Interruptions to intravitreal anti-VEGF therapy for neovascular AMD occurred among more than a quarter of patients in an Italian study.  

The multicentre retrospective analysis, published in the British Journal of Ophthalmology, included 2,298 individuals newly diagnosed with neovascular exudative AMD who commenced anti-VEGF therapy between January 2019 and December 2021. Investigators calculated overall discontinuation rates, assessed the probability of each cause over time and examined demographic and risk factors linked to the reasons for stopping. 

The team found 655 individuals (28.5%) ceased treatment during follow-up. Five main discontinuation categories were identified: patient decision against clinical advice; continuation of therapy at another clinic; clinical decision; systemic disease; and death. ‘Clinical decision’ was the most frequent cause and appeared to occur more often in the first two years of treatment, said researchers. 

Authors noted poorer visual acuity (VA) increased the likelihood of treatment being stopped through clinical decision. Younger individuals were more likely to discontinue by personal choice, whereas those with better VA and those living farther from the clinic were more likely to continue treatment at another centre. 

The authors said discontinuation in routine practice reflects a mix of clinician-driven, health-related and personal factors, emphasising the need for careful monitoring of patients at higher risk of stopping therapy.