Intravitreal VEGF Inhibitors Associated With HbA1c Reduction for Patients With DME

Intravitreal injections of ranibizumab and aflibercept were associated with a reduction in glycated hemoglobin A1c (HbA1c) without worsening renal impairment in patients with diabetic macular edema (DME). Researchers reported their findings in Medicina.

Ranibizumab and aflibercept are vascular endothelial growth factor (VEGF) inhibitors that are guideline-indicated for the treatment of DME.

“Some recent data have suggested that [intravitreal injections of] VEGF inhibitors might, through systemic absorption, lead to a reduction in renal function,” investigators said.

To understand the impact of anti-VEGF agents on glycemic control and renal function, study authors analyzed real-world data from patients with DME who had ophthalmology visits at China Medical University Hospital between 2013 and 2019. Excluded from the study were patients with a history of end-stage renal disease and treatment with bevacizumab.

There were 17,165 patients who met the inclusion criteria. Researchers used data on age, gender, and year of visit to match 154 patients treated with ranibizumab and aflibercept to 154 patients not treated with VEGF inhibitors.

The analysis showed mean HbA1c levels and estimated glomerular filtration rates (eGFR) decreased over 12 months from baseline in both groups. However, HbA1c was significantly lower in patients treated with VEGF inhibitors compared to those who did not receive treatment.

“In the generalized estimating equations (GEE) model, HbA1c in the treatment group was lower than the non-treatment group (-0.44%, 95% CI -0.75, -0.14), but eGFR was similar after adjusting for age, gender, and index-year,” researchers said. “HbA1c and eGFR decreased with time in the adjusted GEE model (P = 0.0001) in both groups.”

Investigators speculated systemic absorption of anti-VEGF agents may improve glycemic control in this patient population.

“Our study also demonstrated that mean eGFR did not change after intravitreal ranibizumab or aflibercept. These results suggest that DME patients can receive intravitreal VEGF inhibitors without inducing more renal impairment,” they concluded.

Reference:
Ku WN, Tien PT, Lin CJ, et al. Changes of estimated glomerular filtration rate and glycated hemoglobin A1c in diabetic macular edema patients treated by ranibizumab and aflibercept in the tertiary referral hospital. Medicina (Kaunas). 2022;58(8):1081. doi:10.3390/medicina58081081