Patients with nAMD more likely to discontinue longer interval anti-VEGF treatments
Contrary to expectations, more patients with neovascular age-related macular degeneration undergoing longer interval anti-VEGF therapy discontinued treatment compared with those on shorter interval treatment, according to a study.
While 76.8% of patients on a 4-week interval regimen remained on treatment at 60 months following study entry, only 60.6% of those on 12-week or longer interval regimens remained on treatment. The overall rate of discontinuation from 24 months to 60 months was 30.4%, Sophie J. Bakri, MD, chair of ophthalmology at the Mayo Clinic, and colleagues wrote in the American Journal of Ophthalmology.
The study was a retrospective review of 8,167 neovascular age-related macular degeneration (nAMD) patients receiving continuous, unilateral anti-VEGF therapy for at least 24 months between 2011 and 2020.
A key finding in the study was that while treatment burden for frequent anti-VEGF injections was evident, results indicate that there are other factors contributing to patient persistence.
“A potential reason for increased persistence in patients with high treatment frequency is that treatment fatigue is outweighed by perceived immediate benefits of treatment,” Bakri and colleagues wrote. “Vision is likely to deteriorate quickly in this cohort because of high disease activity.”
Moreover, a patient’s perceived beneficial treatment outcome may prompt them to tolerate a more frequent treatment interval. The study adds to existing research that shows treatment burden is not the sole driver of patient discontinuation.
According to the authors, “these findings should support physicians in continuing to treat patients according to their disease activity and treatment need.”
However, Bakri and colleagues acknowledged that more research needs to be done in this area.
“Further studies on the impact of visual acuity would be useful considering low baseline visual acuity, poor response to treatment and low final visual acuity have been shown to be drivers of non-persistence,” the authors wrote.
They added, “As longer-lasting agents for the treatment of nAMD become available, patient education on the chronic nature of nAMD will become more important to support treatment persistence in patients with well-controlled disease,” the authors wrote.
Perspective
Back to Top
Treatment for nAMD with intravitreal anti-VEGF injections can be quite burdensome for the patient due to the continuous treatment intervals.
Based on the frequency of treatment, one would think that patients are more likely to self-discontinue treatment when receiving intravitreal anti-VEGF injections in shorter interval treatments than longer interval treatments. This study, however, shows quite the opposite, as patients are more likely to self-discontinue treatment when receiving intravitreal anti-VEGF injections in longer interval treatments compared to shorter interval treatments. There are a myriad of reasons for this. Patients who receive shorter interval treatments are more likely to have active nAMD and subsequently are more likely to see an improvement in vision after treatment, while patients who receive longer interval treatments are more likely to have stable, inactive nAMD and are less likely to see any benefits after treatment. As an optometrist, it is important to reiterate to patients the need to continue the recommended interval treatments to achieve maximum positive outcomes and longstanding benefits, especially if complacency is noticed.
There are a few shortcomings in the study. Only insured patients were looked at, as the data was taken from the IBM MarketScan Commercial and Medicare Supplemental databases. Because patient information is from a database, there is heavy reliance on accurate medical billing and coding. Finally, data such as visual acuity and OCT analysis were not included in this study, which could have given valuable reasons why some patients discontinued treatment.
Collapse
Read more about