Patterns of treatment discontinuation in patients receiving anti-vascular endothelial growth factor for neovascular age-related macular degeneration

Purpose: To report the reasons for treatment discontinuation within 5 years in patients receiving intravitreal anti?vascular endothelial growth factor (anti?VEGF) therapy for neovascular age?related macular degeneration (nAMD). Methods: A retrospective case?notes review of patients commenced on anti?VEGF for nAMD who failed to complete 5 years of follow?up was undertaken. The reasons for treatment discontinuation, baseline age, baseline visual acuity (VA) in Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and the VA change at the last follow?up were recorded. Age?specific all?cause mortality was calculated for deceased patients. Results: Of the 1177 patients, 551 patients (46.8%) failed to complete the 5?year follow?up. The reasons for treatment discontinuation were death (251), early discharge due to stable disease (110), further treatment deemed futile (100), failure to attend (15), ill health (14), patient choice (7), and transfer of care (1). In 53 patients, no reason was documented. The mean baseline age of those who completed the 5?year follow?up (77.4 ± 7.8 years, 95% confidence interval (CI): 76.8–77.9) was significantly lower than those who discontinued the treatment for any reason (82 ± 7.7 years, 95% CI: 81.4–82.6) (P < 0.0001). Survival analysis showed that baseline VA was not a factor in treatment discontinuation; however, visual stability (±5 letters from baseline) was associated with treatment continuation. The age?specific all?cause mortality in deceased patients was lower than that in the general population. Conclusion: At 5 years, only 53% of patients remained in active care, and death was the most common reason for treatment discontinuation. Lower baseline age and VA stability during therapy were associated with treatment continuation.

Current Challenges in Osteoporosis Treatment Discontinuation

@#Osteoporosis is a chronic disease that may require lifelong therapy. Therefore, evidence-based approach regarding the efficacy and safety of long‐term osteoporosis therapy and therapy discontinuation is important. The most important goals for osteoporosis and fragility fracture patients are the recovery of pre-fracture functional level and reduction of fracture risk. There has been increasing consensus that a treat-to-target (T2T) strategy is applicable to osteoporosis and that bone mineral density (BMD) is currently the most clinically appropriate target. However, there is no clear consensus with regard to the definition of a specific BMD treatment target and timeframes applicable to T2T in osteoporosis, and these would need to be individually determined. Treatment with bisphosphonates may be interrupted after 3-5 years, only in patients in whom fracture risk is low or lowered because of the treatment itself. It is recommended never to discontinue treatment in patients with one or more prevalent osteoporotic fractures or in whom the BMD values are still below -2.5 (T score). Recent reports imply that denosumab discontinuation may lead to an increased risk of multiple vertebral fractures. Patients considered at high fracture risk should either continue denosumab therapy for up to ten years or be switched to an alternative treatment. For patients at low-risk, a decision to discontinue denosumab could be made after five years, but bisphosphonate therapy should be considered to reduce or prevent the rebound increase in bone turnover.

Motivo de abandono del tratamiento desde la perspectiva del paciente con un trastorno de la conducta alimentaria / Reason for treatment abandonment from the perspective of the patient with an eating disorder

Los tratamientos psicológicos y farmacológicos para los trastornos de la conducta alimentaria comportan costes personales y sanitarios. En este trabajo estudiamos los diferentes motivos que pueden estar asociados al abandono en ambos tipos de tratamientos en pacientes diagnosticados con un trastorno de la conducta alimentaria, así como el tipo de abandono: abandono tras evaluar, abandono precoz y tardío. Por otro lado, analizamos si existe alguna relación entre el diagnóstico y el tipo de abandono. Se examinaron diversas características (edad, sexo, diagnóstico, motivos y tipos de abandono, y satisfacción respecto a la unidad de trastornos de la conducta alimentaria) en 212 pacientes atendidos en un servicio especializado en el tratamiento de trastornos de la conducta alimentaria durante un periodo de dos años. Nuestros datos apoyan la hipótesis de que el tipo de abandono de los tratamientos más frecuente es de tipo tardío, motivado por la mejoría del trastorno de la conducta alimentaria, mientras que no se verifica que exista relación alguna entre el diagnóstico y el tipo de abandono. Nuestros resultados indican que los motivos de abandono son heterogéneos. Se pueden establecer dos perfiles diferenciados de abandono; uno ligado a la mejoría y a los impedimentos físicos temporales, y otro relacionado con motivos diversos.

