Tracking real-world persistence and adherence to anti-VEGF intravitreal therapy with prefilled syringes: a German prescription sales analysis

Objective Intravitreal antivascular endothelial growth factor (anti-VEGF) therapy is the standard treatment for neovascular age-related macular degeneration and other retinal vascular diseases. Despite proven efficacy in clinical trials, real-world data suggest suboptimal persistence and adherence. This study aimed to assess therapy continuity in routine practice using pharmacy-based dispensing data in Germany, focusing on treatment with prefilled syringes (PFS). Methods and analysis This retrospective cohort study used anonymised nationwide pharmacy sales data from Germany to evaluate patients who initiated anti-VEGF therapy with PFS between 2020 and 2023. Patient trajectories were followed from treatment initiation for up to 12 months. 46 546 therapy beginners with 297 454 anti-VEGF PFS purchases were included. Discontinuation of treatment was defined by not purchasing a relevant medication for >6 months. Results Mean time on therapy for all patients was 8.1±8.2 months (median=5.5) with 6.9±6.1 purchases (median=5). 20.5% of patients initiating anti-VEGF treatment stopped therapy before completing the loading phase (first three injections), and more than half of all patients discontinued treatment after 6 months. 49.4% of the patients who completed the loading phase (n all=34 895) adhered to the recommended monthly regimen. Non-adherence significantly decreased the number of injections later on (average of 7.5 vs 8.7 injections). Further, patients who stayed longer on therapy bought more PFSs within the first 6 and 12 months. Conclusions Real-world adherence and persistence to intravitreal anti-VEGF therapy in Germany are suboptimal, even with the use of PFS formulation. The high rate of early treatment discontinuation, especially during the loading phase, underscores the need for improved patient support, education and flexible treatment approaches to sustain long-term outcomes. A ‘breaking point’ or sensitive phase already seems to exist right at the beginning of therapy.