May 17, 2016
American Journal of Ophthalmology
TAKE-HOME MESSAGE
- The analysis of databases from the British Columbia Ministry of Health and the FDA Adverse Event Reporting System found an increased risk of developing wet age-related macular degeneration with the use of oral bisphosphonates (prescribed for osteoporosis prevention). Compared with controls, those using alendronate, ibandronate, and risedronate had increased risk of developing wet AMD, which is postulated to be related to the inflammation-promoting properties of the drugs.
- The authors suggest further studies should be done to explore this finding.
– Kathleen Freeman, OD
Abstract
PURPOSE
To examine the risk of age related macular degeneration (AMD) with oral bisphosphonates.
DESIGN
Three study designs were used. 1) disproportionality analysis;2) case-control study; 3) Self-controlled case series (SCCS).
METHODS
Setting: 1) Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) Database;2) Two patient cohorts from British Columbia, Canada.
STUDY POPULATION
1) All reports of AMD to the FDA with oral bisphosphoantes;2) Patients with wet AMD in British Columbia (2009-2013) and one million controls (2000-2007).
INTERVENTION
Oral bisphosphonates.
MAIN OUTCOME MEASURES
1) Reports of AMD to the FDA;2) First diagnosis of wet AMD verified by a retina specialist in British Columbia.
RESULTS
In the disproportionality analysis there were 133 cases of AMD reported with alendronate, 20 with ibandronate, and 14 with risedronate. The reported odds ratios (RORs) for alendronate, ibandronate and risedronate were 3.82 (2.94-4.96), 2.40 (1.49-3.86) and 2.87 (1.58-5.19) respectively. In the case-control analysis there were 6,367 cases and 6370 corresponding controls. The adjusted OR for wet AMD among regular users of bisphosphonates in the one, two and three years prior to the index date were 1.27 (95%CI: 1.14-1.41), 1.41 (95%CI: 1.25- 1.59) and 1.61 (95%CI:1.40- 1.86) respectively. In the SCCS analysis there were 198 cases of wet AMD on continuous bisphosphonate therapy. The RR for wet AMD for continuous bisphosphonate use was 1.99 (95% CI:1.41-2.79). We did not have information on intravenous bisphosphonates.
CONSLUSIONS
Continuous users of oral bisphosphonates are at a higher risk of developing wet AMD. Given the observational nature of this study and limitation of the data, future studies are needed to confirm these findings.