Risks of Mortality, Myocardial Infarction, Bleeding, and Stroke Associated With Therapies for Age-Related Macular Degeneration
Risks of Mortality, Myocardial Infarction, Bleeding, and Stroke Associated With Therapies for Age-Related Macular Degeneration
复制标题
DOI：
10.1001/archophthalmol.2010.223
复制
发表时间：
2010-10-01
影响因子：
--
通讯作者：
Cousins, Scott W.
中科院分区：
文献类型：
--
作者：
Curtis, Lesley H.;Hammill, Bradley G.;Cousins, Scott W.
目的：探讨年龄相关性黄斑变性治疗与全因死亡、心肌梗塞、出血和中风风险之间的关联。方法：我们对 2005 年 1 月 1 日至 2006 年 12 月 31 日期间提出年龄相关性黄斑变性索赔的 146 942 名 65 岁或以上医疗保险受益人进行了一项回顾性队列研究。根据初始治疗的索赔，我们将4 组中的一组的受益人。积极对照组包括接受光动力治疗的患者。其他组包括接受玻璃体内注射哌加他尼八钠、贝伐珠单抗或雷珠单抗的患者。当患者接受与初始治疗不同的治疗时，我们审查了患者的数据。主要结局指标是光动力、培加他尼、贝伐单抗和雷珠单抗治疗与全因死亡率、心肌梗死、出血和中风风险之间的关联。结果：在调整基线特征和合并症后，我们发现治疗组的死亡率和心肌梗死率存在显着差异。具体而言，雷珠单抗治疗的死亡风险显着低于光动力治疗（风险比，0.85；99%置信区间，0.75-0.95）或培加他尼（0.84；0.74-0.95），并且雷珠单抗使用的心肌梗死风险显着低于光动力治疗（0.73；0.58-0.92）。使用贝伐珠单抗与其他疗法之间的死亡或心肌梗塞风险没有显着差异。我们发现治疗组与出血事件或中风之间没有统计学上的显着关系。结论：与光动力疗法或培加他尼的使用相比，贝伐珠单抗和雷珠单抗的使用与死亡率、心肌梗死、出血或中风的风险增加无关。
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.