Kidney injury during treatment with aflibercept versus ranibizumab: a population-based study

Purpose — Systemically administered anti-cancer VEGF inhibiting therapies can cause severe kidney injury. Intravitreal aflibercept has a greater impact on renal VEGF levels than ranibizumab. We compared the risk of kidney injury among patients receiving intravitreal aflibercept vs. ranibizumab.

Methods — This population-based new-user active-comparator cohort study in Ontario, Canada, evaluated 44,571 patients aged 66 years and older, newly treated with intravitreal aflibercept or ranibizumab between August 1, 2015, and July 31, 2019. The risk of adverse renal outcomes was compared while controlling for baseline and time-varying covariates.

Results — The composite renal outcome occurred in 12.0% (1,778/14,863) of aflibercept recipients versus 10.0% (1,327/13,289) of ranibizumab recipients (Relative risk: 1.00, 95% CI: 0.93–1.06 at 5 years follow up). No significant differences were observed across retinal disease subgroups

Conclusion — Intravitreal aflibercept and ranibizumab carry comparable risks of renal adverse events despite their distinct systemic pharmacodynamics.