Intravitreal anti-VEGF therapy and risk of limb complications in individuals with diabetic eye disease

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-09-05 DOI:10.1016/j.diabres.2025.112457

Alexander T. Hong , Ivan Y. Luu , Forest Lin , Tze-Woei Tan , Brian C. Toy

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Abstract

Aims

To evaluate the association between intravitreal anti-VEGF therapy and lower extremity complications in diabetic eye disease (DED), and compare risks among ranibizumab, aflibercept, and bevacizumab.

Methods

This retrospective cohort study used a U.S. electronic health records network. Adults with DED receiving ≥3 intravitreal anti-VEGF injections (IVI) were compared to those receiving ≤2 (controls). Outcomes included diabetic foot ulcer (DFU) and lower extremity amputation (LEA). Propensity score matching (1:1) balanced baseline characteristics. Cox models estimated hazard ratios (HRs) with 95 % confidence intervals (CIs) for LEA, above-ankle LEA, and DFU in the overall cohort and subgroups with proliferative diabetic retinopathy (PDR), peripheral artery disease (PAD), end-stage renal disease (ESRD), or prior DFUs.

Results

Of 448,100 individuals with DED, 35,269 received ≥3 injections; 34,070 remained in each group after matching. IVI was associated with higher risk of LEA (HR 1.54 [95 % CI 1.38–1.72]), above-ankle LEA (HR 1.31 [1.08–1.59]), and DFU (HR 1.36 [1.30–1.42]) versus controls. LEA risk was greater in IVI versus control subgroups with PDR, PAD, ESRD, or DFUs. Risks were similar across agents.

Conclusions

Anti-VEGF therapy in DED was linked to increased DFU and LEA risk, especially in high-risk subgroups. Prospective studies are needed for confirmation.

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玻璃体内抗vegf治疗与糖尿病眼病患者肢体并发症的风险

目的：评估玻璃体内抗vegf治疗与糖尿病性眼病（DED）下肢并发症之间的关系，并比较雷尼单抗、阿非利塞普和贝伐单抗的风险。方法：这项回顾性队列研究使用了美国电子健康记录网络。将接受≥3次玻璃体内抗vegf注射（IVI）的DED成人与接受≤2次（对照组）的DED成人进行比较。结果包括糖尿病足溃疡（DFU）和下肢截肢（LEA）。倾向评分匹配（1:1）平衡基线特征。Cox模型估计在整个队列和具有增殖性糖尿病视网膜病变（PDR）、外周动脉疾病（PAD）、终末期肾病（ESRD）或既往DFU的亚组中，LEA、踝上LEA和DFU的风险比（hr）为95% %置信区间（CIs）。结果：在448,100例DED患者中，35,269例接受≥3次注射；配对后每组各保留34,070只。与对照组相比，IVI患者发生LEA（危险度1.54[95 % CI 1.38-1.72]）、踝部以上LEA（危险度1.31[1.08-1.59]）和DFU（危险度1.36[1.30-1.42]）的风险较高。与PDR、PAD、ESRD或DFUs的对照亚组相比，IVI的LEA风险更高。不同药剂的风险相似。结论：在DED患者中，抗vegf治疗与DFU和LEA风险增加有关，特别是在高危亚组中。需要前瞻性研究来证实。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.