Many Patients With Proliferative Diabetic Retinopathy Treated With Ranibizumab Skip Follow-Ups

By Linda Carroll

October 25, 2021

NEW YORK (Reuters Health) - More than half of the patients in a clinical trial evaluating ranibizumab for the treatment of proliferative diabetic retinopathy (PDR) skipped follow-up appointments, a new study shows.

The post hoc analysis of data from 170 adult participants in the trial who were treated with anti-vascular endothelial growth factor (VEGF) revealed that through five years of follow-up, 94 participants had one or more long lapses in care, researchers report published in JAMA Ophthalmology.

"Among the approximately 50% of participants who had a long lapse in care, the proportion of individuals with a loss of VA (visual acuity) of 15 or more letters was higher than in participants without a long lapse (14% vs. 3%); however, it is unclear whether these worse outcomes resulted from missed visits or were related to patient and/or eye characteristics that were more prevalent among participants who miss visits," Adam Glassman of the Jaeb Center for Health Research in Tampa, Florida, and colleagues write.

"Most (90%) participants in this study returned for at least one visit after their first lapse in care," the researchers write. "This finding suggests that clinicians may have opportunities to counsel returning patients about the importance of timely follow-up to optimize their outcomes."

Follow-up visits, the researchers explain, are needed to detect worsening retinopathy that may require additional injections.

To take a closer look at whether patients treated with VEGF comply with the follow-up visits needed for monitoring and repeat treatments, the researchers analyzed data from a clinical trial that enrolled 305 adults with PDR in 2012. Patients' eyes were randomly assigned to receive either panretinal photocoagulation (PRP) or ranibizumab. Follow-up visits for those treated with ranibizumab were scheduled ever four weeks during year 1 and every four, eight, 16 or 20 weeks thereafter depending on individual treatment course.

Among the 191 patients who had been assigned to receive ranibizumab, 21 died during the follow-up period, and the remaining 170 were included in the analysis. At baseline their median age was 51, and 45% were women.

Over five years, 26 of 170 (15.3%) patients had no lapses in care. Among the remaining patients, the median number of lapses in care was three. The median time to the first long lapse in care - defined as seight or more weeks past a scheduled examination - was 210 weeks, and 50 of 170 patients dropped out of follow-up by five years.

Among the 120 participants who completed the five-year examination, the median change from baseline in VA was minus two letters for those who had one or more long lapse as compared with plus five letters for those without a long lapse (P=0.02).

"This paper demonstrates how important it is for clinicians to factor in all aspects of patient care when it comes to deciding upon treatment options," said Dr. Avnish Deobhakta, a vitreoretinal surgeon at the New York Eye and Ear Infirmary of Mount Sinai in New York.

"Regardless of how well an intervention performs in theory, merely considering whether a patient can even make the appointments necessary for a given treatment to work should be of the utmost concern to any physician," Dr. Deobhakta, who was not involved in the study, told Reuters Health by email. "Indeed, this paper is noteworthy for showing that even in a controlled clinical trial setting, the prospect of a patient attending all envisioned visits might be that of a coin-flip, at best."

Glassman did not respond to requests for comment.

SOURCE: JAMA Ophthalmology, online October 21, 2021.