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US Retina Specialists' Preferences for Geographic Atrophy Treatment
Karl Csaky1, Anthony M Pepio2, Caitlin Thomas3
1Ophthalmology Department, Retina Foundation of the Southwest, Dallas, TX, USA.
Purpose:
Two complement inhibitors are US-approved for geographic atrophy (GA) and other treatments are in development. We present the first quantitative assessment of retina specialists' (RS) preferences for GA treatment. We explored how GA treatment characteristics affect RS' preferences, the trade-offs RS are willing to make between them, and whether this varies across patient profiles.
Methods:
US-based RS with ≥7 years of clinical experience and ≥50 patients with GA in the previous year selected their best and second-best treatment recommendations for specific patient profiles in 12 tasks showing two hypothetical treatment options and no treatment (best-best discrete choice experiment, BB-DCE). Treatment characteristics comprised lesion growth rate reduction, three treatment risks (mild-to-moderate uveitis, progression to wet age-related macular degeneration [AMD], and retinal vasculitis), and intravitreal injection frequency (every month, every other month, and one-time [gene therapy]). Patient profiles were defined by GA lesion location and visual acuity. Preferences were evaluated using a mixed-logit model. Relative importance of each characteristic and trade-offs were analyzed.
Results:
Of 166 RS, 83.1% had experience treating GA with complement inhibitors. Improving lesion growth rate reduction from 10% to 50% had the greatest impact (almost half of decision-making). Among risks, reducing the chance of progressing to wet AMD from 15% to 1% had the greatest impact (~20% of decision-making). All else equal, RS preferred a one-time over monthly injection(s). Risk tolerance increased with higher lesion growth rate reduction and, to a lesser extent, with less frequent injections; risk tolerance was highest when considering patients with foveal-threatening GA lesions.
Conclusion:
Across patient profiles, RS prioritized lesion growth rate reduction over risks; intravitreal injection frequency was the least important. However, RS were more risk-tolerant with patients with foveal-threatening lesions. RS would tolerate slightly higher risks for a one-time over monthly injection(s) if lesion growth rate reduction was comparable.
