Acute Kidney Injury from Intravitreal Anti-vascular Endothelial Growth Factor Drugs: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

IF 5.4 2区医学 Q1 IMMUNOLOGY BioDrugs Pub Date : 2023-11-01 Epub Date: 2023-09-07 DOI:10.1007/s40259-023-00621-6

Yu-Chien Tsao, Ting-Ying Chen, Li-An Wang, Chia-Chun Lee, Wan-Ju Annabelle Lee, Sheng-Min Hsu, Chi-Chun Lai, Shih-Chieh Shao, Jia-Horung Hung, Edward Chia-Cheng Lai

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Abstract

Background: Several observational studies have reported acute kidney injury from intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs for retinal diseases. However, systematic reviews and meta-analyses of randomized controlled trials on this critical topic are scant.

Objective: To evaluate acute kidney injury risk associated with intravitreal anti-VEGF drugs in patients with retinal diseases.

Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials on 12 July, 2023, and included randomized controlled trials reporting acute kidney injury between anti-VEGF drugs (e.g., aflibercept, bevacizumab, brolucizumab, and ranibizumab) and controls for retinal diseases (e.g., age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy/diabetic macular edema, retinal vein occlusion, and myopic choroidal neovascularization). Data were synthesized by a fixed-effects model for pooling odds ratios (ORs) using the Peto method.

Results: We included 13 randomized controlled trials (four and nine trials for aflibercept and ranibizumab, respectively) with a total of 4282 participants. The meta-analysis indicated intravitreal anti-VEGF drugs did not increase the acute kidney injury risk, compared with controls (odds ratio [OR]: 1.00, 95% confidence interval [CI] 0.49-2.04, I²: 0%), and no differences in the acute kidney injury risk were observed between different anti-VEGF drugs (OR: 1.10, 95% CI 0.27-4.43, I²: 0% for aflibercept; OR: 0.97, 95% CI 0.42-2.22, I²: 0% for ranibizumab) and between different retinal diseases (OR: 4.61, 95% CI 0.07-284.13, I²: not applicable for age-related macular degeneration; OR: 0.90, 95% CI 0.42-1.93, I²: 0% for diabetic retinopathy/diabetic macular edema; OR: 1.57, 95% CI 0.16-15.88, I²: 0% for retinal vein occlusion).

Conclusions: Intravitreal anti-VEGF drugs were not associated with an acute kidney injury risk, regardless of which anti-VEGF drugs (aflibercept or ranibizumab) or retinal diseases (age-related macular degeneration, diabetic retinopathy/diabetic macular edema, or retinal vein occlusion) were involved.

Systematic review protocol registration: PROSPERO CRD42021267854.

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玻璃体内抗血管内皮生长因子药物引起的急性肾损伤：随机对照试验的系统评价和荟萃分析。

背景：一些观察性研究报道了玻璃体内抗血管内皮生长因子（anti-VEGF）药物治疗视网膜疾病引起的急性肾损伤。然而，关于这一关键主题的随机对照试验的系统综述和荟萃分析很少。目的：评价玻璃体内注射抗血管内皮生长因子药物对视网膜疾病患者急性肾损伤的风险。方法：我们于2023年7月12日检索PubMed、Embase和Cochrane对照试验中央登记册，包括随机对照试验，报告抗VEGF药物（如阿非利西普、贝伐单抗、布鲁珠单抗和雷尼珠单抗）与视网膜疾病对照（如年龄相关性黄斑变性、息肉状脉络膜血管病、糖尿病视网膜病变/糖尿病性黄斑水肿、视网膜静脉闭塞和近视性脉络膜新生血管）之间的急性肾损伤。数据通过使用Peto方法的合并优势比（OR）的固定效应模型进行合成。结果：我们纳入了13项随机对照试验（分别为4项和9项阿非利西普和雷珠单抗试验），共有4282名参与者。荟萃分析表明，与对照组相比，玻璃体内抗VEGF药物不会增加急性肾损伤风险（比值比[OR]：1.00，95%置信区间[CI]0.49-2.04，I2:0%），并且在不同的抗VEGF药物之间以及在不同的视网膜疾病之间没有观察到急性肾损伤风险的差异（对于阿哌西普，OR:1.10，95%CI 0.27-4.43，I2:0%；对于雷尼珠单抗，OR:0.97，95%CI 0.42-2.22，I2:0%）（OR:4.61，95%CI 0.07-284.13，I2：不适用于年龄相关性黄斑变性；OR:0.90，95%CI 0.42-1.93，I2:0%适用于糖尿病视网膜病变/糖尿病黄斑水肿；OR:1.57，95%CI 0.16-15.88，I2:00%适用于视网膜静脉闭塞）。结论：玻璃体内抗VEGF药物与急性肾损伤风险无关，无论涉及哪种抗VEGF药物（阿非利西普或雷珠单抗）或视网膜疾病（年龄相关性黄斑变性、糖尿病视网膜病变/糖尿病黄斑水肿或视网膜静脉阻塞）。系统审查方案注册：PROSPERO CRD42021267854。

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来源期刊

BioDrugs 医学-免疫学

CiteScore

12.60

自引率

2.90%

发文量

审稿时长

>12 weeks

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