Bevacizumab Use and the Risk of Arterial and Venous Thromboembolism in Patients with High‐Grade Gliomas: A Nested Case‐Control Study

Pharmacotherapy - Tập 39 Số 9 - Trang 921-928 - 2019
In-Young Lee1, Sruthi Adimadhyam1, Edith A. Nutescu2,1, Jifang Zhou1, Alemseged Ayele Asfaw1, Karen Sweiss3, Pritesh Patel4, Gregory S. Calip2,1,5
1Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
2Center for Pharmacoepidemiology & Pharmacoeconomic Research University of Illinois at Chicago Chicago Illinois
3Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
4Division of Hematology/Oncology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
5Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington

Tóm tắt

Study ObjectiveBevacizumab is used in the treatment of recurrent glioblastoma, but evidence is limited on the incidence of thromboembolic complications regarding the use of this drug in real‐world settings. We evaluated the risk of arterial thromboembolism (ATE) and venous thromboembolism (VTE) associated with the use of bevacizumab among adults diagnosed with high‐grade gliomas in a commercially insured U.S. population.DesignNested case‐control study.Data SourceTruven Health MarketScan Commercial and Medicare Supplemental health claims databases (2009–2015).PatientsA total of 2157 patients with high‐grade gliomas who underwent incident (first‐time) craniotomy, radiation, and concurrent temozolomide treatment between 2009 and 2015 were identified. Overall, 25 cases of ATE and 99 cases of VTE were each identified in this cohort, and each case was matched to up to 10 controls (170 for ATE and 819 for VTE) based on sex, age, quarter year of index time, and follow‐up duration by using incidence density sampling without replacement from the overall cohort. Controls were at risk for the outcome of interest (ATE or VTE) at the time of case occurrence and survived at least as long as their referent case.Measurements and Main ResultsExposure to bevacizumab was determined during inpatient or outpatient encounters between the index date (date of the incident craniotomy) and the ATE or VTE event or corresponding matched control date. Multivariable conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of ATE and VTE separately. A higher proportion of patients with ATE received bevacizumab compared with controls (28% vs 17%; adjusted OR 1.51, 95% CI 0.54–4.24), but this excess in odds was not statistically significant. Similarly, bevacizumab was not significantly associated with VTE (13% vs 9%; adjusted OR 1.40, 95% CI 0.71–2.75).ConclusionWe found no significant association between the use of bevacizumab and the occurrence of thromboembolic events in patients with high‐grade gliomas, although our study was limited by the small number of ATE events. Because the potential for complications from arterial thrombosis cannot be completely ruled out, further research is needed to confirm the thromboembolic safety of bevacizumab in a larger sample of patients with high‐grade gliomas.

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Pharmacotherapy

Tập 39 Số 9

921-928

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