# Meta-analysis of 20 trials: CHF in 2.0–2.5% on intravitreal anti-VEGF drugs, 3.8% with sham injection

- Published: 2026-11-14 07:41 UTC
- Section: Life & Health › Medicine
- Tags: intravitreal anti-VEGF therapy, congestive heart failure, systematic review, randomized controlled trials, aflibercept, ranibizumab, faricimab, brolucizumab, nAMD, macular edema
- URL: https://realtech.media/news/rt-bf8aff26eeafbb9319660b5e_meta_analysis_of/

**A systematic review of randomized trials in 11,803 eyes found congestive heart failure uncommon after intravitreal anti-VEGF therapy; the authors note the evidence is limited.**

![Meta-analysis of 20 trials: CHF in 2.0–2.5% on intravitreal anti-VEGF drugs, 3.8% with sham injection](https://realtech.media/media/2026/11/54fa90d234685d62.jpg)
*Tony Webster, Wikimedia Commons, CC BY 2.0*

A systematic review and meta-analysis in the Canadian Journal of Ophthalmology, covered by endocrinologyadvisor.com, examined congestive heart failure (CHF) and other cardiac adverse events after intravitreal anti-VEGF therapy. The authors analysed 14 reports from 20 randomized controlled trials with 11,803 eyes; mean patient age was 71±12 years and 53% were women [1]. Ovid MEDLINE, Embase and the Cochrane Library were searched for the period from January 2005 to February 2024.

## Trial design and CHF rates

The included trials tested intravitreal anti-VEGF therapy for nAMD, diabetic macular edema and retinal vein occlusion. CHF was uncommon: 2.0% (84/4172) with aflibercept, 2.2% (25/1158) with ranibizumab, 2.3% (44/1926) with faricimab and 2.5% (40/1612) with brolucizumab. In the sham groups the rate was 3.8% (20/524) [1].

Ranibizumab did not differ from sham for CHF (RR=1.53, 95% CI 0.46-5.06). Aflibercept was associated with a higher CHF risk than sham in 2 trials (RR=2.08, 95% CI 1.03-4.23) [1].

No significant differences in CHF risk were observed between aflibercept and brolucizumab, faricimab or ranibizumab. Rates of other cardiac events were comparable across the medications [1].

## Conclusions and limitations

The researchers wrote that randomized evidence suggests intravitreal anti-VEGF therapy is associated with a low incidence of CHF and other cardiac adverse events, with broadly similar risks across most agents. According to them, the findings support cardiovascular risk awareness and individualized decision-making, and reaffirm the favourable systemic safety profile of the therapy for most patients [1].

At the same time, the review states that the evidence is limited and that clinical decisions should be made cautiously and on an individual basis [1].

The authors list several limitations. The clinical phenotype and severity of individual CHF events could not be determined. Patients with severe or unstable cardiovascular disease were excluded from the trials. Dosing schedules, retreatment criteria and follow-up durations varied across the trials [1].

## Sources

1. [endocrinologyadvisor.com](https://www.optometryadvisor.com/news/intravitreal-anti-vegf-therapy-congestive-heart-failure-risk)

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Source: RealTech, realtech.media — https://realtech.media/news/rt-bf8aff26eeafbb9319660b5e_meta_analysis_of/