Author: Nitin Maksane (India)
Co-authors: Maulik Bhavsar
Age-related macular degeneration (AMD) is a common chronic retinal disease with the global and Indian prevalence of 8.7% and ~3% respectively. The intravitreally administered anti-vascular endothelial growth factor (anti-VEGF) therapy is currently the mainstay treatment. However, there are still significant gaps and challenges in the treatment and management of nAMD, which pose barriers in achieving optimal outcomes for these patients. Few of the many considerations include individual patient characteristics or response to the anti-VEGF therapy, financial considerations, and inadequate patient adherence to the treatment and monitoring. Such factors highlight the substantial logistical, emotional, and financial burdens of the long-term, frequent intravitreal injections. Management of nAMD patients with personalized treatment approach has moderately helped overcome the challenges. For example, reducing the number of anti-VEGF injections per year by using alternative dosing regimens like pro re nata (PRN) or treat-and-extend (T&E) strategies in the specific nAMD patient population. Although there are several studies underlining the treatment burden and mitigation strategies, there is lack of India-specific studies exploring these aspects. Thus, the present survey was conducted to get insights from the Indian HCPs on the anti-VEGF dosing regimens, along with the status of and factors affecting the treatment adherence to the anti-VEGF therapy.
HCP-based survey conducted in 11 cities (metro and non-metro cities) across India in real-world settings.
This was a nationwide, cross-sectional, questionnaire-based survey conducted between August 2020 to October 2020. Total 222 HCPs comprising of retina specialists (n=122) and ophthalmologists (n=100) who manage patients with nAMD and administer intravitreal anti-VEGF injections were included. The survey was performed using a mix of computer-assisted personal interviews (75%) and computer assisted web-based or telephonic interviews (25%) for a duration of 30 to 35 minutes. The questionnaire used for the survey was checked for validity and reliability, and then used to collect data from the HCPs. The survey evaluated anti-VEGF therapy dosing regimens followed by the HCPs, patient adherence to the therapy, as well as frequency and reasons for the patient dropouts. This information was further analysed to compare the practice patterns among retina specialists and ophthalmologists, as well as across the four zones of India (North, East, West, South)
Each HCP managed 13% nAMD patients (14%: retina specialist; 12 % ophthalmologists) of the total patient pool per month. Most HCPs used PRN regimen (43%) followed by T&E (32%), the usage for PRN was relatively higher among retina specialists (45%) than the ophthalmologists (40%). The PRN regimen scored highest in the East (59%) and T&E scored highest in South (44%). In PRN regimen, ~70% patients were on 4-8 weeks dosing regimen. Similar trend was observed across all the zones, except for the South, where ~66% patients were on 6-12 weeks dosing regimen. In terms of treatment adherence, HCPs opined ~ 35% patients on anti-VEGF therapy dropped out before completing the ideal dosage (as decided after diagnosis based on the patient profile). Overall HCPs observed a slight improvement in vision (74%), affordability (71%), and symptomatic relief (67%) as the top three reasons for patients dropping out of an anti-VEGF therapy. Considering zonal trends, in East affordability (94%); for West a slight improvement in vision (53%) were ranked as the number 1 dropout reason by HCPs. The HCPs from North opined symptomatic relief (74%) to be the topmost dropout reason, while in South all the top three reasons scored equally (~51%).
The survey concluded that most of the HCPs preferred the use of anti-VEGF therapy on PRN basis for 4 to 8 weeks. Treatment dropouts were mainly driven by the patients experiencing slight improvement in vision, affordability of anti-VEGF therapy, and symptomatic relief from the nAMD.
I am an employee of Novartis India Limited