Exploring patient acceptability of emerging intravitreal therapies for Geographic Atrophy: a mixed-methods study

Abstract

Purpose: The acceptability of emerging intravitreal therapies for GA (that can slow down, but not stop or reverse, GA progression) is currently unknown. This study therefore aimed to: investigate whether regular intravitreal injections will be acceptable as treatment for GA patients; identify which attributes of current treatments in late stage development patients find less acceptable; and explore whether patient-related factors influence GA treatment acceptability. Design: Exploratory, cross-sectional, mixed-methods study. Participants: 30 UK-based individuals with GA secondary to AMD, recruited from two London-based hospitals, interviewed in April-October 2021. Methods: Participants responded to a structured questionnaire, as well as open-ended questions in a semi-structured interview. Quantitative data were analysed using descriptive statistics and non-parametric measures of correlation. Qualitative data were analysed using the Framework Method of analysis, using the Theoretical Framework of Acceptability to guide deductive analysis. Main outcome measures: Main quantitative measures were Likert-type scale responses about acceptability of GA treatments. Qualitative outcomes of interest related to participants' hopes, concerns and understanding of the proposed new intravitreal treatments for GA. Results: Twenty participants (67%) were female, and median (interquartile range (IQR)) age was 83 (78, 87) years. 37% of participants had centre-involving GA, and better eye median (IQR) logMAR visual acuity was 0.30 (0.17, 0.58). Data suggested that 18 participants (60% (95% CI: 41-79%)) would accept the treatment at any cost, despite their awareness of the drawbacks. Eight participants (27% (95% CI: 10-43%) were ambivalent or undecided about treatment, and four (13%) (95% CI: 0-26%)) would be unlikely to accept treatment. Qualitative data indicated that participants' prioritisation of continuation with vision-specific activities influenced treatment acceptability. Conversely, factors limiting acceptability clustered around: the limited magnitude of treatment efficacy; concerns about side effects or the increased risk of neovascular AMD; and the logistical burden of regular clinic visits for intravitreal injections. There were common misunderstandings regarding the likely effects of GA treatment. Conclusions: This exploratory study suggests that a majority of participants would be positive about intravitreal treatment for GA, even in spite of manifold burdens and inconveniences. Insights from this study will inform the development of a larger, UK-wide quantitative study on GA treatment acceptability.

Patient acceptability of intravitreal complement inhibitors in geographic atrophy (GA): protocol for a UK-based cross-sectional study

“…We have adapted the prevalidated generic TFA quantitative questionnaire using insights from our pilot mixed-methods study,23 our patient advisory group, expert clinical opinion and a literature review.…”

“…The process of developing the questionnaire and testing of content validity through involvement of patients and the public is the topic of a forthcoming paper, where we will discuss in detail how input from the patient advisory group helped transform and improve the questionnaire. The patient advisory group will also be involved when writing up and developing a lay summary of the findings, as took place for the writing up of the pilot study 23…”

“…We recently conducted a pilot mixed-methods qualitative cross-sectional study with 30 individuals diagnosed with GA to understand the impact these new therapies may have from a patient’s perspective 23. We sought to identify patient-related factors, contexts and circumstances that influence acceptability.…”

PEGylated therapeutics in the clinic

“…Palynziq™ is also considered as the first‐in‐class medication approved by the FDA 51 . The recent approval of Syfovre™ (pegcetacoplan) represents the first FDA‐approved treatment for geographic atrophy secondary to age‐related macular degeneration, a leading cause of blindness 52,53 …”