Incidence and reasons for discontinuation of anti-VEGF treatment in neovascular age-related macular degeneration

Abstract

Purpose: To explore the factors and frequency of interruptions in intravitreal treatment for patients with neovascular age-related macular degeneration (AMD) and to evaluate the demographic and clinical factors linked to the reasons for discontinuation.

Methods: In this multicentre study, patients who began anti-vascular endothelial growth factor (VEGF) treatment between January 2019 and December 2021 for treatment-naïve neovascular exudative AMD were retrospectively analysed. The overall incidence of treatment discontinuation, along with the rates for each specific cause, was calculated. The probability of each cause of discontinuation over time from the start of treatment, as well as the risk factors associated with each case, was also determined.

Results: 655 individuals (28.5%) discontinued intravitreal anti-VEGF therapy. Among the five main categories of causes for discontinuation (patient's decision against clinician's advice, continuation of therapy at another clinic, clinical decision, systemic diseases or death), clinical decision emerged as the most common reason for interruption. The qualitative evaluation of the Kaplan-Meier curves suggests a higher frequency of the clinical decision as a cause of discontinuation within the initial 2 years of treatment. Worse visual acuity increased the risk of discontinuation due to clinical decisions. Younger patients were more likely to stop anti-VEGF therapy by choice. Better visual acuity and longer distance from the clinic increased the likelihood of patients continuing treatment elsewhere.

Conclusions: The discontinuation of anti-VEGF treatment is common among individuals with neovascular AMD. Causes of discontinuation include not only clinician decisions but also those related to the patient's health and personal choices.

Keywords: Age-Related Macular Degeneration; Neovascularisation; Vascular Endothelial Growth Factor.

Figure 1. Flowchart of patients with neovascular age-related macular degeneration included in the final analysis.

Figure 2. Kaplan–Meier curves showing the probability to interrupt for a cause vs all other causes over time. The horizontal axis (time) represents time in days, and the vertical axis shows the probability of not being interrupted by the cause. The complement of the Kaplan–Meier curve shows a vertical drop in the presence of an event (interrupt for the cause).