Adherence and Persistence with First-Line Therapy and Compliance with Glaucoma Guidelines Using Japanese Health Care/Pharmacy Claims Database

Abstract

Purpose: This study evaluated Japanese patients' adherence to first-line therapy and physicians' compliance with the guidelines (GLs) for glaucoma in daily practice. Methods: This retrospective, noninterventional cohort study used a Japanese health care/pharmacy claims database from 2011 to 2016. We compared adherence based on the primary outcomes assessed as proportion of days covered (PDC) and persistence between patients who received first-line monotherapy followed by secondline fixed-combination therapy (GL-compliant cohort) and those who received first-line fixed-combination therapy (GL-noncompliant cohort). Furthermore, we explored treatment patterns, glaucoma consultation, and key factors associated with GL noncompliance. Results: Among 11,666 patients who received first-line therapy, 1,183 (10.1%) and 542 (4.6%) were in the GLcompliant and GL-noncompliant cohorts, respectively. Prostaglandin (70.7%) and subsequent prostaglandin/b blocker (BB) (20.9%) within 12 months were most used by the GL-compliant cohort. Prostaglandin/BB (48.9%) and carbonic anhydrase inhibitor/BB (51.1%) were prescribed for the GL-noncompliant cohort. The mean PDC [standard deviation (SD)], persistence rate (95% confidence interval), and consultation (SD) over 12 months were 60.9% (34.0), 16.0% (14.0-18.1), and 5.23 (3.21) times, respectively, in the GL-compliant cohort and 59.7% (35.8), 22.0% (18.6-25.5), and 4.76 (3.19) times, respectively, in the GL-noncompliant cohort. No significant differences were observed between the 2 cohorts. No clinically relevant factor associated with GL noncompliance was found. Conclusions: Around 5% of patients were prescribed a fixed-combination eye drop as first-line therapy not in accordance with GLs. The similarity of adherence and persistence between the 2 cohorts indicates that first-line fixed-combination therapy could be considered for glaucoma treatment.

Initial medication adherence in newly diagnosed glaucoma patients: three adherence measures

“…Also, and as Wolfram et al [20] found, monotherapies, particularly with prostaglandins, and simplified treatment regimens lead to better adherence and persistence. In spite of fixed-combination eye drops may be a convenient treatment option for glaucoma patients according to the patients' medical needs, especially for those who are already at the severe glaucoma stage at the initial glaucoma consultation and need early IOP lowering treatment, for those who are relatively young and for whom it is important to delay blindness, or for those who need personalized medication due to their lifestyle [21] , the initial medication adherence for this anti-glaucoma drugs was lower than for the monotherapy drugs. Our results also show that younger patients were more likely to early discontinue their treatment, after the first dispensing.…”