Comparison of adherence between fixed and unfixed topical combination glaucoma therapies using Japanese healthcare/pharmacy claims database: A retrospective non-interventional cohort study

Shirai, Chikako; Matsuoka, Nobushige; Nakazawa, Toru

doi:10.21203/rs.3.rs-47479/v2

Cited by 3 publications

(17 citation statements)

References 20 publications

(24 reference statements)

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“…Behandlungsjahr ein Adhärenzniveau von durchschnittlich 60 – 70% aufgrund der Anzahl an eingelösten Verschreibungen feststellen 15 , 16 . Es zeigt sich, dass in Japan Fixkombinationen mit 79,1% deutlich häufiger aus Apotheken abgeholt wurden als Nicht-Fixkombinationen (62,2%) 16 . Dichotomisiert auf ein PDC ≥ 80% zeigt sich, dass nur etwa 50% der Patienten eine gute Adhärenz aufweisen 15 , 16 , 17 .…”

Section: Adhärenz Beim Glaukomunclassified

Beeinflusst Diabetes mellitus die Adhärenz von Glaukompatienten?

Zhao

Hirneiß

2022

Klin Monbl Augenheilkd

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Bei chronisch progredienten und therapierbaren Erkrankungen ist die Adhärenz der Patienten ausschlaggebend für den Krankheitsverlauf und entscheidet maßgeblich über den Therapieerfolg. Dabei ist nicht nur eine geringe Adhärenz bei der Medikamenteneinnahme problematisch, sondern auch beim Einhalten der empfohlenen Nachuntersuchungen. Eine akkurate Einschätzung der Adhärenz ist insbesondere bei Glaukom-Patienten nur schwer möglich aufgrund der Darreichungsform als Augentropfen bei den meisten drucksenkenden Medikamenten. In der Literatur lässt sich eine große Variabilität an Angaben für die Adhärenz von Glaukom-Patienten finden. Die meisten Studien berichten eine durchschnittliche Arzneimittel-Adhärenz von ungefähr 70% mit einem Patientenanteil von um die 50% mit einer guten Adhärenz (mindestens 80% der Medikation wird wie geplant appliziert). Des Weiteren landen 6.8 – 31.4% der Augentropfen nicht im Auge, wodurch noch weniger Wirkstoff einen therapeutischen Effekt erzielen kann. Auch weisen Glaukom-Patienten eine geringe Persistenz und Adhärenz in puncto Kontrolluntersuchungen auf. Da ein bestehender Diabetes das Risiko für ein POAG und sekundäre Glaukom-Formen steigert und Diabetiker eine besonders niedrige Adhärenz aufweisen, stellte sich die Frage, ob eine Diabetes-Diagnose mit einer erniedrigten Adhärenz bei Glaukom-Patienten assoziiert ist. Bisherige Studien fanden keine signifikante Assoziation zwischen einer Diabetes-Komorbidität und einer erniedrigten Adhärenz bei Glaukom-Patienten, allerdings wurde ein signifikanter Einfluss von einem erhöhten HbA1c-Wert auf die Adhärenz bei Glaukom-Patienten in einer Studie festgestellt. Dieser Zusammenhang muss allerdings noch in Studien mit größeren Stichproben genauer untersucht werden. In case of chronic diseases, patient adherence plays a decisive role for delaying disease progression and determine the success of therapy. Not only low medication-adherence is problematic, but also non-adherence to recommended follow-up examinations. An accurate estimate of adherence is difficult, especially in glaucoma, due to the way of administration for most antihypertensive drugs in the form of eye drops. In literature, there is a great variability of adherence found in glaucoma patients. Most studies report an average medication-adherence of approximately 70%, with around 50% of patients with good adherence (at least 80% of medication administered as planned). Furthermore, 6.8 – 31.4% of the eye drops do not end up in the eye, which means that even less active ingredient can achieve a therapeutic effect. Glaucoma patients also show low persistence and adherence to follow-up appointments. Since diabetes increases the risk for POAG and secondary glaucoma and given that diabetics have a particularly low adherence, the question arose whether a diabetes diagnosis is associated with reduced adherence in glaucoma patients. Previous studies found no significant association between diabetes and reduced adherence in glaucoma patients. But a significant impact of elevated HbA1c on adherence in glaucoma patients was found in one study. However, this connection still needs to be examined more closely in studies with larger samples.

