Anti-VEGF therapy in pregnancy and breastfeeding

Authors

  • Amy Basilious, MD Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Health Care, Western University, London, ON
  • Rajeev H. Muni, MD, FRCSC Department of Ophthalmology and Vision Sciences, St. Michael’s Hospital/Unity Health Toronto, ON
  • Verena R. Juncal, MD Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Health Care, Western University, London, ON

DOI:

https://doi.org/10.58931/cect.2023.2227

Abstract

Anti-vascular endothelial growth factor (VEGF) is the mainstay of treatment for several visually debilitating diseases and is considered the standard of care for a number of conditions which may affect younger patients, including women of childbearing age. These commonly include, but are not restricted to, diabetic macular edema (DME), proliferative diabetic retinopathy (PDR) and myopic choroidal neovascularization (CNV). As in other areas of medicine, pregnant and breastfeeding women are often excluded from clinical trials due to the unknown side effect profile of new drugs. This lack of evidence regarding the safety of anti-VEGF agents in pregnancy and breastfeeding introduces challenges for clinicians seeking to counsel these patients, particularly because anti-VEGF injections may be often used for an extended period of time, depending on the nature of the retinal disease. As a precaution, anti-VEGF injections are generally not recommended for women who are either pregnant or breastfeeding, given that they are considered Category C drugs and there is limited data regarding their excretion in human breast milk. Therefore, treatment of this group of patients is typically managed on a case-by-case basis, balancing the potential patient benefits with safety concerns for the infant.

Author Biographies

Amy Basilious, MD, Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Health Care, Western University, London, ON

Dr. Amy Basilious is a graduate from the Schulich School of Medicine & Dentistry, Western University. She is currently a retina research fellow at the Ivey Eye Institute and will be completing her Ophthalmology residency training at Western University.

Rajeev H. Muni, MD, FRCSC, Department of Ophthalmology and Vision Sciences, St. Michael’s Hospital/Unity Health Toronto, ON

Dr. Rajeev Muni is a staff vitreoretinal surgeon at St. Michael's Hospital, The Hospital for Sick Children and the Kensington Eye Institute in Toronto, Canada and is the Vice-Chair of Clinical Research in the Department of Ophthalmology and Vision Sciences, University of Toronto. Dr. Muni completed his medical degree at McMaster University, followed by a residency in ophthalmology and fellowship in vitreoretinal surgery at the University of Toronto. This was followed by a fellowship in pediatric vitreoretinal surgery at the University of Southern California and a Masters degree in clinical epidemiology from the Harvard School of Public Health. Dr. Muni leads an active clinical research program and has a keen interest in randomized clinical trials, particularly in vitreoretinal surgical conditions.

Verena R. Juncal, MD, Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Health Care, Western University, London, ON

Dr. Verena Juncal is currently a vitreoretinal surgeon at the Ivey Eye Institute and an Assistant Professor at the Department of Ophthalmology at Western University. She completed her Ophthalmology residency at the Federal University of Sao Paulo in Brazil. Following her residency, she completed a surgical vitreoretinal fellowship training at St. Michael’s Hospital, University of Toronto. Dr. Juncal is actively engaged in research and has published in various peer-reviewed journals and presented at numerous major retina conferences.

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Published

2023-05-17

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1.
Basilious A, Muni RH, Juncal VR. Anti-VEGF therapy in pregnancy and breastfeeding. Can Eye Care Today [Internet]. 2023 May 17 [cited 2024 Dec. 3];2(2):15–19. Available from: https://canadianeyecaretoday.com/article/view/2-2-basilious_et_al

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Volume 2, Issue 2, May 2023

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