Factors of Anti-Vascular Endothelial Growth Factor Therapy Withdrawal in Patients with Neovascular Age-Related Macular Degeneration: Implications for Improving Patient Adherence
Abstract
:1. Introduction
2. Patients and Methods
2.1. Ethics
2.2. Setting
2.3. Survey Design
2.4. Statistical Analyses
3. Results
3.1. Patient Stratification and Characteristics
3.2. Treatment-Related Components
3.3. Visual Acuity
3.4. Factors Associated with Discontinuation or Dissatisfaction with Treatment
3.5. Quality of Life
3.6. Patient Activation
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Cohort 1-1 (Discontinued Due to the Doctor’s Decision) | Cohort 1-2 (Discontinued Due to Their Own Decision) | Cohort 2 (Continuing Treatment) | |
---|---|---|---|
n | 185 | 22 | 65 |
Sex | |||
Male | 159 (85.9) | 20 (90.9) | 54 (83.1) |
Female | 26 (14.1) | 2 (9.1) | 11 (16.9) |
Age, years | |||
50–59 | 48 (25.9) | 6 (27.3) | 9 (13.8) |
60–69 | 72 (38.9) | 9 (40.9) | 22 (33.8) |
70–79 | 60 (32.4) | 6 (27.3) | 30 (46.2) |
≥80 | 5 (2.7) | 1 (4.5) | 4 (6.2) |
Mean age | 65.7 | 65.9 | 68.2 |
Living with family | |||
Yes | 157 (84.9) | 16 (72.7) | 59 (90.8) |
No | 28 (15.1) | 6 (27.3) | 6 (9.2) |
Family member | |||
Spouse/partner | 140 (89.2) | 15 (93.8) | 57 (96.6) |
Children | 71 (45.2) | 9 (56.3) | 19 (32.2) |
Other | 28 (17.8) | 3 (18.8) | 5 (8.5) |
Employment | |||
Yes | 101 (54.6) | 14 (63.6) | 29 (44.6) |
No | 84 (45.4) | 8 (36.4) | 36 (55.4) |
Smoking | |||
Everyday | 28 (15.1) | 6 (27.3) | 8 (12.3) |
Sometimes | 1 (0.5) | 1 (4.5) | 1 (1.5) |
Used to | 108 (58.4) | 11 (50.0) | 36 (55.4) |
Never | 48 (25.9) | 4 (18.2) | 20 (30.8) |
Comorbidity | |||
Glaucoma | 15 (8.1) | 0 | 2 (3.1) |
Cataract | 24 (13.0) | 0 | 9 (13.8) |
Stroke | 5 (2.7) | 1 (4.5) | 2 (3.1) |
Heart disease | 16 (8.6) | 3 (13.6) | 6 (9.2) |
Diabetes | 32 (17.3) | 6 (27.3) | 13 (20.0) |
Hypertension | 71 (38.4) | 13 (59.1) | 22 (33.8) |
Hyperlipidemia | 22 (11.9) | 4 (18.2) | 8 (12.3) |
Cancer | 12 (6.5) | 1 (4.5) | 4 (6.2) |
Other | 33 (17.8) | 2 (9.1) | 12 (18.5) |
None | 44 (23.8) | 5 (22.7) | 22 (33.8) |
Cohort 1-1 (Discontinued Due to the Doctor’s Decision) | Cohort 1-2 (Discontinued Due to Their Own Decision) | Cohort 2 (Continuing Treatment) | |
---|---|---|---|
n | 185 | 22 | 65 |
Diagnosis | |||
Within 1 year | 2 (1.1) | 0 | 6 (9.2) |
Within 3 years | 55 (29.7) | 4 (18.2) | 23 (35.4) |
Within 5 years | 59 (31.9) | 7 (31.8) | 16 (24.6) |
Within 10 years | 47 (25.4) | 5 (22.7) | 13 (20.0) |
More than 10 years | 22 (11.9) | 6 (27.3) | 7 (10.8) |
Number of affected eyes | |||
One | 166 (89.7) | 21 (95.5) | 56 (86.2) |
Both | 19 (10.3) | 1 (4.5) | 9 (13.8) |
Current BCVA of the affected eye (self-reported) | |||
0.01–0.1 (20/2000 to 20/200) | 44 (23.8) | 4 (18.2) | 9 (13.8) |
0.2–0.3 (20/100 to 20/67) | 26 (14.1) | 4 (18.2) | 11 (16.9) |
0.4–0.6 (20/50 to 20/33) | 39 (21.1) | 5 (22.7) | 22 (33.8) |
