Burden of disease assessment in patients with neovascular age-related macular degeneration in Spain: Results of the AMD-MANAGE study

Abstract

Background/Aims: The present study evaluates the burden of neovascular age-related macular degeneration (nAMD) to Healthcare System and patients, describing the management and treatment effectiveness in routine clinical practice in Spain. Methods: Observational, non-interventional, cross-sectional, retrospective (24 months), multicentre study including patients who started treatment with licensed vascular endothelial growth factor inhibitors (anti-VEGF) for nAMD with a minimum follow up of 24 months. Results: 126 evaluable patients were included with mean (SD) age of 79.1 (7.5) years. From diagnosis, it took a mean (SD) of 0.5 (0.5) months for the first treatment. Throughout 24 months, mean (SD) number of visits per patient was 16.0 (5.0), 9.4 (4.3) associated intravitreal injection. There were 1186 injection visits, 53.6% of them only with injection and 46.3% with injection and tests. After loading phase, preferred treatment regimens were T&E (46.0%), PRN (44.4%), fixed regimen (4.0%), and others (5.6%). Total number of visits in patients with T&E and PRN were 16.5 (5.7) and 15.5 (4.7), respectively. After complete loading phase, mean (SD) time between two consecutive treatment injections was 2.2 (1.6) months. 27.8% patients underwent a treatment change, being lack of response the most frequent reason to change (43.2%). Mean (SD) best-corrected visual acuity change was 2.1 (15.9) letters at 24 months. Conclusion: This study showed an important burden to Healthcare System and patients related to monitoring visits. More efficacious and longer lasting treatments could be useful to increase treatment intervals, thus reducing the burden of patients and caregivers and the use of healthcare resources.

Patient Preference and Treatment Satisfaction With a Port Delivery System for Ranibizumab vs Intravitreal Injections in Patients With Neovascular Age-Related Macular Degeneration

“… Another analysis of anti-VEGF regimens in patients with nAMD reported a preference for treat-and-extend (46%), followed by pro re nata (44%), and fixed (4%) anti-VEGF regimens, thereby reducing the burden for patients and caregivers and use of health care resources. These studies highlight the unmet need for improvements in the treatment approach for patients with nAMD. In addition, these findings suggest that patients may prefer less burdensome treatment regimens.…”

“…One study comparing pro re nata vs monthly injections with ranibizumab in patients with nAMD reported that a higher proportion of patients favored a less burdensome pro re nata regimen over monthly injections (53% vs 38%, respectively) . Another analysis of anti-VEGF regimens in patients with nAMD reported a preference for treat-and-extend (46%), followed by pro re nata (44%), and fixed (4%) anti-VEGF regimens, thereby reducing the burden for patients and caregivers and use of health care resources . These studies highlight the unmet need for improvements in the treatment approach for patients with nAMD.…”

Early Canadian Real-World Experience with Brolucizumab in Anti-Vascular Endothelial Growth Factor-Experienced Patients with Neovascular Age-Related Macular Degeneration: A Retrospective Chart Review

“…The principal burden associated with anti-VEGF therapy is the need for frequent treatment and monitoring, which represents considerable loss of patient and caregiver time and leads to reduced work productivity, activity impairment, and increased indirect costs. [15][16][17][18] Patient anxiety related to their intravitreal injection was also found to be an important burden in a European study, with 93% of 131 patients reporting anxiety, including 54% for ≥2 days prior to their appointment. 17 Patient-reported effects of this anxiety included inability to relax (58%), disrupted sleep (26%), reduced concentration (13%), and headache and/or nausea (10%).…”

Patient and retina specialists’ preferences in neovascular age-related macular degeneration treatment. A discrete choice experiment

“…Patients over the age of 50 years with nAMD receiving anti-VEGF drugs for at least 2 years and retina specialists working in the Spanish National Healthcare System (SNHS) were invited to participate in the study. They were selected from the universe of the AMD-MANAGE study (patients recruited from 20 public and private tertiary hospitals from different Spanish regions that met the following selection criteria: adult naïve (no previous exposure to anti-VEGF treatment) patients �50 years with confirmed nAMD diagnosis who started anti-VEGF treatment between November 1st, 2016 and February 28th, 2017, with a follow-up of 24 months and not participating in any other clinical study) (S1 Table) [22].…”

“…results [16-20, 30, 31]. Data from real world evidence on treatment burden shows that at 2 years approximately 70% of visit intervals (n = 1.344) were � 8 weeks (<4 weeks: 20%; 4-6 weeks: 30%; 6-8 weeks: 14%) while nearly 50% of injection intervals (n = 781) were � 8 weeks (<4 weeks: 4% 4-6 weeks: 26%, 6-8 weeks: 18%) [22]. The burden of treatment related to the need for frequent visits to the hospital may not only have an impact on patients and retinal specialists, but also on caregivers [33].…”