Abstract
BackgroundPoor persistence with glaucoma therapy can lead to disease progression and subsequent blindness. Persistence with second-line glaucoma combination treatment in a Japanese real-world setting and whether it differed from fixed and unfixed combination drugs was investigated.MethodsThis was a retrospective, non-interventional, cohort study using data from a Japanese medical claims database. Patients with glaucoma aged ≥20 years with a first drug claim for glaucoma treatment between 01 July 2005 and 30 October 2014 and with data for > 6 months before and after this first prescription were included. The primary endpoint was duration of drug persistence among glaucoma patients with and without the use of fixed combination drugs in the year following initiation of second-line combination treatment.ResultsOf 1403 patients included in the analysis, 364 (25.94%) received fixed combination drugs and 1039 (74.06%) received unfixed combination drugs as second-line treatment. Baseline characteristics were generally comparable between the groups. A total of 39.01% of patients on fixed combination drugs, compared with 41.67% of patients on unfixed combination drugs, persisted on their glaucoma drugs 12 months post second-index date. Median persistence durations for the fixed combination drugs and unfixed combination drugs groups were 6 (95% confidence interval [CI]: 5–8) and 7 months (95% CI 6–9), respectively. Patients who received prostaglandin analogs (PGAs) were the most persistent with their treatment (n = 99, 12.84%). Patients diagnosed with primary open-angle glaucoma were less likely to experience treatment modification (hazard ratio [HR]: 0.800, 95% CI 0.649–0.986, P = 0.036), while those diagnosed with secondary glaucoma were more likely to experience treatment modification (HR: 1.678, 95% CI 1.231–2.288, P = 0.001) compared with glaucoma suspects.ConclusionsIn this retrospective claims database study, the persistence rate of second-line glaucoma combination treatment was low, with no difference in persistence between glaucoma patients receiving unfixed combination drugs compared with fixed combination drugs. Patients on PGA showed greater persistence rates compared with other treatments.
Highlights
Poor persistence with glaucoma therapy can lead to disease progression and subsequent blindness
In cases where monotherapy is deemed insufficient, combination therapy with two or more intraocular pressure (IOP)-lowering agents is recommended to achieve and maintain target IOP [8]
Patient disposition and baseline characteristics Of the 100,723 glaucoma patients identified from the Japan Medical Claim Data Center (JMDC), 1403 met the eligibility criteria and were included in the analysis (Fig. 2)
Summary
Poor persistence with glaucoma therapy can lead to disease progression and subsequent blindness. Persistence with second-line glaucoma combination treatment in a Japanese real-world setting and whether it differed from fixed and unfixed combination drugs was investigated. A life-long disease, is the leading cause of irreversible blindness in the world [1, 2]. This disease is characterized by a progressive neurodegeneration of the optic nerve and irreversible loss of retinal ganglion cells that results in visual field defects [3]. The Japan Glaucoma Society recommends monotherapy with topical IOP-lowering agents as first-line treatment for open-angle glaucoma (OAG) and ocular hypertension (OHT) [7]. There are four different fixed combinations of PGAs and BBs (PGA/BB) and two of CAIs and BBs (CAI/BB) [7]
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