Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients

Christoph Ehlken,1,2 Mandy Helms,1 Daniel Böhringer,1 Hansjürgen T Agostini,1 Andreas Stahl1 1Ophthalmology, Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, 2Ophthalmology, Eye Center, University Hospital Schleswig-Holstein, Campus Ki...

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Autores principales:	Ehlken C, Helms M, Böhringer D, Agostini HT, Stahl A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	AMD RVO DME adherence anti-VEGF Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/e0bc1a851b94451283f13bc9504d800a
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spelling	oai:doaj.org-article:e0bc1a851b94451283f13bc9504d800a2021-12-02T04:46:34ZAssociation of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients1177-5483https://doaj.org/article/e0bc1a851b94451283f13bc9504d800a2017-12-01T00:00:00Zhttps://www.dovepress.com/association-of-treatment-adherence-with-real-life-va-outcomes-in-amd-d-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Christoph Ehlken,1,2 Mandy Helms,1 Daniel Böhringer,1 Hansjürgen T Agostini,1 Andreas Stahl1 1Ophthalmology, Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, 2Ophthalmology, Eye Center, University Hospital Schleswig-Holstein, Campus Kiel, Germany Purpose: Real-life clinical outcomes of patients treated with anti-VEGF drugs for neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or macular edema secondary to branch retinal vein occlusion (BRVO) are often inferior to results from randomized clinical trials. This observational cohort study investigates treatment adherence and real-life clinical outcomes within the first year of treatment.Patients and methods: A total of 708 treatment-naïve patients (466 nAMD, 134 DME, and 108 BRVO) were included. Patients were followed with a PRN treatment protocol with three intravitreal injections (IVIs) and a series of 3 monthly injections in case of persistent or recurrent disease activity, as determined by monthly follow-up exams including optical coherence tomographies. Occurrence of gaps of >56 days between treatments or follow-up (nonadherence [NA]) and the reasons for NA (patient- or center-associated) as well as disease activity within the first 12 months of treatment were analyzed. Visual acuity (VA) as well as numbers and dates of optical coherence tomography and IVI were extracted from medical records.Results: NA occurred significantly more often in patients with DME (44%) than nAMD (32%) or BRVO (25%, p<0.01 between groups). NA was mainly patient-associated (nAMD: 80.0%, DME: 83.1%, BRVO: 70.4%, p=0.38 between groups). Patients with nAMD and DME and appropriate treatment/follow-up adherence had a better chance of significantly gaining or maintaining VA, respectively (19.9% vs 12.0% with 3-line-gain in nAMD and 1.3% vs 15.3% 3-line loss in DME; each p<0.05). NA did not correlate with VA outcomes in BRVO (3-line gain 30.9% vs 48.1% and 3-line loss 8.6% vs 7.4%; p>0.05).Conclusion: NA to treatment and follow-up regimens is a common problem in the management of patients with AMD and DME and limits clinical treatment outcomes under real-life conditions. Patients with DME have the highest risk of patient-associated NA, associated with a higher risk for significant VA loss. Keywords: AMD, RVO, DME, adherence, anti-VEGF, PRN, follow-upEhlken CHelms MBöhringer DAgostini HTStahl ADove Medical PressarticleAMDRVODMEadherenceanti-VEGFOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 12, Pp 13-20 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	AMD RVO DME adherence anti-VEGF Ophthalmology RE1-994
spellingShingle	AMD RVO DME adherence anti-VEGF Ophthalmology RE1-994 Ehlken C Helms M Böhringer D Agostini HT Stahl A Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients
description	Christoph Ehlken,1,2 Mandy Helms,1 Daniel Böhringer,1 Hansjürgen T Agostini,1 Andreas Stahl1 1Ophthalmology, Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, 2Ophthalmology, Eye Center, University Hospital Schleswig-Holstein, Campus Kiel, Germany Purpose: Real-life clinical outcomes of patients treated with anti-VEGF drugs for neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or macular edema secondary to branch retinal vein occlusion (BRVO) are often inferior to results from randomized clinical trials. This observational cohort study investigates treatment adherence and real-life clinical outcomes within the first year of treatment.Patients and methods: A total of 708 treatment-naïve patients (466 nAMD, 134 DME, and 108 BRVO) were included. Patients were followed with a PRN treatment protocol with three intravitreal injections (IVIs) and a series of 3 monthly injections in case of persistent or recurrent disease activity, as determined by monthly follow-up exams including optical coherence tomographies. Occurrence of gaps of >56 days between treatments or follow-up (nonadherence [NA]) and the reasons for NA (patient- or center-associated) as well as disease activity within the first 12 months of treatment were analyzed. Visual acuity (VA) as well as numbers and dates of optical coherence tomography and IVI were extracted from medical records.Results: NA occurred significantly more often in patients with DME (44%) than nAMD (32%) or BRVO (25%, p<0.01 between groups). NA was mainly patient-associated (nAMD: 80.0%, DME: 83.1%, BRVO: 70.4%, p=0.38 between groups). Patients with nAMD and DME and appropriate treatment/follow-up adherence had a better chance of significantly gaining or maintaining VA, respectively (19.9% vs 12.0% with 3-line-gain in nAMD and 1.3% vs 15.3% 3-line loss in DME; each p<0.05). NA did not correlate with VA outcomes in BRVO (3-line gain 30.9% vs 48.1% and 3-line loss 8.6% vs 7.4%; p>0.05).Conclusion: NA to treatment and follow-up regimens is a common problem in the management of patients with AMD and DME and limits clinical treatment outcomes under real-life conditions. Patients with DME have the highest risk of patient-associated NA, associated with a higher risk for significant VA loss. Keywords: AMD, RVO, DME, adherence, anti-VEGF, PRN, follow-up
format	article
author	Ehlken C Helms M Böhringer D Agostini HT Stahl A
author_facet	Ehlken C Helms M Böhringer D Agostini HT Stahl A
author_sort	Ehlken C
title	Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients
title_short	Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients
title_full	Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients
title_fullStr	Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients
title_full_unstemmed	Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients
title_sort	association of treatment adherence with real-life va outcomes in amd, dme, and brvo patients
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/e0bc1a851b94451283f13bc9504d800a
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Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients

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