Ophthalmol Retina 2024; 8:731-732. [PMID: 39097397 DOI: 10.1016/j.oret.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 08/05/2024]
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Dupas B, Castro-Farias D, Girmens JF, Eginay A, Couturier A, Villeroy F, Delyfer MN, Creuzot-Garcher C, Giocanti-Auregan A, Béral L, Arndt C, Mesnard C, Vicaut E, Chaumet-Riffaud P, Durand-Zaleski I, Paques M. Photocoagulation or sham laser in addition to conventional anti-VEGF therapy in macular edema associated with TelCaps due to diabetic macular edema or retinal vein occlusion (TalaDME): a study protocol for a multicentric, French, two-group, non-commercial, active-control, observer-masked, non-inferiority, randomized controlled clinical trial. Trials 2024; 25:273. [PMID: 38649937 PMCID: PMC11034085 DOI: 10.1186/s13063-024-07994-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Macular edema (ME) results from hyperpermeability of retinal vessels, leading to chronic extravasation of plasma components into the retina and hence potentially severe visual acuity loss. Current standard of care consists in using intravitreal injections (IVI), which results in a significant medical and economic burden. During diabetic retinopathy (DR) or retinal vein occlusion (RVO), it has recently been shown that focal vascular anomalies (capillary macro-aneurysms, also termed TelCaps) for telangiectatic capillaries may play a central role in the onset, early recurrence, and/or persistence of ME. Since targeted photocoagulation of TelCaps may improve vision, identification, and photocoagulation of TelCaps, it may represent a way to improve management of ME. OBJECTIVE The Targeted Laser in (Diabetic) Macular Edema (TalaDME) study aims to evaluate whether ICG-guided targeted laser (IGTL), in association with standard of care by IVI, allows reducing the number of injections during the first year of treatment compared with IVI only, while remaining non-inferior for visual acuity. METHODS TalaDME is a French, multicentric, two-arms, randomized, sham laser-controlled, double-masked trial evaluating the effect of photocoagulation of TelCaps combined to IVI in patients with ME associated with TelCaps. Patients with vision loss related to center involved ME secondary to RVO or DR and presenting TelCaps are eligible. Two hundred and seventy eyes of 270 patients are randomized in a 1:1 ratio to standard care, i.e., IVI of anti-VEGF solely (control group) or combined with IGTL therapy (experimental group). Stratification is done on the cause of ME (i.e., RVO versus diabetes). Anti-VEGF IVI are administered to both groups monthly for 3 months (loading dose) and then with a pro re nata regimen with a monthly follow-up for 12 months. The primary endpoint will be the number of IVI and the change in visual acuity from baseline to 12 months. Secondary endpoints will be the changes in central macular thickness, impact on quality of life, cost of treatment, and incremental cost-utility ratio in each groups. KEY SAFETY Rare but severe AE linked to the use of IVI and laser, and previously described, are expected. In the sham group, rescue laser photocoagulation may be administered by the unmasked investigator if deemed necessary at month 3. DISCUSSION The best management of ME associated with TelCaps is debated, and there have been no randomized study designed to answer this question. Given the fact that TelCaps may affect 30 to 60% of patients with chronic ME due to DR or RVO, a large number of patients could benefit from a specific management of TelCaps. TalaDME aims to establish the clinical and medico-economic benefits of additional targeted laser. The results of TalaDME may raise new recommendations for managing ME and impact healthcare costs. TRIAL REGISTRATION EudraCT: 2018-A00800-55/ NCT03751501. Registration date: Nov. 23, 2018.
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Affiliation(s)
- Bénédicte Dupas
- Service d'ophtalmologie, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France.
