Plasma Vascular Endothelial Growth Factor Concentrations after Intravitreous Anti–Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema

Abstract

These data suggest that decreases in plasma free-VEGF levels are greater after treatment with aflibercept or bevacizumab compared with ranibizumab at 4 weeks. At 52 and 104 weeks, a greater decrease was observed in bevacizumab versus ranibizumab. Results from 2 subgroups of participants who did not receive injections within at least 1 month and 2 months before collection suggest similar changes in VEGF levels after stopping injections. It is unknown whether VEGF levels return to normal as the drug is cleared from the system or whether the presence of the drug affects the assay's ability to accurately measure free VEGF. No significant associations between VEGF concentration and systemic factors were noted.

Intravitreal bevacizumab-induced exacerbation of proteinuria in diabetic nephropathy, and amelioration by switching to ranibizumab

“…3 New literature reports suggest that they may induce temporary or continual intravascular VEGF depletion. 7 Molecularly VEGF depletion affects trophic signals to podocytes and endothelial cells through upregulation of (v-rel avian reticuloendotheliosis viral oncogene homolog A) Rel-A and causes inflammation via renal angiotensin aldosterone system (RAAS) upregulation and (nuclear factor kappa light chain enhancer of activated B cells) NF-κB signaling. 2,8 Nephrotic syndrome can be caused via podocyte cytoskeleton effects can be observed as via disruption of C-MIP (though this is classically seen more with inhibition of the closely related tyrosine kinase pathway).…”

“…3 New literature reports suggest that they may induce temporary or continual intravascular VEGF depletion. 7…”

Nephrotoxicity induced by intravitreal vascular endothelial growth factor inhibitors: emerging evidence

“…There was not a similar decrease in systemic VEGF levels with ranibizumab. [56][57][58] Intravitreal anti-VEGF administration: nephrotoxicity…”

Worsening proteinuria and renal function after intravitreal vascular endothelial growth factor blockade for diabetic proliferative retinopathy

“…Several studies corroborate that VEGF suppression is detected by measuring serum VEGF levels [ 19–21 , 28 ], but the clinical significance is only now being investigated [ 23 ]. Accordingly, it is expected that these agents are absorbed at levels capable of causing systemic effects due to the finding of suppressed intravascular VEGF [ 29 ]. Bevacizumab and aflibercept are higher potencies, with a longer half-life, stronger absorption have more pronounced VEGF depletion [ 15–18 , 28 ].…”