Three-Year Outcomes of Patients with Neovascular Age-Related Macular Degeneration Treated with Aflibercept under the National Health Insurance Program in Taiwan

Abstract

Purpose. To observe and analyze the long-term outcomes of patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept monotherapy under the National Health Insurance (NHI) program in Taiwan. Methods. This retrospective observational study was conducted at Taipei Veterans General Hospital. Patients with naive nAMD who were treated with aflibercept and followed for more than 3 years were reviewed. The better eye was enrolled if both eyes were affected. Visual acuity (VA) and central macular thickness (CMT) were recorded for 3 years. The lost-to-follow-up rate, number of injections, and predictive factors for visual outcomes were analyzed. Results. Ninety-nine eyes in 99 patients were followed up for 3 years. The mean age at onset of nAMD was 82.8 ± 9.26 years, and 65% of the patients were male. Compared with initial visual acuity, 5 (5.1%) of our patients improved their vision for 3 or more lines after 3 years of follow-up, 11 (11.1%) of our patients improved for 1 to 3 lines, 62 (62.6%) patients remained their vision with 1 line or less changes, 15 (15.2%) patients lost their vision for 1 to 3 lines, and 6 (6%) patients lost their vision for 3 or more lines. The CMT was 359 ± 180 µm before treatment and 259 ± 98 after 3 years (p<0.001). The mean number of injections was 4.63 ± 1.91 in the first year, 2.13 ± 2.2 in the second year, and 1.42 ± 1.79 in the third year. Multivariate analysis showed that final VA was significantly associated with VA at year 1, the presence of retinal pigment epithelial detachment at year 1, and receiving more than four injections in the first year. Final CMT was only significantly associated with CMT at year 1. Conclusion. After 3 years of treatment under the NHI program in Taiwan, 21.2% of the patients with nAMD still had a visual decline despite good anatomical outcomes. More aggressive treatment or other strategies should be used for patients who may have a poor prognosis.

Risk of dialysis in patients receiving intravitreal anti–vascular endothelial growth factor treatment: a population-based cohort study

“…The possible explanations might be as follows: The approved doses injections had to be administered within five years following the reimbursement approval under the policy of National Health Insurance reimbursement criteria for ranibizumab and aflibercept during the study period. Moreover, in recent real-world studies, [ 33 , 34 ] investigators found that most injections were given in the first four years following the initialization of intravitreal anti-VEGF treatment. This may explain the reason why the survival line of anti-VEGF agents was unchanged after 48 months, since further renal adverse effects may not be present after the termination of regular intravitreal anti-VEGF treatment.…”

Three-Year Outcomes of Intravitreal Aflibercept Injections for Retinal Angiomatous Proliferation According to Disease Stage

“…In our previous work, we described the real-world outcomes of patients with nAMD treated with aflibercept with an average total of 8.16 ± 4.57 injections over 3 years [ 29 ]. Despite good anatomical outcomes, the average BCVA at 3-year follow-up had declined to a level below the baseline one.…”

“…Undoubtedly, some patients do not receive sufficient anti-VEGF treatment [ 31 ]. In previous work, we concluded that in treating nAMD in a real-world setting, intensive treatment with more injections or other strategies would be required for patients that are at risk of having a poor prognosis [ 29 ].…”

“…However, a larger study demonstrated stabilization of BCVA in stage III RAP [ 18 ], which was consistent with our results. It is expected that patients with poor treatment response to anti-VEGF therapy tend to be lost to follow-up [ 29 ]. Indeed, we found that there was a relatively higher lost to follow-up rate in patients stage III RAP.…”