Abstract
Objective
To report on anti–vascular endothelial growth factor (anti-VEGF) discontinuation in
neovascular age-related macular degeneration (nAMD).
Design
Retrospective cohort study.
Participants
Treatment-naive nAMD patients initiating anti-VEGF injections between 2015 and 2021.
Methods
Demographics, treatment start and end dates, number of injections, treatment length,
reason for discontinuation, and baseline and final data (i.e., age, best-corrected
visual acuity, and central subfield thickness) were recorded. Statistical analyses
using STATA 17.0 assessed differences between baseline and final values and between
treatment-discontinuation subgroups.
Results
A total of 619 eyes of 502 treatment-naive patients (9015 injections) were included
(age, 81.6 ± 8.4 years; 64.0% female). Discontinuation rate was 58.3% (361 of 619),
with 310 patients discontinuing because of the lack of visual benefit (n = 152), severe
comorbidity or death (n = 82), transferred (n = 33), stable off active treatment (n = 19),
lack of benefit plus stable off treatment (n = 14), patient decision (n = 6), and
ocular comorbidity (n = 4). Among the 309 remaining patients, 51 (16.5%) were lost
to follow-up. Discontinuation occurred within the first year in 49.3% (n = 178). Visual
acuity was at least maintained in all groups and improved in the following groups:
severe comorbidity or death (p < 0.0001), lost to follow-up (p = 0.0003), transferred (p = 0.0004), and stable off treatment (p = 0.0053). The lack of visual benefit group had no improvement in vision regardless
of treatment length. Compared with other subgroups, those stable off treatment group
was younger (p = 0.0055), had better baseline vision (p = 0.0018), received more injections (p = 0.0437) over a longer time (p = 0.0034), and achieved better final vision (p < 0.0001).
Conclusion
While there was a high discontinuation rate over 7.5 years, most were attributable
to disease or treatment factors and nonmodifiable patient factors. Discontinuation
frequently occurred within the first year.
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Article info
Publication history
Published online: March 13, 2023
Accepted:
February 15,
2023
Received in revised form:
January 25,
2023
Received:
September 22,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