- FRCRnet/FCRIN Network, Paris, France.
| | - Daniela Castro-Farias
- Hopital Des Quinze-Vingts, Centre d'Investigation Clinique 1423, INSERM, Paris, France
| | - Jean-François Girmens
- Hopital Des Quinze-Vingts, Centre d'Investigation Clinique 1423, INSERM, Paris, France
| | - Ali Eginay
- Service d'ophtalmologie, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France
| | - Aude Couturier
- Service d'ophtalmologie, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France
| | - Frederic Villeroy
- Service d'ophtalmologie, CHU de La Réunion, Hôpital Félix Guyon, Saint-Denis, France
| | - Marie-Noëlle Delyfer
- Service d'ophtalmologie, CHU de Bordeaux - Hôpital Pellegrin, Bordeaux, France
- FRCRnet/FCRIN Network, Bordeaux, France
| | - Catherine Creuzot-Garcher
- Service d'Ophtalmologie, CHU de Dijon - Hopital François Miterrand, Dijon, France
- FRCRnet/FCRIN Network, Dijon, France
| | | | - Laurence Béral
- Service d'Ophtalmologie, CHU de Pointe-À-Pitre, Les Abymes, France
| | - Carl Arndt
- Service d'Ophtalmologie, CHU de Reims, Reims, France
| | - Charles Mesnard
- Service d'Ophtalmologie, CHU de Martinique, Fort-de-France, France
| | - Eric Vicaut
- URC Lariboisière-St Louis, Hôpital Fernand Widal, AP-HP Nord, Université Paris Cité, Paris, France
| | | | | | - Michel Paques
- FRCRnet/FCRIN Network, Paris, France
- Hopital Des Quinze-Vingts, Centre d'Investigation Clinique 1423, INSERM, Paris, France
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Roy A, Dodd-O JB, Robang AS, He D, West O, Siddiqui Z, Aguas ED, Goldberg H, Griffith A, Heffernan C, Hu Y, Paravastu AK, Kumar VA. Self-Assembling Peptides with Insulin-Like Growth Factor Mimicry. ACS APPLIED MATERIALS & INTERFACES 2024; 16:364-375. [PMID: 38145951 DOI: 10.1021/acsami.3c15660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Growth factor (GF) mimicry involves recapitulating the signaling of larger molecules or cells. Although GF mimicry holds considerable promise in tissue engineering and drug design applications, difficulties in targeting the signaling molecule to the site of delivery and dissociation of mimicking peptides from their target receptors continue to limit its clinical application. To address these challenges, we utilized a self-assembling peptide (SAP) platform to generate synthetic insulin-like growth factor (IGF)-signaling, self-assembling GFs. Our peptide hydrogels are biocompatible and bind target IGF receptors in a dose-dependent fashion, activate proangiogenic signaling, and facilitate formation of angiogenic microtubules in vitro. Furthermore, infiltrated hydrogels are stable for weeks to months. We conclude that the enhanced targeting and long-term stability of our SAP/GF mimicry implants may improve the efficacy and safety of future GF mimic therapeutics.
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Affiliation(s)
- Abhishek Roy
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
| | - Joseph B Dodd-O
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
| | - Alicia S Robang
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Dongjing He
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Owen West
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
| | - Zain Siddiqui
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
| | - Erika Davidoff Aguas
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey 08544, United States
| | - Hannah Goldberg
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
| | - Alexandra Griffith
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
| | - Corey Heffernan
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
| | - Yuhang Hu
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Anant K Paravastu
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Vivek A Kumar
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
- Department of Biological Sciences, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, United States
- Department of Endodontics, Rutgers School of Dental Medicine, Newark, New Jersey 07103, United States
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Hanhart J, Jeon S, Tuuminen R. Should patient enrollment criteria for anti-VEGF phase III trials be reconsidered. J Diabetes 2023; 15:911-912. [PMID: 37731062 PMCID: PMC10590675 DOI: 10.1111/1753-0407.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Joel Hanhart
- Department of Ophthalmology, Shaare Zedek Medical CenterJerusalemIsrael
- Hebrew University of JerusalemJerusalemIsrael
| | - Sohee Jeon
- Vitreoretinal ServiceKeye Eye CenterSeoulSouth Korea
| | - Raimo Tuuminen
- Department of OphthalmologyKymenlaakso Central HospitalKotkaFinland
- Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Helsinki Retina Research Group, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
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Bloomgarden Z. A diabetes update. J Diabetes 2023; 15:542-544. [PMID: 37310420 PMCID: PMC10345974 DOI: 10.1111/1753-0407.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Affiliation(s)
- Zachary Bloomgarden
- Department of MedicineDivision of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount SinaiNew YorkNYUSA
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