Causes of interruption of bevacizumab therapy in age-related macular degeneration

Nunes, Renata Portella; Nóbrega, Mário Junqueira; Novelli, Fernando José De; Coral, Samuel Ângelo; Berti, Thaís Bacha; Missen, M. M. D.; Correa, Marina Canuto

doi:10.1590/s0004-27492010000200009

Cited by 10 publications

(8 citation statements)

References 16 publications

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“…The systematic review identified 21 studies that reported definitions of compliance , adherence , persistence , discontinuation , and/or loss to follow-up . Additional insights into reasons for nonadherence and nonpersistence were also included from 9 studies .…”

Section: Resultsmentioning

confidence: 99%

Defining Nonadherence and Nonpersistence to Anti–Vascular Endothelial Growth Factor Therapies in Neovascular Age-Related Macular Degeneration

et al. 2021

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IMPORTANCEPoor adherence or persistence to treatment can be a barrier to optimizing clinical practice (real-world) outcomes to intravitreal injection therapy in patients with neovascular age-related macular degeneration (nAMD). Currently, there is a lack of consensus on the definition and classification of adherence specific to this context. OBJECTIVE To describe the development and validation of terminology on patient nonadherence and nonpersistence to anti-vascular endothelial growth factor therapy.DESIGN, SETTING, AND PARTICIPANTS Following a systematic review of currently used terminology in the literature, a subcommittee panel of retinal experts developed a set of definitions and classification for validation. Definitions were restricted to use in patients with nAMD requiring intravitreal anti-vascular endothelial growth factor therapy. Validation by the full nAMD Barometer Leadership Coalition was established using a modified Delphi approach, with predetermined mean scores of 7.5 or more signifying consensus. Subsequent endorsement of the definitions was provided from a second set of retinal experts, with more than 50% members agreeing or strongly agreeing with all definitions.MAIN OUTCOMES AND MEASURES Development of consensus definitions for the terms adherence and persistence and a classification system for the factors associated with treatment nonadherence or nonpersistence in patients with nAMD.RESULTS Nonadherence was defined as missing 2 or more treatment or monitoring visits over a period of 12 months, with a visit considered missed if it exceeded more than 2 weeks from the recommended date. Nonpersistence was defined by nonattendance or an appointment not scheduled within the last 6 months. The additional terms planned discontinuation and transfer of care were also established. Reasons for treatment nonadherence and nonpersistence were classified into 6 dimensions: (1) patient associated, (2) condition associated, (3) therapy associated, (4) health system and health care team associated, (5) social/economic, and (6) other, with subcategories specific to treatment for nAMD.CONCLUSIONS AND RELEVANCE This classification system provides a framework for assessing treatment nonadherence and nonpersistence over time and across different health settings in the treatment of nAMD with current intravitreal anti-vascular endothelial growth factor treatments. This may have additional importance, given the potential association of the coronavirus pandemic on adherence to treatment in patients with nAMD.

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Section: Resultsmentioning

confidence: 99%

Defining Nonadherence and Nonpersistence to Anti–Vascular Endothelial Growth Factor Therapies in Neovascular Age-Related Macular Degeneration

et al. 2021

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“…However, patient perception that the treatment was not helpful or not required was a strong risk factor, accounting for up to 42% in some series. 39 However, the studies did not clarify if this was related to an expectation of improvement with treatment and subsequent disappointment when only stability of vision was achieved. This is in keeping with the finding that patients who ceased treatment often reported that lack of information about the treatment plan or the expected outcomes of treatment versus natural history.…”

Section: Resultsmentioning

confidence: 99%

“…This is in keeping with the finding that patients who ceased treatment often reported that lack of information about the treatment plan or the expected outcomes of treatment versus natural history. 39 , 40 …”

