Conclusions
nAMD
This 48-month analysis of the RAINBOW study of the real-world use of IVT-AFL in France to treat nAMD demonstrated a lack of long-term effectiveness due to undertreatment and poor persistence. The treatment frequency for all cohorts, including the regular cohort, was at the discretion of the treating physician, and progressive undertreatment after the first year resulted in the loss of initial vision gains. Treatment-naïve patients who received 3 initial monthly IVT-AFL injections followed by regular treatment over the first 12 months showed a trend of improved functional outcomes over 48 months compared with patients who received irregular treatment without the initial injections. Further, patients who received the 3 initial monthly IVT-AFL injections were much more likely to persist with treatment than those who did not. Arguably, patients are more likely to persist with treatment when they are achieving positive outcomes, and patients are more likely to achieve positive outcomes if they persist with treatment; we cannot definitively separate these effects. Overall, the initial monthly injections followed by continuous proactive treatment beyond the first year appear to be key to achieving optimal real-world functional outcomes with IVT-AFL in patients with nAMD. Future studies need to examine the factors underlying poor persistence and undertreatment and explore ways in which to promote regular treatment in routine clinical practice in France. For example, patient education to manage expectations may be necessary, to emphasize that regular treatment is needed to achieve improved outcomes.