Persistence and Adherence With Topical Glaucoma Therapy

• Published in: American journal of ophthalmology 2005-10, Vol.140 (4), p.598.e1-598.e11
• Main Authors: Nordstrom, Beth L., Friedman, David S., Mozaffari, Essy, Quigley, Harry A., Walker, Alexander M.
• Format: Article
• Language: English
• Subjects: Administration, Topical; Adrenergic alpha-Agonists - administration & dosage; Adrenergic beta-Antagonists - administration & dosage; Adult; Age; Aged; Antihypertensive Agents - administration & dosage; Biological and medical sciences; Carbonic Anhydrase Inhibitors - administration & dosage; Codes; Cohort Studies; Databases, Factual; Drug Prescriptions - statistics & numerical data; Drug Utilization - statistics & numerical data; Female; Gender; Glaucoma; Glaucoma and intraocular pressure; Glaucoma, Open-Angle - drug therapy; Humans; Hypertension; Insurance, Health - statistics & numerical data; Intraocular Pressure; Male; Medical sciences; Middle Aged; Miscellaneous; Ocular Hypertension - drug therapy; Ophthalmology; Patient Compliance - statistics & numerical data; Prostaglandins - administration & dosage; Retrospective Studies; Self Administration; Studies; Survival analysis; Time Factors
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2005.04.051

The present study describes the patterns and predictors of treatment persistence and adherence among patients who are diagnosed with glaucoma or as glaucoma suspects (based on claims codes). A retrospective cohort study using health insurance claims data. Newly treated individuals with diagnosed glaucoma (n = 3623) and suspect glaucoma (n = 1677) were obtained from healthcare claims data in the Ingenix Research Database. For each of these two diagnostic groups, we calculated the duration of continuous treatment with the initially prescribed medication (persistence) and the prevalence of use of the initial medication at various time points (adherence). Four drug classes were included: β-blockers, α-agonists, carbonic anhydrase inhibitors, and prostaglandin analogs. Nearly one half of the individuals who had filled a glaucoma prescription discontinued all topical ocular hypotensive therapy within six months, and just 37% of these individuals recently had refilled their initial medication at three years after the first dispensing. Prostaglandins were associated with better persistence than any other drug class, which was indicated by hazard ratios for discontinuation of prostaglandins compared with β-blockers of 0.40 (95% confidence interval, 0.35–0.44) for diagnosed patients and 0.44 (95% confidence interval, 0.37–0.52) for patients with suspect glaucoma. Prostaglandins showed a similar advantage in adherence. Furthermore, patients with diagnosed glaucoma were more likely to adhere to therapy than patients with suspect glaucoma (relative risk = 1.11; 95% confidence interval, 1.05–1.18). Persistence and adherence were substantially better with prostaglandins than with other drug classes, and patients with diagnosed open-angle glaucoma were more likely to adhere to treatment than suspected glaucoma.