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Association of Treatment Adherence With Real-Life VA Outcomes in AMD, DME, and BRVO Patients

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Association of Treatment Adherence With Real-Life VA Outcomes in AMD, DME, and BRVO Patients

Christoph Ehlken et al. Clin Ophthalmol.

Abstract

Purpose: Real-life clinical outcomes of patients treated with anti-VEGF drugs for neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or macular edema secondary to branch retinal vein occlusion (BRVO) are often inferior to results from randomized clinical trials. This observational cohort study investigates treatment adherence and real-life clinical outcomes within the first year of treatment.

Patients and methods: A total of 708 treatment-naïve patients (466 nAMD, 134 DME, and 108 BRVO) were included. Patients were followed with a PRN treatment protocol with three intravitreal injections (IVIs) and a series of 3 monthly injections in case of persistent or recurrent disease activity, as determined by monthly follow-up exams including optical coherence tomographies. Occurrence of gaps of >56 days between treatments or follow-up (nonadherence [NA]) and the reasons for NA (patient- or center-associated) as well as disease activity within the first 12 months of treatment were analyzed. Visual acuity (VA) as well as numbers and dates of optical coherence tomography and IVI were extracted from medical records.

Results: NA occurred significantly more often in patients with DME (44%) than nAMD (32%) or BRVO (25%, p<0.01 between groups). NA was mainly patient-associated (nAMD: 80.0%, DME: 83.1%, BRVO: 70.4%, p=0.38 between groups). Patients with nAMD and DME and appropriate treatment/follow-up adherence had a better chance of significantly gaining or maintaining VA, respectively (19.9% vs 12.0% with 3-line-gain in nAMD and 1.3% vs 15.3% 3-line loss in DME; each p<0.05). NA did not correlate with VA outcomes in BRVO (3-line gain 30.9% vs 48.1% and 3-line loss 8.6% vs 7.4%; p>0.05).

Conclusion: NA to treatment and follow-up regimens is a common problem in the management of patients with AMD and DME and limits clinical treatment outcomes under real-life conditions. Patients with DME have the highest risk of patient-associated NA, associated with a higher risk for significant VA loss.

Keywords: AMD; DME; PRN; RVO; adherence; anti-VEGF; follow-up.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Follow-up over 12 months in nAMD, DME, and BRVO patients. Notes: Success, no treatment or follow-up necessary, leading to intended gap >56 days; continuous adherence, patient underwent frequent treatments or follow-ups at least every 56 days; nonadherence, at least one unintended gap >56 days between treatments or follow-ups; this subgroup is further analyzed in Figure 2. Abbreviations: nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion.
Figure 2
Figure 2
Reasons for unintended treatment gaps (NA). Notes: Patient, patient-associated NA; center, center-associated NA; inactive, no treatment necessary at last visit before NA; active, treatment intended at last visit before NA. Abbreviations: nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion; NA, nonadherence.
Figure 3
Figure 3
Kaplan–Meier estimation of incidence of NA over the course of 365 days. Note: p=0.014 between groups, log-rank test. Abbreviations: NA, nonadherence; nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion.
Figure 4
Figure 4
Development of visual acuity after 12 months for nAMD, DME, and BRVO, stratified for follow-up (adherent/nonadherent). Note: *p<0.05. Abbreviations: nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion.

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