Faculty of Medicine and Health, University of Leeds, Leeds, UK.
Genentech, South San Francisco, California, USA.
Ophthalmologica. 2023;246(2):90-98. doi: 10.1159/000529446. Epub 2023 Feb 6.
The aim of the study was to investigate non-persistence with treatment for neovascular age-related macular degeneration (NvAMD) before day 720 (24 months) after initiation, explore associations with baseline characteristics and variation between sites.
Anonymised demographic and clinical data were extracted from electronic medical records at treating National Health Service (NHS) Trusts for NvAMD eyes starting intra-vitreal therapy from 2017 to 2018. Time to non-persistence with treatment, defined as no recorded attendance for either monitoring or treatment for a period ≥6 months, was visualised with a Kaplan-Meier survival plot. Associations with treatment non-persistence were investigated using a Cox proportional hazards model.
Analysis included 7,970 eyes of 7,112 patients treated at 13 NHS trusts. Censoring deaths and those eyes in which treatment was stopped permanently, the Kaplan-Meier analyses demonstrated survival figures of 77.7% for persistence with treatment to day 360 and 71.8% to day 720. Hazard ratios for non-persistence with treatment were reduced at 10 sites, relative to the reference, with first-treated eye status and with baseline acuity worse than or equal to LogMAR 1.0. Hazard ratios increased with younger age, in the presence of other ocular co-morbidities and with baseline acuity better than or equal to LogMAR 0.5. After an episode of non-persistence, visual acuity decreased by at least 0.1 and 0.3 LogMAR in 39% and 18% of eyes, respectively.
Non-persistence with treatment was common, especially in the first year of treatment, and was often associated with a decrease in visual acuity. Treatment site, baseline visual acuity, and age were the strongest predictors of treatment non-persistence before day 720. Understanding and addressing reasons for non-persistence are important to ensure that effective but expensive treatments are used cost-effectively and to maintain acuity. Variation in non-persistence between sites, even after adjustment for other variables, suggests that local factors in treatment provision may be particularly important.
本研究旨在调查在开始接受玻璃体内治疗后 720 天（24 个月）之前，新生血管性年龄相关性黄斑变性（NvAMD）患者治疗的非持续性情况，并探讨其与基线特征的相关性及各治疗点之间的差异。
本研究从 2017 年至 2018 年期间，在接受国家卫生服务（NHS）信托机构治疗的 NvAMD 患者的电子病历中提取了匿名的人口统计学和临床数据。无记录的监测或治疗期≥6 个月的患者被定义为治疗非持续性，并通过 Kaplan-Meier 生存图进行可视化。采用 Cox 比例风险模型对治疗非持续性的相关性进行了分析。
共纳入了 7112 名患者的 7970 只眼，这些患者均在 13 个 NHS 信托机构接受了治疗。在排除了死亡病例和那些永久性停止治疗的患者后，Kaplan-Meier 分析显示，治疗持续性的生存数据为：治疗至 360 天的比例为 77.7%，至 720 天的比例为 71.8%。与参考治疗点相比，在 10 个治疗点，首次治疗眼的状态以及基线视力等于或差于 LogMAR 1.0 的患者，其治疗非持续性的风险比降低。而年龄较小、存在其他眼部合并症以及基线视力等于或好于 LogMAR 0.5 的患者，其治疗非持续性的风险比增加。在发生一次治疗非持续性后，39%和 18%的患者视力至少下降了 0.1 和 0.3 LogMAR。
治疗非持续性很常见，尤其是在治疗的第一年，且通常与视力下降有关。治疗点、基线视力和年龄是 720 天前治疗非持续性的最强预测因素。了解并解决治疗非持续性的原因对于确保有效但昂贵的治疗能够以成本效益的方式使用并维持视力至关重要。即使在调整了其他变量后，各治疗点之间的非持续性差异仍存在，这表明治疗提供中的局部因素可能特别重要。
