Author: Sirpa Loukovaara (Finland)
Co-authors: Anssi Auvinen, Jari Haukka
To examine whether systemic medications are associated with the subsequent development of wet age-related macular degeneration (AMD).
Pharmacoepidemiologic study. A population-based cohort study of 259,562 individuals, from January 1, 2001, to December 31, 2017, in Finland. We obtained the prescription data from the Social Insurance Institution (permission Kela 16/522/2012).
Association between baseline medication (85 generic drugs) usage and the incidence of wet AMD was evaluated using Poisson regression adjusted for age, sex, diabetes, cancer and socioeconomic group. All data analyses were conducted using R language (R Core Team2019). Results are presented as incidence rate ratios (IRR) with 95% confidence intervals (CIs).
The mean length of follow up was 9.84 years. The number of cases with wet AMD was 2947 and incidence rate was 1.15 per 1000 person-years. After adjustment we observed increased risk for the development of wet AMD for patients exposed to amlodipine (IRR 1.33, 95% CI 1.16-1.53), or felodipine (IRR 1.24, 95% CI 1.02-1.50). Similarly, increased risks were also associated with use of bicalutamide (IRR 2.14, 95% CI 1.14-4.02), estradiol (IRR 1.20, 95% CI 1.03-1.40), and atorvastatin (IRR 1.22, 95% CI 1.05-1.43). Of note, digoxin users had a decreased incidence of wet AMD (adjusted IRR 0.72, 95% CI 0.57-0.91), as well as those using ramipril (adjusted IRR 0.80, 95% CI 0.65-0.99).
In this real-world pharmaco-epidemiological study, we demonstrated that use of second-generation calcium channel blockers (amlodipine or felodipine) was associated with a higher incidence of wet AMD in nearly 10 years’ follow-up. Meanwhile, the incidence of wet AMD was decreased in patients using an angiotensin-converting enzyme (ACE) inhibitor (ramipril) and digoxin. Avoiding systemic medication leading to wet AMD could potentially offer means for decreasing disease burden and need for treatment including the repeated intravitreal injections of anti-VEGF drugs.
No conflict of interest