Long-term persistence to aflibercept therapy among treatment-naïve patients with exudative age-related macular degeneration in a universal health care system: A retrospective study

Background: This study aimed to analyse the persistence rates of treatment-naïve patients with neovascular age-related macular degeneration (nAMD) that received intravitreal aflibercept therapy in a universal health care system. Methods In this single-centre retrospective cohort study, we audited data of 918 treatment-naïve patients that received exclusively intravitreal aflibercept therapy for nAMD between September 2015 and May 2021. Primary outcome measures were nonpersistence (gap of ophthalmological care > 6 months) and long-term nonpersistence (> 12 months) rates. Results The rates of nonpersistence and long-term nonpersistence were 12.3% and 3.4%, respectively, after one year and 22.4% and 9.5%, respectively, after two years; and increased to 38.3% and 19.3%, respectively, after five years. Logistic regression analysis revealed that older age (p = 0.045), male patients (p = 0.039), patients requiring caretakers or ambulance (p = 0.001), and patients with a low visual acuity of the study eye (p = 0.010) or fellow eye (p = 0.029) were independent risk factors for long-term nonpersistence. Patients aged > 80 and > 85 years (p = 0.013 and p = 0.022, respectively) had more than twice the risk for being nonpersistent to therapy within two years of follow-up. Male patients (p = 0.033), patients requiring caretaker (p = 0.038), and patients living > 60 km from the clinic (p = 0.029) had a two times higher risk of being persistently nonpersistent to therapy. Conclusions We found a lower nonpersistence rate in patients with nAMD treated with aflibercept compared to that of current literature. Multiple independent risk factors were correlated with long-term nonpersistence, early nonpersistence, or complete loss to follow-up. Considering the possible consequences of reduced compliance, further strategies are urgently needed for patients at risk of nonpersistence to therapy.