Psychological and pharmacological treatments for eating disorder involve personal and health costs. In this paper we study the various reasons that may be associated to abandonment in both types of treatments in patients diagnosed with a disorder of eating behavior and the kind of neglect: neglect after evaluation, early and late abandonment. On the other hand, we analyze whether there is any relationship between the diagnosis and the type of abandonment. Various characteristics (age, sex, diagnosis, motives and types of neglect, and satisfaction with the unit eating disorder) in 212 patients treated at a specialized service in the treatment of eating disorder were examined during a period of two years. Our data support the hypothesis that the rate of abandonment of the most common treatments is delayed type, motivated by the improvement of the disorder of eating behavior, while no verified that there is some relationship between the diagnosis and the type of abandonment. Our results indicate that the reasons for dropping out are heterogeneous. You can set two different profiles of dropouts, one linked to improvement and to temporary disability, and other related tovarious reasons

Reason for Clozapine Discontinuation / 대한정신분열병학회지

OBJECTIVES: Approximately 30% of individuals diagnosed with schizophrenia suffer from treatment-resistant schizophrenia. Clozapine is underutilized in the management of treatment-resistant schizophrenia. To understand contributing factors, we analyzed the time course and causes of clozapine discontinuations that occurred over a 20-year period in a clinical setting. METHODS: The reasons for discontinuation and duration of clozapine treatment from a retrospective database of 138 patients with schizophrenia who had prescribed clozapine at least a month were reviewed, with the motives for discontinuation coded. The causes for termination were analyzed. RESULTS: Over two-thirds of the patient had ceased clozapine. The two most common causes for discontinuation were side-effects (50%), and own decision (30%). Somnolence accounted for 34% of all side-effects induced discontinuations. Hematological problems accounted for 23% of side-effect. The Maximal treatment dose of clozapine was higher in continuation group (442.36 mg) than in discontinuation group (397.26 mg). The CGI-S score when prescribing clozapine last was higher in discontinuation group than in continuous group. The patients who took atypical antipsychotics before clozapine tended to cease clozapine because of side-effects than who took typical agent. CONCLUSION: Future studies should seek various methods to relieve side-effects of clozapine. Prospective researches using more objective tools are needed to clarify the reason for clozapine discontinuation.

The Rate and Risk Factors of Early Discontinuation of Antidepressant Treatment in Patients with Major Depressive Disorder / 대한정신약물학회지

OBJECTIVE: Although clinical guidelines for major depressive disorder (MDD) recommended sufficient duration of treatment, many patients discontinue antidepressant medication early in the course of treatment in clinical practice. In this study, we investigated the rate of early treatment-discontinuation and risk factors related to the discontinuation. METHODS: Medical records of 400 outpatients were reviewed. Patients who were diagnosed as MDD according to the DSM-IV criteria and were prescribed a single antidepressant were included in this study. Information on age, sex, education, marital status, job, disease recurrence, clinical severity and type of antidepressant medications were obtained. The rate of early treatment-discontinuation and factors leading to early discontinuation were also investigated. RESULTS: Data of 354 patients were analyzed. Mean age was 50.6+/-15.9 years and female patients were 225 (63.6%). Treatment-discontinuation rate was 29.1% at 2 weeks and 43.5% at 6 weeks. Logistic regression analysis demonstrated that severity of depression decreased the risk of treatment-discontinuation at 2 weeks. Other clinical factors and type of antidepressant medications did not affect the risk of early treatment-discontinuation. CONCLUSION: This study shows that the rate of early treatment-discontinuation is high in patients with MDD in usual clinical practice. Considering chronicity and high relapse rate of MDD, education programs to enhance drug compliance in patients and their family are needed to reduce early treatment-discontinuation in MDD patients.