Risk Factors for Discontinuation of Treatment for Neovascular Age-Related Macular Degeneration

Purpose: To investigate risk factors for treatment discontinuation for neovascular age-related macular degeneration (nAMD). Methods: Data from the Swedish Macula Register and the Skane Healthcare Register are reported on the treatment received by 932 nAMD patients diagnosed 2013-2015. Treatment discontinuation is defined as having a termination visit or lacking a control or treatment visit during the period of 10-14months after the diagnostic visit. The risk of treatment discontinuation during the first year is estimated using a Poisson model and a classification tree. Results: 503 eyes (50.9%) discontinued the treatment within the first year. Patients with visual acuity below 60 ETDRS letters (20/60 Snellen) at baseline, serious comorbidities, or treated at the university hospital have a 42% (95% CI 25-61%, P<0.001), 27% (95% CI 13-43%, P=0.001) and 30% (95% CI 15-46%, P<0.001) increased risk to discontinue treatment compared with similar patients. Patients on ranibizumab therapy have a 45% (95% CI 28-63%, P<0.001) increased risk for treatment discontinuation during year 1 compared with patients on aflibercept therapy. The classification tree also shows that patients on ranibizumab therapy and those with low VA at baseline are at a higher risk of terminating treatment. Conclusions: Almost half of the patients starting anti-VEGF therapy discontinue treatment during the first year. Patients with risk factors may require additional support to continue with the treatment. Aflibercept therapy could be an alternative to patients at risk of treatment discontinuation.