Quantifying burden of intravitreal injections: questionnaire assessment of life impact of treatment by intravitreal injections (QUALITII)

Abstract

AimTo quantify the areas of burden experienced by patients requiring repeated intravitreal injections (IVI) in the management of exudative retinal diseases.MethodsThe validated Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections survey was administered to patients at four retina clinical practices across four US states. The primary outcome measure was Treatment Burden Score (TBS), a single score assessing overall burden.ResultsOf 1416 (n=657 age-related macular degeneration; n=360 diabetic macular oedema/diabetic retinopathy; n=221 retinal vein occlusion; n=178 other/uncertain) patients, 55% were women with an average age of 70 years. Patients most frequently reported receiving IVI every 4–5 weeks (40%). The mean TBS was 16.1±9.2 (range 1–48; scale of 1–54), and the TBS was higher in patients with diabetic macular oedema and/or diabetic retinopathy (DMO/DR) (17.1) compared with those with age-related macular degeneration (15.5) or retinal venous occlusive (15.3) (p=0.028). Though the mean level of discomfort was quite low (1.86) (scale 0–6), 50% of patients reported experiencing side effects more than half of the visits. Patients having received fewer than 5 IVI reported higher mean anxiety levels before (p=0.026), during (p=0.050) and after (p=0.016) treatment compared with patients having received more than 50 IVI. After the procedure, 42% of patients reported restrictions from usual activities due to discomfort. Patients reported a high mean satisfaction rating of 5.46 (scale 0–6) with the care of their diseases.ConclusionsThe mean TBS was moderate and highest among patients with DMO/DR. Patients with more total injections reported lower levels of discomfort and anxiety but higher disruption to daily life. Despite the challenges related to IVI, the overall satisfaction with treatment remained high.

Switching from a Fixed Monthly Aflibercept Regimen to Bi-Monthly Brolucizumab in Refractory Cases of Neovascular Age-Related Macular Degeneration

“…Tamiya et al reported that 56% of patients with aflibercept–refractory nAMD showed a reduction or complete absorption after switching to faricimab [ 33 ]. The treatment-resistant patients are at a particularly high risk of discontinuing treatment due to frustration with poor response and the need for frequent injections [ 34 , 35 ]. Initial positive responses usually decrease over time, which leads to increased pressure and reduced compliance, thereby resulting in adverse outcomes [ 36 ].…”

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“…As a result, FDA- and EMA-approved gene therapy products exist for a rare form of IRD, and so the technology offers hope in terms of developing treatments for ICDs. Presently, sub-retinal delivery is the accepted delivery route, though, in the longer term, the development of effective products that can be delivered via an intravitreal route is desirable, given the lower risk profile and commonality of the approach [ 92 , 93 ]). AAV vectors are commonly used for gene delivery as they allow for long-term gene expression from one injection and have low immunogenicity.…”

Calculated Drug Concentrations in Currently Available Intravitreal Therapies: Determination of Dilution Factor and Deviation From Recommended Doses

“…Intravitreal drug deliveries have revolutionized the treatment of many retinal diseases, including neovascular age-related macular degeneration (AMD), diabetic retinopathy (DR), and retinal vein occlusion [ 4 , 5 ]. Moreover, diseases like uveitis, endophthalmitis, and cystoid macular edema are common diseases that are treated by intravitreal injections [ 6 ].…”

“…According to market research data and the American Academy of Ophthalmology (AAO) News/Health Statistics, it is estimated that nearly seven million intravitreal injections are performed in the United States annually, making it one of the most commonly performed procedures in all of medicine [ 4 , 5 ]. The global intravitreal injectable (IVI) market valued at USD 17,559.91 million in 2023 is projected to reach USD 26,520.45 million by 2032, reflecting a compound annual growth rate (CAGR) of 4.16% [ 12 ].…”