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Section: Adhärenz Beim Glaukomunclassified

Beeinflusst Diabetes mellitus die Adhärenz von Glaukompatienten?

Zhao

Hirneiß

2022

Klin Monbl Augenheilkd

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Section: Combinations Drugs Therapymentioning

confidence: 99%

“…In a cohort study in Japan, most patients prescribed a combination of a prostaglandin analogue and a beta-blocker (Shirai et al 2021). The study also showed that the fixed combination of latanoprost + timolol was high with a percentage of 54.5% (Shirai et al 2021). The combination of prostaglandin analogues and beta-blockers is a good combination because of the high effectiveness of each drug class.…”

Section: Combinations Drugs Therapymentioning

confidence: 99%

Selection of Medical Therapy in Glaucoma Patients in the Outpatient Eye Clinic Soetomo General Academic Hospital Surabaya

Praba

Primitasari

Qorib

et al. 2021

FMI

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Highlight:Medical therapy selection in the outpatient eye clinic were determined.Treatment of prostaglandin analogue therapyfor primary open angle glaucoma was the most common glaucoma type. Abstract:Glaucoma is the second leading cause of blindness and the third cause of visual impairment. Glaucoma management includes medical therapy, laser, and incisions. This study aims to determine the selection of medical therapy in the outpatient eye clinic Soetomo General Academic Hospital Surabaya. This study was a retrospective descriptive study. The variables were type of glaucoma, visual acuity, intraocular pressure, and drug therapy. Data processing was done by collecting, grouping, and describing data. Glaucoma was mostly common in 50-64 years old (37.66%), male (50.65%), most patients lived in Surabaya (53.68%), the most common type was Primary Open-Angle Glaucoma (32.90%), the most medical therapy given in the first visit in 2019 was single medical therapy (67.97%), the most single drug therapy was latanoprost (49.68%), the most drugs combination was timolol maleat with acetazolamide (35.14%), the most commonly drugs class were prostaglandin analogues (48.48%), most of the visual acuity values were 6/6 - 6/18 (1,00 – 0,33) (37.88%), most intraocular pressure was in the 11-21 mmHg (62.55%). The most common type of glaucoma was primary open angle glaucoma with the most therapy given was prostaglandin analogue.

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“…7 Our database study also demonstrated that fixed-combination therapy was associated with greater adherence than unfixed therapy. 8 Specifically, latanoprost/timolol fixed-combination therapy for glaucoma has a high adherence rate. It lowers IOP more potently than unfixed-combination latanoprost or timolol monotherapy, 9 and was developed with the aim of reducing the number of eye drops (reducing patient burden), avoiding the washout effect due to an inadequate interval of instillation time (reducing the drug's efficacy), and reducing preservative exposure (reducing the risk of ocular surface disease).…”

Section: Introductionmentioning

confidence: 99%

“… 7 Our database study also demonstrated that fixed-combination therapy was associated with greater adherence than unfixed therapy. 8 …”

Section: Introductionmentioning

confidence: 99%

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

Shirai

Matsuoka

Nakazawa

2021

Journal of Ocular Pharmacology and Therapeutics

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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.

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Comparison of adherence between fixed and unfixed topical combination glaucoma therapies using Japanese healthcare/pharmacy claims database: A retrospective non-interventional cohort study

Cited by 3 publications

References 20 publications

Beeinflusst Diabetes mellitus die Adhärenz von Glaukompatienten?

Beeinflusst Diabetes mellitus die Adhärenz von Glaukompatienten?

Selection of Medical Therapy in Glaucoma Patients in the Outpatient Eye Clinic Soetomo General Academic Hospital Surabaya

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

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