Factors related to discontinuation of intravitreal injection for neovascular age-related macular degeneration in the clinical setting: A multicenter cohort study in Japan

Abstract

Purpose : We investigated the clinical features of neovascular age-related macular degeneration (nAMD) patients initiated with anti-VEGF therapy and followed for 1 year. Although treatment-naïve 621 patients newly diagnosed with nAMD were registered in this study, 102 patients failed to continue anti-VEGF therapy for 1 year excluding 19 patients who underwent cataract surgery after initiation of anti-VEGF therapy. In this post-hoc study, we conducted to elucidate factors related to discontinuation of anti-VEGF therapy in these patients.

Methods : This study was a multicenter retrospective cohort study conducted at nine tertiary referral centers in Japan, which are members of the Japanese Clinical Retinal Study (J-CREST) Group. We reviewed the medical records of 500 patients with nAMD who were able to continue anti-VEGF therapy for 1 year (continuation group) with those of 102 patients who discontinued treatment within o year (discontinuation group), and compared demographic data, visual acuity (VA) at baseline and 1 year after treatment, spectral domain-optical coherence tomography (SD-OCT) findings, underlying medical conditions, the treatment regimen, number of hospital visits, and number of intravitreal injections between the two groups of patients.

Results : There was no significant difference in age, gender, or nAMD type (typical AMD, polypoidal Choroidal Vasculopathy, or retinal Angiomatous Proliferation), but pretreatment logMAR VA and retinal thickness in the affected eye were significantly higher in the discontinuation group than in the continuation group (0.59 ± 0.56 vs. 0.42 ± 0.50 P = 0.0039, 403 ± 183 µm vs.348 ± 145 µm P = 0.0028 ). In the treatment regimen, continuation group was treated with pro re nata (PRN) in 267 patients (53.4%) and treat and extend (TAE) in 222 patients (44.4%), while discontinuation group was treated with PRN in 85 patients (83.3%) and TAE in 16 patients (15.7%). PRN was significantly higher in the discontinuation group than in the continuation group (P < 0.0001). Anti-VEGF agent used, number of hospital visits, or number of injections did not differ significantly between two groups.

Conclusions : This real-world study indicated that pretreatment retinal thickness and visual acuity, regardless of nAMD type or anti-VEGF drug, and PRN treatment regimen were associated with treatment discontinuation.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.