Título / Title

RANIBIZUMAB AND VASCULAR ENDOTHELIAL GROWTH FACTOR A LEVELS IN HUMAN BREAST MILK FOLLOWING INTRAVITREAL INJECTION

Introdução / Purpose

To measure the levels of ranibizumab and VEGF-A in the breast milk of a nursing patient after receiving intravitreal ranibizumab.

Material e Método / Methods

Prospective study performed at St. Michael’s Hospital, Canada. A 37 year-old woman who was breastfeeding a 16-month old child was diagnosed with myopic CNV and was treated with intravitreal ranibizumab. Breast milk samples were collected 1 hour before the first injection and at days 1-7, 14, 21, and 28 after the injection.

Resultados / Results

Ranibizumab levels were not detected in the breast milk at baseline, days 1 and 2. Ranibizumab was detected at day 3 (34.7ng/ml), with generally increasing levels over time; day 4, 50.3ng/ml; day 5, 53.2ng/ml; day 6, 52.1ng/ml, day 7, 38.6ng/ml; day 14, 75.1ng/ml; day 21, 121.1ng/ml; day 28, 128.9ng/ml. VEGF-A was significantly suppressed at day 1 compared to baseline and demonstrated a reduction over time: baseline, 22.8ng/ml; day 1, 12.3ng/ml; day 2, 7.1ng/ml; day 3, 7.2ng/ml; day 4, 6.1ng/ml; day 5, 5.9ng/ml; day 6, 5.4ng/ml; day 7, 6.4ng/ml; day 14, 2.2ng/ml; day 21, 3.2ng/ml; day 28, 4.9ng/ml.

Discussão e Conclusões / Conclusion

Ranibizumab passes into human breast milk with increasing levels up to day 28 following an intravitreal injection, while VEGF-A levels decline significantly. These results suggest that ranibizumab reaches the breast milk by day 1 and binds to free VEGF, reducing the amount of free VEGF secreted in the milk and available to the infant, which raises a concern of possible adverse events in the developing child. This data is important to consider when counseling nursing women who develop retinal diseases requiring anti-VEGF injections.

Palavras Chave

ranibizumab, breast milk, vascular endothelial growth factor-A