Optimal Patient Adherence and Long-Term Treatment Outcomes of Neovascular Age-Related Macular Degeneration in Real-Life

Abstract

Purpose

To report on long-term real-life outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy in neovascular age-related macular degeneration (nAMD) with optimal patient adherence.

Methods

For this retrospective monocenter study, we identified 3217 eyes of 2793 patients that received a minimum of three intravitreal anti-VEGF injections for nAMD therapy between 2006 and 2014 at the University Eye Hospital Munich. From those, we included eyes with treatment-naïve nAMD, follow-up (FU) of ≥60 months and continuous adherence during FU. Primary measures were corrected visual acuity (VA), number of injections and visits as well as treatment regimen.

Results

We included 161 eyes of 125 patients with a mean FU of 8.0 ± 2.3 years. Mean VA at baseline was 60.1 letters (Snellen equivalent, 20/63). After the third year, mean VA declined constantly by 2–3 letters per year. After 5 and 8 years, 26.1% and 42.1% had lost at least 3 lines from baseline. Mean cumulative number of injections was 5.3 after the first year, and 23.9, 38.1, 48.5 after 5, 8, and 10 years. “Treat and extent” regimen with higher injection frequency correlated with better function. At time of last FU, 69.8% of eyes were under active treatment. Eyes with ≥70 letters at baseline correlated with better VA at the end of FU.

Conclusions

Despite optimal patient adherence, visual function declined progressively in real-life nAMD therapy over long-term. The highest impact on treatment success is given by an early treatment start with individual but intensive anti-VEGF therapy.

Keywords:

• Anti-vascular endothelial growth factor
• intravitreal injection
• neovascular age-related macular degeneration
• patient adherence

Ethical Approval

This study protocol was reviewed and approved by the Institutional Review Board and the Ethics Committee of the Ludwig-Maximilians-University Munich. The study was conducted according to the tenets of the Declaration of Helsinki.

Informed Consent

Informed consent was obtained from participants.

Ethical Review Board

This study protocol was reviewed and approved by Institutional Review Board and the Ethics Committee of the Ludwig-Maximilians-University Munich, approval number 210-15.

Author Contributions

Design and conduct of study (D.V., V.D., R.G.S.); collection, management, analysis, and interpretation of data (D.V., V.D., T.R.H., S.R.G., K.K., R.G.S.); critical review and approval of the final manuscript (D.V., A.W., S.G.P., R.G.S.). All authors attest that they meet the current ICMJE criteria for authorship.

Disclosure Statement

The authors D.V., V.D., S.G. have no conflicts of interest to declare. The authors R.G.S., K.K., S.P., T.H. and A.W. declare to have received personal fees, travel reembursement and grants for lectures, presentations and expert meetings from Novartis, Bayer, Allergan, Zeiss, and Heidelberg Engineering in the past three years.

Data Availability Statement

All data generated or analysed during this study are included in this article. There are no supplementary material files. Further enquiries can be directed to the corresponding author.

The authors have no proprietary interest in any aspect of this study.

The manuscript has not been published elsewhere and it has not been submitted simultaneously for publication elsewhere. Study data is part of the doctoral thesis of Viktoria Deiters.