Macula Service, Eye Centre, Mid Yorkshire NHS Trust, Wakefield, WF1 2DG, UK.
Bradford Teaching Hospitals, NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK.
Indian J Ophthalmol. 2022 Jun;70(6):2065-2070. doi: 10.4103/ijo.IJO_3066_21.
To report the reasons for treatment discontinuation within 5 years in patients receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD).
A retrospective case-notes review of patients commenced on anti-VEGF for nAMD who failed to complete 5 years of follow-up was undertaken. The reasons for treatment discontinuation, baseline age, baseline visual acuity (VA) in Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and the VA change at the last follow-up were recorded. Age-specific all-cause mortality was calculated for deceased patients.
Of the 1177 patients, 551 patients (46.8%) failed to complete the 5-year follow-up. The reasons for treatment discontinuation were death (251), early discharge due to stable disease (110), further treatment deemed futile (100), failure to attend (15), ill health (14), patient choice (7), and transfer of care (1). In 53 patients, no reason was documented. The mean baseline age of those who completed the 5-year follow-up (77.4 ± 7.8 years, 95% confidence interval (CI): 76.8-77.9) was significantly lower than those who discontinued the treatment for any reason (82 ± 7.7 years, 95% CI: 81.4-82.6) (P < 0.0001). Survival analysis showed that baseline VA was not a factor in treatment discontinuation; however, visual stability (±5 letters from baseline) was associated with treatment continuation. The age-specific all-cause mortality in deceased patients was lower than that in the general population.
At 5 years, only 53% of patients remained in active care, and death was the most common reason for treatment discontinuation. Lower baseline age and VA stability during therapy were associated with treatment continuation.
报告接受抗血管内皮生长因子（anti-VEGF）治疗新生血管性年龄相关性黄斑变性（nAMD）的患者在 5 年内停药的原因。
对未完成 5 年随访的接受抗 VEGF 治疗 nAMD 的患者进行回顾性病历回顾。记录停药原因、基线年龄、早期治疗糖尿病视网膜病变研究（ETDRS）字母中的基线视力（VA）以及最后一次随访时的 VA 变化。为死亡患者计算了特定年龄的全因死亡率。
在 1177 名患者中，有 551 名（46.8%）患者未能完成 5 年随访。停药的原因是死亡（251 例）、疾病稳定提前出院（110 例）、进一步治疗被认为无效（100 例）、未能就诊（15 例）、健康状况不佳（14 例）、患者选择（7 例）和转院（1 例）。在 53 例患者中，未记录停药原因。完成 5 年随访的患者的平均基线年龄（77.4 ± 7.8 岁，95%置信区间（CI）：76.8-77.9）明显低于因任何原因停止治疗的患者（82 ± 7.7 岁，95%CI：81.4-82.6）（P < 0.0001）。生存分析表明，基线 VA 不是停药的因素，但视力稳定性（与基线相比±5 个字母）与治疗的延续有关。死亡患者的特定年龄全因死亡率低于一般人群。
5 年后，只有 53%的患者仍在接受积极治疗，死亡是停药的最常见原因。较低的基线年龄和治疗期间的 VA 稳定性与治疗的延续有关。