Section: Resultsmentioning

confidence: 99%

Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration

et al. 2021

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Topic Systematic review of risk factors for non-adherence and non-persistence to intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection therapy for neovascular age-related macular degeneration (nAMD). Clinical Relevance Lack of adherence (non-adherence) or under-treatment (non-persistence) with respect to evidence from clinical trials remains a significant barrier to optimizing real-world outcomes for patients with nAMD. Contributing factors and strategies to address this are poorly understood. Methods Studies that reported factors for non-adherence and/or non-persistence to anti-VEGF therapy as well as studies examining strategies to improve this were included. Trial eligibility and data extraction were conducted according to Cochrane review methods. Risk of bias was assessed using the Mixed Method Assessment Tool and certainty of evidence evaluated according to the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) tool. Data were collated descriptively. Results Of the 1284 abstract results screened, 124 articles were assessed in full and 37 studies met the inclusion criteria. Definitions of non-adherence and non-persistence varied or were not reported. Non-persistence occurred early with up to 50% of patients stopping treatment by 24 months. High rates of non-adherence were similarly reported, occurring in 32 – 95% of patients. Certainty of this finding was downgraded to moderate level due to heterogeneity in definitions used across studies. Multiple factors determine non-adherence and non-persistence, including at condition, therapy, patient, social/economic and health systems/health-care team level. Moderate quality evidence points to lower baseline vision and poorer response to treatment as condition-related variables. The effects of other factors were of lower certainty, predominantly due to small numbers and potential biases in retrospective assessment. Although many factors are non-modifiable (e.g., patient co-morbidity), other factors are potentially correctable (e.g., lack of transport or mismatched patient expectations). Evidence on strategies to improve adherence and persistence is limited, but where available, these have proven effective. Conclusions Awareness of factors related to poor patient adherence and persistence in nAMD could help identify at-risk populations and improve real world outcomes. Further work is required to develop uniform definitions as well as establishing high quality evidence on interventions that can be easily implemented.

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“…or obj.) Oishi et al [ 54 ], Polat et al [ 15 ], Weiss et al [ 16 ], Ziemssen et al [ 56 ] Boulanger-Scemama et al [ 13 ], Gillies et al [ 49 ], McGrath et al [ 52 ] 4 , Nunes et al [ 53 ], Polat et al [ 15 ], Weiss et al [ 16 ], Westborg et al [ 55 ] Boyle et al [ 2 ], Sii et al [ 58 ], Kostadinov et al [ 59 ], Mueller et al [ 20 ] Health system Center-dependent Ehlken et al [ 17 ], Heimes et al [ 50 ], Westborg et al [ 55 ], Ehlken et al [ 48 ] Krüger Falk et al [ 51 ], Nunes et al [ 53 ], Polat et al [ 15 ], Weiss et al [ 16 ] Patient Anxiety, fear Droege et al [ 14 ] 5 Polat et al [ 15 ] Boyle et al [ 2 ], Droege et al [ 60 ], Müller et al [ 61 ], Senra et al [ 62 ], Sii et al [ 58 ], Kostadinov et al [ 59 ] Motivation, knowledge, expectations Droege et al [ 14 ], Krüger Falk et al [ 51 ], Weiss et al [ 16 ], Westborg et al [ 55 ] Boyle et al [ 2 ], Müller et al [ 61 ], Sii et al [ 58 ] <...>…”

Section: Resultsmentioning

confidence: 99%

Systematic review: non-adherence and non-persistence in intravitreal treatment

Ehlken

Ziemssen

Eter

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose Intravitreal injection of VEGF inhibitors has become the standard of care for different macular diseases within the last years resulting in improved visual outcomes. Under real-life conditions, however, the necessity for frequent retreatments and reexaminations poses a burden for patients and treatment centers. Non-adherence and non-persistence to intravitreal treatment may lead to inferior clinical outcomes, and knowledge of contributing factors is crucial to improve adherence. This systematic review analyzes current literature for potential factors involved in non-adherence and non-persistence. Methods A systematic search was conducted in PubMed and Embase including three different aspects of intravitreal injection therapy: (1) diseases with intravitreal injections as treatment, (2) intravitreal injection, and (3) aspects of therapy adherence or therapy persistence. Data from identified quantitative studies were further extracted and grouped according to WHO criteria (condition, socio-economy, therapy, patient, and health system). The methodological quality of identified studies was graded. Identified qualitative studies (i.e., interviews) were descriptively analyzed and their findings narratively reported. Results Twenty-four publications were included. In 16 of those publications, a quantitative data analysis was conducted, analyzing factors associated with non-adherence. Worse visual acuity at baseline and unfavorable development of visual acuity, higher age, and greater distance to the treatment center were associated with non-adherence, while there was inconsistent evidence for an association of comorbidity. In qualitative studies, high follow-up/treatment burden, fear and anxiety, disappointed patient expectations, and lack of motivation to continue treatment were reported as reasons for non-persistence. Conclusions Knowledge of potential barriers in IVT treatment may improve adherence and potentially clinical results. Improvements can be achieved particularly in the healthcare complex (organizational improvements) and the “patient” complex by establishing realistic expectations. Recurrent education of the patient may be necessary.

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Causes of interruption of bevacizumab therapy in age-related macular degeneration

Cited by 10 publications

References 16 publications

Defining Nonadherence and Nonpersistence to Anti–Vascular Endothelial Growth Factor Therapies in Neovascular Age-Related Macular Degeneration

Defining Nonadherence and Nonpersistence to Anti–Vascular Endothelial Growth Factor Therapies in Neovascular Age-Related Macular Degeneration

Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration

Systematic review: non-adherence and non-persistence in intravitreal treatment

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