# Predictors of Disengagement and Loss to Follow-Up of Intravitreal Injection for Neovascular Age-Related Macular Degeneration in a Real-World Clinical Setting: Post Hoc Analysis of the Multicenter Survey from the Japanese Clinical Retinal Study (J-CREST) Group

## TL;DR

This study identifies factors linked to discontinuation of anti-VEGF therapy for neovascular age-related macular degeneration in real-world clinical settings.

## Contribution

The study reveals that poor initial visual acuity and PRN treatment regimens are significant predictors of treatment dropout.

## Key findings

- A 13% dropout rate was observed among patients after one year of anti-VEGF therapy.
- Poor initial visual acuity was significantly associated with higher odds of treatment discontinuation.
- PRN treatment regimen increased the risk of dropout compared to other regimens.

## Abstract

Background/Objectives: In a recent study, we investigated anti-VEGF treatment strategies for three subtypes of neovascular age-related macular degeneration (nAMD)—typical AMD (tAMD), polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP)—among a large cohort of Japanese patients. To further explore these findings, we conducted a post hoc analysis of this cohort to identify factors associated with the discontinuation of anti-VEGF therapy for nAMD in a real-world clinical setting. Methods: We collected medical records of patients newly diagnosed with nAMD who initiated intravitreal anti-VEGF antibody injection therapy. Patients were divided into two groups: those who continued anti-VEGF therapy for one year and those who discontinued treatment. Baseline best-corrected visual acuity, optical coherence tomography (OCT) findings, injection regimen, and the type of anti-VEGF antibody drug used were analyzed using univariate and multivariate analyses. Results: A total of 667 treatment-naïve nAMD patients initiated anti-VEGF agents and followed the therapy for 1 year. The one-year dropout rate in this study was 13%. Logistic regression analysis revealed that poor initial visual acuity and a PRN treatment regimen were significantly associated with higher odds of dropout. Age, gender, systemic factors, and the choice of intravitreal injection did not show any significant differences. Conclusions: Poor initial visual acuity and PRN treatment regimens may increase the risk of treatment dropout and should be carefully monitored.