Non-adherence and non-persistence to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy: a systematic review and meta-analysis

Systematic Reviews

Research

Sajid Mahmood¹  Sayeed Haque²  Alastair K. Denniston³  Lisa J. Hill⁴  Sean McGee⁴  Jessica Hubbard⁴  Vibhu Paudyal⁵  Zahraa Jalal⁵  Haris Shahzad⁶ 

[1] Deputy Drugs Controller, Specialized Healthcare and Medical Education Department, Lahore, Punjab, Pakistan;Institute of Applied Health Research, University of Birmingham, Birmingham, UK;National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK;Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK;Health Data Research UK, London, UK;School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;

关键词: Intravitreal;    Anti-VEGF;    COVID-19;    Non-adherence;    Non-persistence;    Macular;    Meta-analysis;   

DOI  :  10.1186/s13643-023-02261-x

 received in 2023-01-09, accepted in 2023-05-26,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIntravitreal anti-vascular endothelial growth factor (anti-VEGF) injections play a key role in treating a range of macular diseases. The effectiveness of these therapies is dependent on patients’ adherence (the extent to which a patient takes their medicines as per agreed recommendations from the healthcare provider) and persistence (continuation of the treatment for the prescribed duration) to their prescribed treatment regimens. The aim of this systematic review was to demonstrate the need for further investigation into the prevalence of, and factors contributing to, patient-led non-adherence and non-persistence, thus facilitating improved clinical outcomes.MethodsSystematic searches were conducted in Google Scholar, Web of Science, PubMed, MEDLINE, and the Cochrane Library. Studies in English conducted before February 2023 that reported the level of, and/or barriers to, non-adherence or non-persistence to intravitreal anti-VEGF ocular disease therapy were included. Duplicate papers, literature reviews, expert opinion articles, case studies, and case series were excluded following screening by two independent authors.ResultsData from a total of 409,215 patients across 52 studies were analysed. Treatment regimens included pro re nata, monthly and treat-and-extend protocols; study durations ranged from 4 months to 8 years. Of the 52 studies, 22 included a breakdown of reasons for patient non-adherence/non-persistence. Patient-led non-adherence varied between 17.5 and 35.0% depending on the definition used. Overall pooled prevalence of patient-led treatment non-persistence was 30.0% (P = 0.000). Reasons for non-adherence/non-persistence included dissatisfaction with treatment results (29.9%), financial burden (19%), older age/comorbidities (15.5%), difficulty booking appointments (8.5%), travel distance/social isolation (7.9%), lack of time (5.8%), satisfaction with the perceived improvement in their condition (4.4%), fear of injection (4.0%), loss of motivation (4.0%), apathy towards eyesight (2.5%), dissatisfaction with facilities 2.3%, and discomfort/pain (0.3%). Three studies found non-adherence rates between 51.6 and 68.8% during the COVID-19 pandemic, in part due to fear of exposure to COVID-19 and difficulties travelling during lockdown.DiscussionResults suggest high levels of patient-led non-adherence/non-persistence to anti-VEGF therapy, mostly due to dissatisfaction with treatment results, a combination of comorbidities, loss of motivation and the burden of travel. This study provides key information on prevalence and factors contributing to non-adherence/non-persistence in anti-VEGF treatment for macular diseases, aiding identification of at-risk individuals to improve real-world visual outcomes. Improvements in the literature can be achieved by establishing uniform definitions and standard timescales for what constitutes non-adherence/non-persistence.Systematic review registrationPROSPERO CRD42020216205.

【 授权许可】

CC BY   
© Crown 2023

【 图 表 】

41116_2023_37_Article_IEq250.gif

41116_2023_37_Article_IEq244.gif

41116_2023_37_Article_IEq238.gif

41116_2023_37_Article_IEq233.gif