0.7–1.0 (20/29 to 20/20) | 53 (28.6) | 6 (27.3) | 11 (16.9) |
≥1.2 (≥20/17) | 12 (6.5) | 2 (9.1) | 8 (12.3) |
Not sure | 11 (5.9) | 1 (4.5) | 4 (6.2) |
Difficulties in daily life | |||
Recognizing faces or objects | 21 (11.4) | 4 (18.2) | 8 (12.3) |
Reading books or newspapers | 72 (38.9) | 13 (59.1) | 20 (30.8) |
Driving | 33 (17.8) | 6 (27.3) | 15 (23.1) |
Going out alone | 2 (1.1) | 0 | 3 (4.6) |
Other | 21 (11.4) | 2 (9.1) | 7 (10.8) |
No particular difficulties | 81 (43.8) | 3 (13.6) | 30 (46.2) |
Cohort 1-1 (Discontinued Due to the Doctor’s Decision) | Cohort 1-2 (Discontinued Due to Their Own Decision) | Cohort 2 (Continuing Treatment) | |
---|---|---|---|
n | 185 | 22 | 65 |
Type of hospital | |||
Eye clinic | 42 (22.7) | 10 (45.5) | 13 (20.0) |
Eye hospital with referral | 123 (66.5) | 8 (36.4) | 47 (72.3) |
Eye hospital without referral | 20 (10.8) | 4 (18.2) | 5 (7.7) |
Time to hospital | |||
<30 min | 77 (41.6) | 7 (31.8) | 31 (47.7) |
30–59 min | 76 (41.1) | 10 (45.5) | 19 (29.2) |
1 to <1.5 h | 21 (11.4) | 2 (9.1) | 11 (16.9) |
≥1.5 h | 11 (5.9) | 3 (13.6) | 4 (6.2) |
Method of transport to hospital | |||
Car | 71 (38.4) | 11 (50.0) | 21 (32.3) |
Taxi | 2 (1.1) | 1 (4.5) | 1 (1.5) |
Public transport | 85 (45.9) | 7 (31.8) | 34 (52.3) |
Bicycle | 13 (7.0) | 1 (4.5) | 2 (3.1) |
Foot | 14 (7.6) | 2 (9.1) | 7 (10.8) |
Accompanied by someone | |||
Yes | 41 (22.2) | 8 (36.4) | 14 (21.5) |
No | 144 (77.8) | 14 (63.6) | 51 (78.5) |
Treatment duration | |||
<3 months | 55 (29.7) | 7 (31.8) | 4 (6.2) |
≥3 months | 52 (28.1) | 7 (31.8) | 7 (10.8) |
≥1 year | 37 (20.0) | 5 (22.7) | 23 (35.4) |
≥3 years | 24 (13.0) | 3 (13.6) | 16 (24.6) |
≥5 years | 17 (9.2) | 0 | 15 (23.1) |
Visit frequency | |||
Monthly | 102 (55.1) | 11 (50.0) | 29 (44.6) |
Every 2 months | 37 (20.0) | 5 (22.7) | 24 (36.9) |
Every 3 months | 28 (15.1) | 1 (4.5) | 11 (16.9) |
Every 6 months | 7 (3.8) | 2 (9.1) | 0 |
None of the above | 11 (5.9) | 3 (13.6) | 1 (1.5) |
Injection frequency | |||
Monthly | 57 (30.8) | 4 (18.2) | 10 (15.4) |
Every 2 months | 38 (20.5) | 6 (27.3) | 19 (29.2) |
Every 3 months | 27 (14.6) | 1 (4.5) | 25 (38.5) |
Every 6 months | 11 (5.9) | 3 (13.6) | 7 (10.8) |
None of the above | 52 (28.1) | 8 (36.4) | 4 (6.2) |
Out-of-pocket payment (JPY) | |||
<10,000 | 38 (20.5) | 5 (22.7) | 9 (13.8) |
10,000–29,999 | 40 (21.6) | 7 (31.8) | 26 (40.0) |
30,000–49,999 | 50 (27.0) | 5 (22.7) | 22 (33.8) |
≥50,000 | 57 (30.8) | 5 (22.7) | 8 (12.3) |
Relationship with their doctor | |||
Very good | 45 (24.3) | 1 (4.5) | 17 (26.2) |
Good | 68 (36.8) | 7 (31.8) | 23 (35.4) |
Neither good nor bad | 67 (36.2) | 13 (59.1) | 22 (33.8) |
Not good | 2 (1.1) | 1 (4.5) | 3 (4.6) |
Not good at all | 3 (1.6) | 0 | 0 |
Understanding of AMD at the start of treatment | |||
Good | 34 (18.4) | 5 (22.7) | 16 (24.6) |
Quite good | 78 (42.2) | 8 (36.4) | 22 (33.8) |
