Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration: A...

Area of Science:

• Ophthalmology
• Retinal Diseases
• Pharmacology

Background:

• Nonadherence and nonpersistence to anti-VEGF injections are significant barriers in treating neovascular age-related macular degeneration (nAMD).
• Optimizing real-world outcomes for nAMD patients is hindered by poor treatment adherence.
• Factors contributing to nonadherence and strategies to improve it are not well understood.

Purpose of the Study:

• To systematically review risk factors for nonadherence and nonpersistence to intravitreal anti-VEGF therapy in nAMD.
• To identify factors influencing patient adherence and persistence with anti-VEGF treatment.
• To explore strategies for improving adherence and persistence in nAMD management.

Main Methods:

• Systematic review of studies reporting factors for nonadherence/nonpersistence and strategies to improve them.
• Cochrane review methods for trial eligibility and data extraction.
• Mixed Method Assessment Tool for risk of bias and GRADE for certainty of evidence.

Main Results:

• 37 studies met inclusion criteria; definitions of nonadherence/nonpersistence varied.
• High rates of nonpersistence (up to 50% by 24 months) and nonadherence (32-95%) were reported.
• Multiple factors (condition, therapy, patient, socio-economic, health systems) influence adherence; lower baseline vision and poor treatment response are key condition-related factors.

Conclusions:

• Awareness of adherence/persistence factors can identify at-risk patients and improve nAMD outcomes.
• Further research is needed for uniform definitions and high-quality, implementable interventions.
• Addressing modifiable factors like patient expectations and logistical barriers is crucial for enhancing treatment adherence.