Anti-VEGF Therapy Places Time-Related Burden on Patients with nAMD

An analysis of treatment burden related to anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD) revealed a significant time-related burden, due to shortened treatment intervals, but no issues with transportation to receive injections.¹

However, the study of an eye care clinic in Sweden revealed lower self-rated vision was associated with discomfort related to nAMD treatment, with investigators also noting a surprising association between longer treatment intervals and a higher risk of discomfort.

“A possible explanation is that patients with shorter intervals may be more used to the clinic and the treatment,” wrote the investigative team, led by Erik Vinge, department of ophthalmology, Höglandssjukhuset Eksjö. “It is also possible that short treatment intervals have a psychologically calming effect on patients, and they have the feeling that they are more closely observed if anything bad were to happen.”

Intravitreal anti-VEGF injections have transformed treatment for nAMD, allowing patients to maintain vision and keep their autonomy and quality of life. However, anti-VEGF therapy can require numerous resources and repeat injections every 1–3 months, often for the rest of a patient’s life. Alongside considerable costs of the medication, treatment can incur indirect costs, including transportation, and can be associated with anxiety and discomfort for patients.

A modern concept in medicine, treatment burden is often defined as the actions and resources patients devote to their healthcare. In nAMD, this can include the psychological and physical efforts of patient and their caregivers during treatment, with this analysis focusing on the time devoted to care.² Vinge and colleagues indicated the need for and importance of the balance between the potential for an increase in quality of life and the cost of undergoing treatment.¹

The cross-sectional, non-interventional study set out to map the treatment burden for patients with ongoing treatment with anti-VEGF for nAMD at a Swedish eye clinic in 2021. The clinic is responsible for the treatment of nAMD in an area of approximately 118,000 people, suggesting the majority of patients had to travel to the clinic.

The recruitment for the study was performed at random among those undergoing active treatment. Study participants then answered a survey about the time spent receiving treatment, caregiver assistance, way of transportation, and self-rated vision, as well as negative experiences associated with nAMD treatment, including discomfort, anxiety, or transportation issues. Medical records were used to obtain information on current visual acuity, treatment start date, number of treatments, and current treatment interval.

Multivariate logistic regression analysis was performed to identify potential risk factors for negative experiences associated with anti-VEGF treatment. The study recruited 93 patients, with an average age of 79.9 years, and consisted of 68% women. The median number of previous treatments was 23 injections, with a mean previous treatment duration of 3.3 years.

Active bilateral treatment was reported in 26% of patients; the average interval between treatments was 7.3 weeks. On average, study participants had to spend 2.7 hours per treatment (95% CI, 2.4 - 2.9), with caregiver assistance required in 58% of cases. The average time for caregivers per visit was 2.6 hours (95% CI, 2.5 - 2.8), with 19% needing to take time off work.

Patients rated their vision as excellent or good in 41% of cases, and bad or very bad in 19% of cases. The proportion of those who experienced discomfort or anxiety was 22% and 14%, respectively. Most patients (91%) did not experience any problems with transportation to the eye clinic for treatment.

Investigators indicated the multivariate analysis revealed a significantly lower odds ratio for discomfort with higher self-rated vision, and a significantly higher odds ratio for discomfort with longer treatment intervals.

“In future studies, it could therefore be interesting to evaluate if close examinations of patients with nAMD, even when treatment is not needed, would have the same effect,” they wrote.

References

1. Vinge E, Bro T. Treatment burden on patients receiving intravitreal anti-VEGF for wet age-related macular degeneration [published online ahead of print, 2023 Oct 6]. Acta Ophthalmol. 2023;10.1111/aos.15783. doi:10.1111/aos.15783
2. Alsadah, A., van Merode, T., Alshammari, R. & Kleijnen, J. (2020) A systematic literature review looking for the definition of treatment burden. Heliyon, 6, e03641.