OBJECTIVES: Anti-vascular endothelial growth factor (anti-VEGF) agents are the standard treatment for neovascular age-related macular degeneration (nAMD); however, previous studies have suggested possible adverse events. The objective of this study was to evaluate the occurrence of ischemic colitis in patients with nAMD treated with intravitreal administration of anti-VEGF agents.

METHODS: Administrative claims data from the IBM MarketScan Research databases covering 2012-2019 was used to identify adults aged 50 and older diagnosed with nAMD (ICD-9-CM and ICD-10-CM codes) and treated with intravitreal aflibercept, ranibizumab, or bevacizumab, excluding patients who switched anti-VEGF therapy in the six-month follow-up period. We identified cases of ischemic colitis (ICD-9-CM and ICD-10-CM codes) assessed up to six months after the first injection.

RESULTS: Overall, 57,734 patients were included: 13,211 (23%) treated with aflibercept (mean number of injections=4.03), 17,633 (31%) with ranibizumab (mean number of injections=4.10), and 26,890 (47%) with bevacizumab (mean number of injections=3.58). In all three treatment groups, approximately 60% of patients were women, and the mean age ranged from 77 to 79 years. At six months follow-up from the first injection, 16 (0.12%) patients experienced ischemic colitis in the aflibercept group, 24 (0.14%) in the ranibizumab group, and 32 (0.12%) in the bevacizumab group. The mean time to the first instance of ischemic colitis was 86 days (range=7-180) in the aflibercept group, 92 days (range=10-170) in the ranibizumab group, and 105 days (range=8-180) in the bevacizumab group.

CONCLUSIONS: Ischemic colitis is uncommon in patients treated with anti-VEGF agents, occurring in approximately 1.1 to 1.4 per 1,000 patients, and, in crude analysis, it does not appear to differ meaningfully between different medications. However, the small number of events in each treatment group limits statistical interpretation and precludes analysis that would control for potential confounding factors, such as age or treatment with other medication.