Sobolewska Bianka, Sabsabi Muhammed, Ziemssen Focke
Center for Ophthalmology, Eberhard- Karls University, Tuebingen, Germany.
University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tuebingen, Germany.
Clin Ophthalmol. 2021 Oct 27;15:4317-4326. doi: 10.2147/OPTH.S325763. eCollection 2021.
Since non-adherence (NA) to intravitreal therapy with VEGF drugs is one of the most important modifiable factors compromising treatment outcome of nAMD, the purpose of this study was to investigate the contributing factors and barriers during long-term nAMD treatment.
Barriers and potential reasons for NA were prospectively measured using the Adherence Barriers Questionnaire Intravitreal Therapy (ABQ-IVT). A random sample of patients receiving intravitreal therapy was drawn based on data for different treatment periods. Three age-sex matched groups included the treatment periods of ≤30 months (group 1), between >30 months and ≤60 months (group 2), and >60 months (group 3). The occurrence of gaps between treatments and/or OCT visits was evaluated.
NA with gaps of >56 days after the scheduled appointment was detected in 39%, 89%, and 100% of patients in group 1, 2, and 3, respectively (groups 1 and 2 vs group 3, p < 0.001). Two or more of such gaps were observed in 6%, 72%, and 94% of patients in group 1, 2, and 3, respectively. The overall ABQ-IVT score showed corresponding differences between the groups: 25.89 ± 7.68 (group 1, 95% CI 22.07-29.71), 34.72 ± 10.32 (group 2, 95% CI: 29.59-38.86), and 33.28 ± 9.04 (group 3, 95% CI 28.78-37.77). Accordingly, the score was inversely correlated with the number of regular follow-up visits in groups 2 and 3 (Pearson correlation coefficient r = -0.65 (p = 0.003) and r = -0.5 (p = 0.034), respectively). Within the groups of longer treatment duration, univariate logistic regression analysis showed higher odds of time commitment and challenge accompanying person to be relevant barriers.
NA is an arising problem with increasing duration of intravitreal therapy. Treatment barriers, detected by the ABQ-IVT, might change or increase during the course of the treatment.
由于抗血管内皮生长因子（VEGF）药物玻璃体内注射治疗的不依从性（NA）是影响湿性年龄相关性黄斑变性（nAMD）治疗效果的最重要的可改变因素之一，本研究旨在调查nAMD长期治疗过程中的影响因素和障碍。
采用玻璃体内注射治疗依从性障碍问卷（ABQ-IVT）前瞻性地测量NA的障碍和潜在原因。根据不同治疗阶段的数据，随机抽取接受玻璃体内注射治疗的患者样本。三个年龄和性别匹配的组分别为治疗时间≤30个月（第1组）、大于30个月且≤60个月（第2组）和大于60个月（第3组）。评估治疗和/或光学相干断层扫描（OCT）检查之间出现间隔的情况。
第1组、第2组和第3组分别有39%、89%和100%的患者在预定就诊后出现间隔大于56天的NA情况（第1组和第2组与第3组相比，p<0.001）。第1组、第2组和第3组分别有6%、72%和94%的患者观察到两个或更多这样的间隔。ABQ-IVT总分在各组之间显示出相应差异：25.89±7.68（第1组，95%置信区间22.07-29.71）、34.72±10.32（第2组，95%置信区间：29.59-38.86）和33.28±9.04（第3组，95%置信区间28.78-37.77）。因此，在第2组和第3组中，该分数与定期随访次数呈负相关（皮尔逊相关系数r分别为-0.65（p=0.003）和r=-0.5（p=0.034））。在治疗时间较长的组中，单因素逻辑回归分析显示时间投入和陪同人员的困难是较高概率的相关障碍。
随着玻璃体内注射治疗时间的延长，NA成为一个日益突出的问题。ABQ-IVT检测到的治疗障碍可能在治疗过程中发生变化或增加。
