Causes of Treatment Discontinuation in Retinal Diseases Treated with Intravitreal Injections

Abstract

Purpose To determine the most common reasons for treatment discontinuation in patients with retinal diseases undergoing intravitreal injections (IVI s).

Methods A retrospective study was conducted with all patients who underwent IVI therapy in our Department of Ophthalmology between January 2016 and January 2024. We investigated the reasons for therapy discontinuation, including non-persistence (declining therapy). Patients who declined therapy (non-persistence) were compared with the remaining patients to determine the potential factors responsible for their decision.

Results The mean age of the 2218 patients (1155 women, 1063 men) who took part in the study was 77.6 ± 12.0 years. A total of 1029 patients (46.4%) achieved a dry macula in both eyes at the time of the study. Treatment was discontinued in 865 patients (39%) due to poor prognosis (visual acuity < 1.3 logMAR) (188, 8.4%), change to another medical centre (175, 7.9%), comorbid systemic diseases (128, 5.7%), loss of contact (128, 5.7%), financial problems with health insurance (13, 0.5%) or death (59, 2.6%), while 174 patients (7.8%) declined IVI therapy (non-persistence). Compared to the other patients, non-persistence patients were significantly older (76.2 ± 12 vs. 81.2 ± 11, p < 0.001), had significantly worse visual acuity (logMAR) at the last visit (0.50 ± 0.5 vs. 0.29 ± 0.2, p = 0.001), received a significantly higher number of IVI s (10 ± 11 vs. 14 ± 15, p < 0.001) and had a significantly higher proportion following the pro re nata treatment protocol (59% vs. 72%, p = 0.001).

Conclusion The most common reason for treatment discontinuation was the poor prognosis, which related to the nature of macular diseases. Advanced age, higher number of injections, pro re nata protocol and reduced visual acuity during therapy were identified as factors that affected patient non-persistence to treatment.

Zusammenfassung

Zweck Es sollten die häufigsten Gründe für einen Behandlungsabbruch bei Patienten mit Netzhauterkrankungen ermittelt werden, die sich einer intravitrealen Injektion (IVI) unterziehen.

Methoden Es wurde eine retrospektive Studie mit allen Patienten durchgeführt, die sich zwischen Januar 2016 und Januar 2024 einer IVI-Therapie in unserer Klinik für Augenheilkunde unterzogen. Wir untersuchten die Gründe für den Therapieabbruch einschließlich der Nicht-Persistenz (Therapieabbruch). Anschließend wurden die Patienten, die eine Therapie ablehnten (Nicht-Persistenz), mit den übrigen Patienten verglichen, um die möglichen Faktoren zu ermitteln, die für ihre Entscheidung verantwortlich waren.

Ergebnisse Das Durchschnittsalter der 2218 Patienten (1155 Frauen, 1063 Männer), die an der Studie teilnahmen, betrug 77,6 ± 12,0 Jahre. Insgesamt 1029 Patienten (46,4%) wiesen zum Zeitpunkt der Studie eine trockene Makula in beiden Augen auf. Die Behandlung wurde bei 865 Patienten (39%) aufgrund einer schlechten Prognose (Sehschärfe < 1,3 logMAR) (188, 8,4%), eines Wechsels in ein anderes medizinisches Zentrum (175, 7,9%), komorbider Systemerkrankungen (128, 5,7%), eines Kontaktverlusts (128, 5,7%), finanzieller Probleme mit der Krankenversicherung (13, 0,5%) oder des Todes (59, 2,6%) abgebrochen, während 174 Patienten (7,8%) eine IVI-Therapie ablehnten (Nicht-Persistenz). Im Vergleich zu den anderen Patienten waren die Nicht-Persistenz-Patienten signifikant älter (76,2 ± 12 vs. 81,2 ± 11; p < 0,001), hatten eine signifikant schlechtere Sehschärfe (logMAR) bei der letzten Visite (0,50 ± 0,5 vs. 0,29 ± 0,2; p = 0,001), erhielten eine signifikant höhere Anzahl von IVI s (10 ± 11 vs. 14 ± 15; p < 0,001) und hatten einen signifikant höheren Anteil, der dem Pro-re-nata-Behandlungsprotokoll folgte (59% vs. 72%, p = 0,001).

Schlussfolgerung Der häufigste Grund für den Abbruch der Behandlung war die schlechte Prognose, die mit der Art der Makulaerkrankung zusammenhing. Fortgeschrittenes Alter, eine höhere Anzahl von Injektionen, das Pro-re-nata-Protokoll und eine reduzierte Sehschärfe während der Therapie wurden als Faktoren identifiziert, die sich auf die Nicht-Persistenz der Behandlung auswirkten.

Conclusion Box

Already known:

• Discontinuation of treatment with intravitreal injections is still a major challenge in daily practice.

Newly described:

• The poor prognosis (visual acuity < 1.3 logMAR) was the most common reason for treatment discontinuation.

• Non-persistence to treatment (declining therapy) is not an uncommon reason for treatment discontinuation.

• Many factors have an impact on patient non-persistence to treatment, including advanced age, higher number of injections, following pro re nata protocol and reduced visual acuity during treatment.

Keywords

anti-VEGF therapy - retinal diseases - persistence - adherence - intravitreal injection

Schlüsselwörter

Anti-VEGF-Therapie - Netzhauterkrankungen - Persistenz - Adhärenz - intravitreale Injektion

Publication History

Received: 12 February 2025

Accepted: 05 August 2025

Article published online:
01 September 2025

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