Loss to Follow-up in Patients with Neovascular Age-Related Macular Degeneration Treated with AntieVEGF Therapy in the United States in the IRIS Registry

在《IRIS Registry》中接受抗血管內皮生長因子（anti-VEGF）治療的新生血管性老年性黃斑變性患者中的隨訪損失

中文摘要

本文呈現了一項回顧性的群體研究，旨在確定在美國接受抗血管內皮生長因子（anti-VEGF）注射治療的新生血管性老年性黃斑變性（AMD）患者中，失去隨訪（lost to follow-up, LTFU）和非持續性(nonpersistence)的發生率。該研究分析了IRIS（Intelligent Research in Sight）登錄的數據，包括2013年至2015年期間接受過抗VEGF治療的156,327名初次治療患者，並在2019年進行了隨訪。使用羅吉斯特迴歸模型，識別與LTFU和非持續性相關的風險因素。

研究發現，年齡增長、男性性別、單側受累、糖尿病、醫療補助保險和種族或族裔與LTFU和非持續性的可能性較高相關。初始視力（VA）較好和雙側受累的患者較不容易出現LTFU和非持續性。分析還顯示，與保持隨訪的患者相比，LTFU或非持續性的患者視力結果較差，有更高比例的患者出現視力喪失。

作者強調在新生血管性AMD患者中遵從治療和減少LTFU和非持續性的重要性，以預防視力喪失。他們建議應採取以患者為中心的策略，如與醫療專業人員的合作和患者教育計劃，以提高遵從治療和隨訪率。

需要注意的是，該研究存在一些限制，包括其回顧性的性質，依賴於易受數據錯誤影響的電子健康記錄，以及無法將LTFU狀態與患者死亡區分開來。研究結果也未考慮COVID-19大流行對醫療提供和遵從性的影響。

總之，本研究凸顯了接受抗VEGF治療的新生血管性AMD患者中的LTFU和非持續性發生率，並識別了相關的風險因素。研究結果強調了改善遵從治療和隨訪以預防這類患者視力喪失的干預措施的必要性。

English Abstract

This article presents a retrospective cohort study that aimed to determine the incidence of being lost to follow-up (LTFU, defined as no follow-up within 12 months from last intravitreal injection) and nonpersistence (defined as no follow-up within 6 months from last intravitreal injection) in patients with neovascular age-related macular degeneration (AMD) who were treated with anti-VEGF injections in the United States. The study analyzed data from the IRIS (Intelligent Research in Sight) Registry, including 156,327 treatment-naive patients with neovascular AMD who received anti-VEGF therapy from 2013 to 2015 and were followed up until 2019. Logistic regression models were used to identify risk factors associated with LTFU and nonpersistence.

The study found that increasing age, male sex, unilateral involvement, diabetes, Medicaid insurance, and race or ethnicity were associated with higher odds of being LTFU and nonpersistence. Patients with better initial visual acuity (VA) and bilateral involvement were less likely to be LTFU and nonpersistent. The analysis also revealed that patients who were LTFU or nonpersistent had worse VA outcomes compared to those who remained in follow-up, with a higher percentage experiencing vision loss.

The authors emphasize the importance of adherence and minimizing LTFU and nonpersistence to prevent vision loss in patients with neovascular AMD. They suggest that patient-centric strategies, such as allied health professional engagement and patient education initiatives, should be implemented to improve adherence and follow-up rates.

It should be noted that the study has some limitations, including its retrospective nature, reliance on electronic health records prone to data errors, and the inability to distinguish LTFU status from patient death. The findings also do not account for the impact of the COVID-19 pandemic on healthcare delivery and adherence.

In conclusion, this study highlights the rates of LTFU and nonpersistence in patients with neovascular AMD receiving anti-VEGF therapy and identifies associated risk factors. The findings underscore the need for interventions to improve adherence and follow-up in order to prevent vision loss in this patient population.