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Clinical outcome most important to AMD patients on anti-VEGF treatment
A questionnaire evaluated patients, retina specialists and industry professionals regarding the impact of anti-VEGF treatment.
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Patients with age-related macular degeneration are most concerned with achieving a positive clinical outcome when choosing a treatment regimen, a speaker said at the American Society of Retina Specialists meeting in Las Vegas.
“If you ask patients the most important factor that affects their drug of choice, good outcomes by far was the most important thing,” Tarek S. Hassan, MD, said in a presentation.
The questionnaire
A 15-question multiple choice survey was given to 151 consecutive patients, 90 women and 61 men, with wet AMD. The survey was completed in its entirety in a single visit.
All patients had received at least one prior injection of Avastin (bevacizumab, Genentech), Lucentis (ranibizumab, Genentech) or Eylea (aflibercept, Regeneron) before completing the questionnaire, but the majority of patients had received at least 10 prior injections. Mean duration of the total injection treatment period was 32.9 months.
The same questionnaire was given to 16 industry professionals from companies that are involved in the treatment of AMD and 28 practicing vitreoretinal surgeons from all major geographic areas in the United States, as well as several surgeons from Europe and Japan.
Patients and physicians were asked questions regarding their expected disease outcomes, the factors that affected their drug choice, their willingness to indefinitely continue injection treatment, their concern over costs and insurance coverage, the treatment of bilateral disease, and the value of new drugs and surgeries to decrease injection frequency.
Patients who participated in the survey primarily resided in a suburban area and were mostly well-insured, Hassan said.
“Such a survey depends a lot on many variables. Most importantly, it depends on how we as doctors explain things to our patients as we care for them,” he said. “Certainly, it depends on the insurance status of our population and the manner in which we actually deliver the injections.”
Results
Most important to patients was the achievement of good visual function above all other factors. According to Hassan, patients overwhelmingly reported that they were willing to continue injections indefinitely if it meant that their vision was maintained or improved.
“It’s interesting that retina specialists significantly underappreciated the patients’ willingness to indefinitely continue injections, especially if you just said, ‘We’re going to maintain your vision,’” Hassan said.
According to the questionnaire, 91% of patients would agree to monthly injections for an indefinite amount of time as long as their visual acuity increased, but only 54% of retina specialists thought that patients would be willing to accept this.
If all factors were treated equally, such as cost, visual outcomes and anatomic outcomes, 84% of patients said they would prefer to be treated with a more expensive drug that is approved by the U.S. Food and Drug Administration, whereas only approximately 50% of retina specialists thought this was an important factor to patients.
Likewise, if patients were well-insured, they preferred a more expensive drug that is approved by the FDA over a less expensive drug that is not approved by the FDA. Industry professionals also appreciated that patients preferred the use of an FDA-approved drug, but retina specialists underestimated this factor.
According to the questionnaire, patients became more concerned with insurance coverage the longer their treatment continued. However, patients did not rank cost or payment issues among the top three or four unfavorable aspects of treatment.
Even if patients were doing well with their current drug, approximately 60% said they would switch to a lower-dose drug if given the opportunity, as long as visual acuity was likely to be maintained. Patients also preferred an as-needed treatment regimen over planned monthly injections.
“Early in the treatment regimen, those that had less than 10 injections were more likely to expect a cure or better vision stability,” Hassan said. “They preferred [as-needed] vs. planned monthly injections, expected the frequency of the injections to decrease over time, and were more likely to change to another drug to have fewer injections.”
As their treatment regimens became longer, patients realized that they were faced with a chronic condition and seemed less likely to anticipate a cure, but rather expected to maintain vision with frequent injections over a longer period. – by Ashley Biro