Exploring patient acceptability of emerging intravitreal therapies for geographic atrophy: A mixed-methods study

Abstract

Background/Objectives The acceptability of emerging intravitreal therapies for patients with Geographic Atrophy (GA) is currently unknown. This study therefore aimed to investigate the extent to which regular intravitreal injections may be acceptable to GA patients. Subjects/Methods Thirty UK-based individuals with GA secondary to age-related macular degeneration (AMD), recruited from two London-based hospitals, were interviewed in April-October 2021 regarding acceptability of new GA treatments. Participants responded to a structured questionnaire, as well as open-ended questions in a semi-structured interview. The Theoretical Framework of Acceptability (TFA) informed framework analysis of the qualitative data. Results Twenty participants (67%) were female, and median (interquartile range (IQR)) age was 83 (78, 87) years. 37% of participants had foveal centre-involving GA, and better eye median (IQR) logMAR visual acuity was 0.30 (0.17, 0.58). Data suggested that 18 participants (60% (95% CI: 41–79%)) would accept the treatment, despite awareness of potential drawbacks. Eight participants (27% (95% CI: 10–43%) were ambivalent or undecided about treatment, and four (13%) (95% CI: 0–26%) would be unlikely to accept treatment. Reducing the frequency of injections from monthly to every other month increased the proportion of participants who considered the treatments acceptable. Conversely, factors limiting acceptability clustered around: the limited magnitude of treatment efficacy; concerns about side effects or the increased risk of neovascular AMD; and the logistical burden of regular clinic visits for intravitreal injections. Misunderstandings of potential benefits indicate the need for appropriately-designed patient education tools to support decision-making. Conclusions Our study suggests a majority of participants would be positive about intravitreal treatment for GA, in spite of potential burdens.

Patient acceptability of intravitreal complement inhibitors in geographic atrophy (GA): protocol for a UK-based cross-sectional study

“…We have adapted the prevalidated generic TFA quantitative questionnaire using insights from our pilot mixed-methods study, 23 our patient advisory group, expert clinical opinion and a literature review.…”

“…The patient advisory group will also be involved when writing up and developing a lay summary of the findings, as took place for the writing up of the pilot study. 23 …”

“…Using this robust framework, a validated generic TFA-based quantitative questionnaire was developed as an adaptable tool to measure acceptability across various healthcare interventions. 28 We have adapted the prevalidated generic TFA quantitative questionnaire using insights from our pilot mixedmethods study, 23 our patient advisory group, expert clinical opinion and a literature review.…”

“…We recently conducted a pilot mixed-methods qualitative cross-sectional study with 30 individuals diagnosed with GA to understand the impact these new therapies may have from a patient’s perspective. 23 We sought to identify patient-related factors, contexts and circumstances that influence acceptability. Approximately 60% of the cohort found regular intravitreal therapy for GA acceptable while recognising potential burdens and inconveniences.…”

Association of sildenafil use with age-related macular degeneration: a retrospective cohort study

“…No licensed treatment has been available for dry AMD until very recently, when the US Food and Drug Administration approved pegcetacoplan under the brand name Syfovre (Apellis Pharmaceuticals) in 2023 5–7. However, it requires intravitreal administration and carries a substantial adverse event profile, alongside significant costs 8 9. For wet AMD, effective licensed therapies exist,10 11 but they carry a high risk of recurrence and a high treatment burden for patients and health services.…”