背景:玻璃体内注射抗血管内皮生长因子(抗VEGF)在治疗一系列黄斑疾病中起关键作用。这些疗法的有效性取决于患者对其规定治疗方案的依从性(患者根据医疗保健提供者的商定建议服用药物的程度)和持久性(在规定的持续时间内继续治疗)。本系统综述的目的是证明有必要对以下疾病的患病率进行进一步调查,以及促成的因素,患者主导的非依从性和非持久性,从而促进改善临床结局。
方法:在GoogleScholar中进行了系统搜索,WebofScience,PubMed,MEDLINE,还有Cochrane图书馆.在2023年2月之前进行的英语研究报告的水平,和/或障碍,纳入了对玻璃体内抗VEGF眼部疾病治疗的非依从性或非持久性.重复文件,文献综述,专家意见文章,案例研究,病例系列在由两名独立作者进行筛查后被排除.
结果:分析了52项研究的409,215名患者的数据。治疗方案包括prorenata,每月和治疗和延长方案;研究持续时间为4个月至8年。在52项研究中,22包括患者不坚持/不坚持的原因的分类。根据使用的定义,患者主导的非依从性在17.5%和35.0%之间变化。患者主导治疗非持续性的总体汇总患病率为30.0%(P=0.000)。不坚持/不坚持的原因包括对治疗结果不满意(29.9%),财政负担(19%),老年/合并症(15.5%),预约困难(8.5%),旅行距离/社会隔离(7.9%),缺乏时间(5.8%),对他们的状况感知改善的满意度(4.4%),害怕注射(4.0%),失去动力(4.0%),对视力冷漠(2.5%),对设施的不满2.3%,不适/疼痛(0.3%)。三项研究发现,在COVID-19大流行期间,非依从率在51.6%至68.8%之间,部分原因是担心接触COVID-19和封锁期间旅行困难。
结论:结果表明高水平的患者导致的抗VEGF治疗不坚持/不持续,主要是由于对治疗结果的不满,合并症的组合,失去动力和旅行负担。这项研究提供了有关黄斑疾病抗VEGF治疗不坚持/不持续的患病率和因素的关键信息,帮助识别有风险的个人,以改善现实世界的视觉结果。文献中的改进可以通过建立构成不遵守/不持久的统一定义和标准时间尺度来实现。
背景:PROSPEROCRD42020216205.
Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections play a key role in treating a range of
macular diseases. The effectiveness of these therapies is dependent on patients\' adherence (the extent to which a patient takes their medicines as per agreed recommendations from the healthcare provider) and persistence (continuation of the treatment for the prescribed duration) to their prescribed treatment regimens. The aim of this systematic review was to demonstrate the need for further investigation into the prevalence of, and factors contributing to, patient-led non-adherence and non-persistence, thus facilitating improved clinical outcomes.
Systematic searches were conducted in Google Scholar, Web of Science, PubMed, MEDLINE, and the Cochrane Library. Studies in English conducted before February 2023 that reported the level of, and/or barriers to, non-adherence or non-persistence to intravitreal anti-VEGF ocular disease therapy were included. Duplicate papers, literature reviews, expert opinion articles, case studies, and case series were excluded following screening by two independent authors.
Data from a total of 409,215 patients across 52 studies were analysed. Treatment regimens included pro re nata, monthly and treat-and-extend protocols; study durations ranged from 4 months to 8 years. Of the 52 studies, 22 included a breakdown of reasons for patient non-adherence/non-persistence. Patient-led non-adherence varied between 17.5 and 35.0% depending on the definition used. Overall pooled prevalence of patient-led treatment non-persistence was 30.0% (P = 0.000). Reasons for non-adherence/non-persistence included dissatisfaction with treatment results (29.9%), financial burden (19%), older age/comorbidities (15.5%), difficulty booking appointments (8.5%), travel distance/social isolation (7.9%), lack of time (5.8%), satisfaction with the perceived improvement in their condition (4.4%), fear of injection (4.0%), loss of motivation (4.0%), apathy towards eyesight (2.5%), dissatisfaction with facilities 2.3%, and discomfort/pain (0.3%). Three studies found non-adherence rates between 51.6 and 68.8% during the COVID-19 pandemic, in part due to fear of exposure to COVID-19 and difficulties travelling during lockdown.
Results suggest high levels of patient-led non-adherence/non-persistence to anti-VEGF therapy, mostly due to dissatisfaction with treatment results, a combination of comorbidities, loss of motivation and the burden of travel. This study provides key information on prevalence and factors contributing to non-adherence/non-persistence in anti-VEGF treatment for
macular diseases, aiding identification of at-risk individuals to improve real-world visual outcomes. Improvements in the literature can be achieved by establishing uniform definitions and standard timescales for what constitutes non-adherence/non-persistence.
PROSPERO CRD42020216205.