Age, race, ethnicity, and insurance status were among factors found to correlate with loss to follow-up (LTFU) or nonpersistence to treatment among patients receiving anti-VEGF therapy for neovascular age-related macular degeneration (AMD), according to this large-scale retrospective study.
Study design
This was a retrospective cohort study using data from the IRIS Registry. A total of 156,327 patients (185,138 eyes) with a new diagnosis of neovascular AMD who were treated with anti-VEGF therapy from 2013 through 2015 and followed through 2019 were included. The rates of patients who were LTFU or had nonpersistence to treatment were calculated and risk factors were assessed; LTFU was defined as having had no follow-up within 12 months of the last intravitreal injection, whereas nonpersistence was defined as lack of follow-up within 6 months of the last intravitreal injection.
Outcomes
During the study period, 11.6% of patients with treatment-naïve neovascular AMD were LTFU, and 14.3% of patients were nonpersistent with treatment. Older age and Black race were associated with increased odds of both LTFU and nonpersistence. Medicaid insurance status and Hispanic ethnicity were also risk factors for LTFU and nonpersistence, respectively.
Limitations
Limitations of the study include its retrospective nature as well as the assumption that electronic health record coding was accurate, complete, and reflective of the population. Moreover, the study period occurred prior to the COVID-19 pandemic, so the risk factors and the magnitude of loss to follow-up or nonpersistence may now be different.
Clinical significance
Early and consistent treatment for neovascular AMD is necessary for achieving the best visual outcomes. Despite this, approximately 1 out of every 9 patients with neovascular AMD were LTFU in the study period. Awareness of potential risk factors for LTFU and nonpersistence and making efforts to improve compliance, especially in patients with risk factors, are warranted to improve patient care and outcomes.
Financial Disclosures: Dr. M. Ali Khan discloses financial relationships with Allergan, Apellis Pharmaceuticals, Genentech (Consultant/Advisor); Regeneron Pharmaceuticals (Grant Support).