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No difference in risk of adverse gastrointestinal events with two popular eye drugs


Vascular endothelial growth factor (VEGF) inhibiting drugs have revolutionized the treatment of retinal diseases. New research done at the Institute for Clinical Evaluative Sciences (ICES) has found intravitreal injections of bevacizumab and ranibizumab (also known by their trade names Avastin and Lucentis) do not increase the risks of gastrointestinal (GI) events as they have been known to do with intravenous injection.

The study, published today in the journal Drug Safety, is the first and largest population-based study to specifically evaluate the adverse GI effects of VEGF inhibitors used in the treatment of eye diseases.  VEGF inhibitors have been associated with several adverse GI events when used as anti-cancer therapy; however, clinical trials have been inconclusive regarding the risks associated with the smaller doses injected directly into the eye to treat age-related macular degeneration.  

“These finding are important because intravenous use of these commonly used drugs has been associated with adverse GI events, and clinical trials of VEGF inhibitors used for the treatment of eye diseases have raised the possibility that the risks are higher among patients treated with bevacizumab,” says Dr. Rob Campbell, scientist at ICES and an ophthalmologist at the School of Medicine at Queen’s University.

The population-based study followed 114,427 older adults with retinal disease identified between November 2005 and April 2011. Intravitreal injections of bevacizumab and ranibizumab were not associated with increased risks of upper GI ulceration, diverticular disease, pancreatitis, cholelithiasis and cholecystitis. The two drugs did not impart differing risks of adverse GI outcomes.

“Given what we know about how VEGF inhibitors act and the risks associated with their systemic use, valid concerns have been raised. Our findings complement results from clinical trials and will inform clinical decision-making and drug policy regarding the comparative safety of VEGF inhibitors used in the treatment of eye diseases,” says Campbell.

Authors:  Robert J. Campbell, Chaim M. Bell, Susan E. Bronskill, J. Michael Paterson, Marlo Whitehead, Erica de L. Campbell and Sudeep S. Gill.

“Adverse gastrointestinal events with intravitreal injection of vascular endothelial growth factor inhibitors: nested case-control study,” was published today in Drug Safety.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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  • Deborah Creatura
  • Communications, ICES
  • [email protected]
  • (o) 416-480-4780 or (c) 647-406-5996


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