TY - JOUR
T1 - Defining Nonadherence and Nonpersistence to Anti-Vascular Endothelial Growth Factor Therapies in Neovascular Age-Related Macular Degeneration
AU - Okada, Mali
AU - Wong, Tien Yin
AU - Mitchell, Paul
AU - Eldem, Bora
AU - Talks, S James
AU - Aslam, Tariq
AU - Daien, Vincent
AU - Rodriguez, Francisco J
AU - Gale, Richard
AU - Barratt, Jane
AU - Finger, Robert P
AU - Loewenstein, Anat
N1 - Funding Information:
reported nonfinancial support from Bayer Travel during the conduct of the study and personal fees from Bayer outside the submitted work. Dr Wong reported personal fees from Bayer, Roche/ Genentech, Novartis, Boehringer-Ingelheim, Genentech, Samsung, and Merck outside the submitted work. Dr Eldem reported personal fees from Bayer during the conduct of the study and personal fees from Bayer, Novartis, Allergan, and Roche outside the submitted work. Dr Talks reported personal fees from Bayer, Novartis, Allergan, and Alimera, all for advisory board participation, outside the submitted work. Dr Aslam reported personal fees from Bayer during the conduct of the study and personal fees from Bayer, Novartis, and Thea Pharmaceuticals and grants from Allergan outside the submitted work. Dr Rodriguez reported personal fees from Novartis, Bayer, Allergan, and Kodiak outside the submitted work. Dr Gale reported personal fees from Bayer during the conduct of the study and personal fees from Bayer and Novartis and grants from Bayer and Novartis outside the submitted work. Dr Barratt reported and unrestricted educational grant from Bayer Global outside the submitted work and being a member of the Vision Academy. Dr Finger reported personal fees from Bayer, Roche/ Genentech, Opthea, Allergan, Alimera, Ellex, and Novartis and grants from CentreVue and Novartis outside the submitted work. Dr Loewenstein reported grants from Allergan, Bayer, and Novartis and consulting with Notal Vision, Syneos Health, Beyeonics, and Roche outside the submitted work. No other disclosures were reported.
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Importance: Poor adherence or persistence to treatment can be a barrier to optimizing clinical practice (real-world) outcomes to intravitreal injection therapy in patients with neovascular age-related macular degeneration (nAMD). Currently, there is a lack of consensus on the definition and classification of adherence specific to this context.Objective: To describe the development and validation of terminology on patient nonadherence and nonpersistence to anti-vascular endothelial growth factor therapy.Design, Setting, and Participants: Following a systematic review of currently used terminology in the literature, a subcommittee panel of retinal experts developed a set of definitions and classification for validation. Definitions were restricted to use in patients with nAMD requiring intravitreal anti-vascular endothelial growth factor therapy. Validation by the full nAMD Barometer Leadership Coalition was established using a modified Delphi approach, with predetermined mean scores of 7.5 or more signifying consensus. Subsequent endorsement of the definitions was provided from a second set of retinal experts, with more than 50% members agreeing or strongly agreeing with all definitions.Main Outcomes and Measures: Development of consensus definitions for the terms adherence and persistence and a classification system for the factors associated with treatment nonadherence or nonpersistence in patients with nAMD.Results: Nonadherence was defined as missing 2 or more treatment or monitoring visits over a period of 12 months, with a visit considered missed if it exceeded more than 2 weeks from the recommended date. Nonpersistence was defined by nonattendance or an appointment not scheduled within the last 6 months. The additional terms planned discontinuation and transfer of care were also established. Reasons for treatment nonadherence and nonpersistence were classified into 6 dimensions: (1) patient associated, (2) condition associated, (3) therapy associated, (4) health system and health care team associated, (5) social/economic, and (6) other, with subcategories specific to treatment for nAMD.Conclusions and Relevance: This classification system provides a framework for assessing treatment nonadherence and nonpersistence over time and across different health settings in the treatment of nAMD with current intravitreal anti-vascular endothelial growth factor treatments. This may have additional importance, given the potential association of the coronavirus pandemic on adherence to treatment in patients with nAMD.
AB - Importance: Poor adherence or persistence to treatment can be a barrier to optimizing clinical practice (real-world) outcomes to intravitreal injection therapy in patients with neovascular age-related macular degeneration (nAMD). Currently, there is a lack of consensus on the definition and classification of adherence specific to this context.Objective: To describe the development and validation of terminology on patient nonadherence and nonpersistence to anti-vascular endothelial growth factor therapy.Design, Setting, and Participants: Following a systematic review of currently used terminology in the literature, a subcommittee panel of retinal experts developed a set of definitions and classification for validation. Definitions were restricted to use in patients with nAMD requiring intravitreal anti-vascular endothelial growth factor therapy. Validation by the full nAMD Barometer Leadership Coalition was established using a modified Delphi approach, with predetermined mean scores of 7.5 or more signifying consensus. Subsequent endorsement of the definitions was provided from a second set of retinal experts, with more than 50% members agreeing or strongly agreeing with all definitions.Main Outcomes and Measures: Development of consensus definitions for the terms adherence and persistence and a classification system for the factors associated with treatment nonadherence or nonpersistence in patients with nAMD.Results: Nonadherence was defined as missing 2 or more treatment or monitoring visits over a period of 12 months, with a visit considered missed if it exceeded more than 2 weeks from the recommended date. Nonpersistence was defined by nonattendance or an appointment not scheduled within the last 6 months. The additional terms planned discontinuation and transfer of care were also established. Reasons for treatment nonadherence and nonpersistence were classified into 6 dimensions: (1) patient associated, (2) condition associated, (3) therapy associated, (4) health system and health care team associated, (5) social/economic, and (6) other, with subcategories specific to treatment for nAMD.Conclusions and Relevance: This classification system provides a framework for assessing treatment nonadherence and nonpersistence over time and across different health settings in the treatment of nAMD with current intravitreal anti-vascular endothelial growth factor treatments. This may have additional importance, given the potential association of the coronavirus pandemic on adherence to treatment in patients with nAMD.
KW - Angiogenesis Inhibitors/administration & dosage
KW - Consensus
KW - Delphi Technique
KW - Humans
KW - Intravitreal Injections
KW - Macular Degeneration/drug therapy
KW - Medication Adherence
KW - Neovascularization, Pathologic
KW - Practice Patterns, Physicians'
KW - Signal Transduction
KW - Socioeconomic Factors
KW - Terminology as Topic
KW - Vascular Endothelial Growth Factor A/antagonists & inhibitors
U2 - 10.1001/jamaophthalmol.2021.1660
DO - 10.1001/jamaophthalmol.2021.1660
M3 - Article
C2 - 34081099
SN - 2168-6165
VL - 139
SP - 769
EP - 776
JO - JAMA Ophthalmology
JF - JAMA Ophthalmology
IS - 7
ER -
