Polat Onur, İnan Sibel, Özcan Serkan, Doğan Mustafa, Küsbeci Tuncay, Yavaş Güliz Fatma, İnan Ümit Übeyt
Afyonkarahisar State Hospital, Ophthalmology Clinic, Afyonkarahisar, Turkey.
Afyon Kocatepe University Faculty of Medicine, Department of Ophthalmology, Afyonkarahisar, Turkey.
Turk J Ophthalmol. 2017 Aug;47(4):205-210. doi: 10.4274/tjo.28003. Epub 2017 Aug 15.
To determine factors influencing compliance in patients with neovascular age-related macular degeneration (n-AMD) undergoing intravitreal anti-vascular endothelial growth factor (VEGF) therapy.
The files of n-AMD patients recommended treatment with ranibizumab were reviewed retrospectively. The treatment regimen was 3 consecutive monthly injections followed by monthly follow-up with intravitreal injections as needed (pro re nata, PRN). Demographic and ocular characteristics were recorded. The patients were categorized into 2 groups: full compliance to treatment, or incomplete loading schedule and/or irregular maintenance treatment. All patients were interviewed by phone about factors affecting continuation of treatment.
Mean age of the 314 patients (160 female, 154 male) included in the study was 71.6±9.1 years. A total of 246 patients (78.3%) could complete 3 consecutive injections at 1-month intervals after the start of treatment; 57 patients (18.2%) did not attend monthly follow-up during the 1-year follow-up period following the 3 consecutive monthly injections. Overall, 39.8% of the patients were not able to fully comply with the ranibizumab treatment by PRN regimen for 1 year. Better visual acuity at baseline, smaller lesion size, living closer to the hospital, higher education and sociocultural level, and better financial status were determined as factors affecting patient compliance. The most frequent reasons to discontinue treatment were fear of injection, disbelief in the benefit of the treatment, financial limitations, continuation of treatment at another center, and comorbid systemic diseases.
Patient compliance and success rates of anti-VEGF therapy may be increased by determining the factors affecting patient compliance and raising awareness about n-AMD among patients and their relatives.
确定影响接受玻璃体内抗血管内皮生长因子（VEGF）治疗的新生血管性年龄相关性黄斑变性（n-AMD）患者依从性的因素。
回顾性分析推荐使用雷珠单抗治疗的n-AMD患者的病历。治疗方案为连续3个月每月注射一次，随后根据需要每月进行随访并按需进行玻璃体内注射（必要时，PRN）。记录人口统计学和眼部特征。将患者分为两组：完全依从治疗组，或加载方案不完整和/或维持治疗不规律组。通过电话采访所有患者，了解影响治疗持续的因素。
纳入研究的314例患者（160例女性，154例男性）的平均年龄为71.6±9.1岁。共有246例患者（78.3%）在治疗开始后能够每隔1个月完成3次连续注射；57例患者（18.2%）在连续3个月每月注射后的1年随访期内未进行每月随访。总体而言，39.8%的患者在1年内无法按照PRN方案完全依从雷珠单抗治疗。基线视力较好、病变较小、住得离医院较近、教育和社会文化水平较高以及经济状况较好被确定为影响患者依从性的因素。最常见的停药原因是害怕注射、不相信治疗的益处、经济限制、在另一家中心继续治疗以及合并全身性疾病。
通过确定影响患者依从性的因素并提高患者及其亲属对n-AMD的认识，可能会提高抗VEGF治疗的患者依从性和成功率。
