What Drives Noncompliance to AMD Treatment?

Journal Highlights

Ophthalmology, February 2021

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In a literature review, Okada et al. examined factors that result in departure from clinical trial regimens (non-adherence) and lack of persistence in following recommended regimens (nonpersistence) in anti-VEGF injection therapy for neovascular age-related macular degeneration. They found myriad complex reasons for noncom­pliance, with the greatest overall barrier being treatment burden. Additional contributing factors included low base­line vision, poor treatment response, and concerns about COVID-19.

The authors evaluated publications that mention factors for nonadherence or nonpersistence to anti-VEGF ther­apy, as well as reports of strategies to address this matter. Cochrane review methods were applied to determine eligibility and to extract data, which were collated descriptively. Bias risk was estimated with the mixed-method as­sessment tool, and certainty of evidence was assessed using the GRADE tool.

Among the 37 full-text articles that met inclusion criteria, definitions of nonadherence and nonpersistence varied or were not stated. Up to 50% of patients stopped treatment within 24 months of starting it. Rates of nonad­herence were high, ranging from 32% to 95%. However, the certainty of this finding was deemed only moderate because of the differing definitions of nonadherence. Although many factors contributed to nonadherence and non­persistence, the most significant barrier to regimen compliance was treatment burden, including visit frequency and travel time. Condition-level factors with moderate evidence for nonadherence/nonpersistence were lower baseline vi­sion and poorer response to treatment.

Although some factors cannot be changed (such as comorbidities), others are potentially modifiable, the authors said. Evidence of strategies to improve treatment compliance is minimal, but what evidence there is shows such efforts to have been successful.

The original article can be found here.