Not quite good | 49 (26.5) | 6 (27.3) | 17 (26.2) |
Not good at all | 24 (13.0) | 3 (13.6) | 10 (15.4) |
Current understanding of AMD | |||
Good | 58 (31.4) | 4 (18.2) | 29 (44.6) |
Quite good | 116 (62.7) | 13 (59.1) | 35 (53.8) |
Not quite good | 10 (5.4) | 4 (18.2) | 1 (1.5) |
Not good at all | 1 (0.5) | 1 (4.5) | 0 |
Self-Reported Visual Acuity | Cohort 1 (n = 207) (Discontinued Treatment) | Cohort 2 (n = 65) (Continuing Treatment) | ||
---|---|---|---|---|
Agree | Disagree | Agree | Disagree | |
n | 46 (22.2) | 161 (77.8) | 38 (58.5) | 27 (41.5) |
0.01–0.3 (20/2000 to 20/67) | 20 (25.6) | 58 (74.4) | 13 (65.0) | 7 (35.0) |
0.4–0.6 (20/50 to 20/33) | 10 (22.7) | 34 (77.3) | 12 (54.5) | 10 (45.5) |
≥0.7 (≥20/29) | 13 (17.8) | 60 (82.2) | 9 (47.4) | 10 (52.6) |
Not sure | 3 (25.0) | 9 (75.0) | 4 (100.0) | 0 |
Cohort 1-1 (Discontinued Due to the Doctor’s Decision) | Cohort 1-2 (Discontinued Due to Their Own Decision) | Cohort 2 (Continuing Treatment) | |
---|---|---|---|
n | 185 | 22 | 65 |
EQ-5D-5L index value | |||
Mean (SD) | 0.923 (0.107) | 0.871 (0.173) | 0.924 (0.111) |
Median (range) | 1.000 (0.505–1.000) | 0.895 (0.285–1.000) | 1.000 (0.605–1.000) |
EQ-VAS score (0–100) | |||
Mean (SD) | 76.5 (15.1) | 69.7 (17.9) | 74.0 (19.2) |
Median (range) | 80 (10–100) | 75 (30–90) | 80 (12–100) |
Cohort 1-1 (Discontinued Due to the Doctor’s Decision) | Cohort 1-2 (Discontinued Due to Their Own Decision) | Cohort 2 (Continuing Treatment) | |
---|---|---|---|
n | 176 | 20 | 65 |
PAM-13 score | |||
Mean (SD) | 51.8 (10.52) | 46.7 (10.31) | 51.5 (11.06) |
Median (range) | 51.0 (30.36–90.69) | 46.1 (30.36–70.15) | 48.9 (32.96–84.76) |
Activation level, n (%) | |||
Level 1 (0.0–47.0) | 71 (40.3) | 11 (55.0) | 31 (47.7) |
Level 2 (47.1–55.1) | 40 (22.7) | 4 (20.0) | 12 (18.5) |
Level 3 (55.2–72.4) | 57 (32.4) | 5 (25.0) | 19 (29.2) |
Level 4 (72.5–100.0) | 8 (4.5) | 0 | 3 (4.6) |
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Gomi, F.; Toyoda, R.; Yoon, A.H.; Imai, K. Factors of Anti-Vascular Endothelial Growth Factor Therapy Withdrawal in Patients with Neovascular Age-Related Macular Degeneration: Implications for Improving Patient Adherence. J. Clin. Med. 2021, 10, 3106. https://doi.org/10.3390/jcm10143106
Gomi F, Toyoda R, Yoon AH, Imai K. Factors of Anti-Vascular Endothelial Growth Factor Therapy Withdrawal in Patients with Neovascular Age-Related Macular Degeneration: Implications for Improving Patient Adherence. Journal of Clinical Medicine. 2021; 10(14):3106. https://doi.org/10.3390/jcm10143106
Chicago/Turabian StyleGomi, Fumi, Reiko Toyoda, Annabelle Hein Yoon, and Kota Imai. 2021. "Factors of Anti-Vascular Endothelial Growth Factor Therapy Withdrawal in Patients with Neovascular Age-Related Macular Degeneration: Implications for Improving Patient Adherence" Journal of Clinical Medicine 10, no. 14: 3106. https://doi.org/10.3390/jcm10143106