Real-World Persistence with Anti-VEGF Therapy in Neovascular Age-related Macular Degeneration

INTRODUCTION: The purpose of this study was to quantify real-world non-persistence and non-adherence to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy among Chinese patients with neovascular age-related macular degeneration (nAMD) and to identify factors associated with treatment continuity in routine practice. METHODS: This single-center retrospective cohort study was conducted at a one-stop intravitreal injection (IVI) clinic (Dalian University Affiliated Zhongshan Hospital) and included consecutive patients initiating anti-VEGF therapy between 1 August 2022 and 1 August 2024 (N = 179). Non-persistence was defined as no visit or treatment for ≥ 6 months. Among patients remaining on therapy, non-adherence was defined as ≥ 2 visit or injection gaps > 16 weeks within any 12-month window. Cox proportional-hazards models were used for time-to-event analyses. RESULTS: The median age was 78 years (IQR 71-86 years), and 26% of patients received bilateral injections. Over a median follow-up of 383 days, 117 of 179 patients (65.4%) became non-persistent. Completion of the initial loading phase was associated with a lower hazard of discontinuation (adjusted HR 0.61, 95% CI 0.38-0.98), with similar estimates in prespecified sensitivity analyses. Among patients remaining on therapy (n = 62), 32.3% met criteria for non-adherence. In parsimonious models, increasing age was associated with a higher likelihood of extended treatment gaps, although this secondary finding was exploratory. CONCLUSION: In this pro re nata (PRN)-managed cohort, loss to follow-up was frequent, and one-third of persistent patients experienced clinically meaningful schedule deviations. Early treatment regularity-particularly completion of the loading phase-was the most actionable factor associated with improved persistence. Associations between older age and non-adherence highlight the need to address age-related barriers to sustained care, but should be interpreted cautiously given the exploratory nature of this secondary endpoint. Strategies focusing on early phase support and burden reduction may help narrow the real-world efficacy gap in nAMD management.