Physicians’ treatment decisions, patient persistence, and interruptions in the continuous use of prostaglandin therapy in glaucoma

Abstract

Background:

Uninterrupted use of ocular hypotensive medication by glaucoma patients is important to prevent vision loss, but medication persistence is poor. Efficacy and tolerability influence physicians’ decisions and patient persistence, and differences between medications may impact persistence.

Objective:

To examine differences in physician’s decisions to continue, switch, or discontinue therapy across three prostaglandin analogs (PGAs) latanoprost, bimatoprost, and travoprost using claims data supplemented by evaluation of physicians’ charted therapeutic decisions.

Methods:

A year of pharmacy claims data for 6271 patients with a first (index) fill between 5/1/2001 and 11/30/2004 for PGA monotherapy were classified as ‘persistent’, ‘switched’, ‘restarted’, or ‘discontinued’ with initial PGA use. An analysis of index therapy continuation during the first 2 years reflected chart reviews for 223 patients with PGA monotherapy as the index prescription.

Results:

Ten percent of patients had uninterrupted use of the initial PGA alone or in combination for a year. More than half (56%) stopped and then restarted, 16% switched, and 19% discontinued the initial PGA. Patients using latanoprost were more likely to be persistent (11%) compared to bimatoprost (9%) or travoprost (5%; p < 0.0001 overall comparison). Overall, 68% of patients on latanoprost persisted or restarted after a gap compared to 61% for bimatoprost and 58% for travoprost (p < 0.0001). Patient charts demonstrated a parallel pattern in physicians’ decisions to continue latanoprost (56%), bimatoprost (45%), and travoprost (40%). Study limitations included the inability to establish causal links between variables, to account for sample use, or to document reasons for patient-driven changes in therapy. The study should be replicated in a more recent database including a larger population.

Conclusions:

Uninterrupted use of ocular hypotensive therapy for a full year is relatively rare. Differences in physicians’ decisions to continue, switch, or discontinue PGAs were observed in claims data, and parallel trends were observed in patient medical records.

Key words::

• Bimatoprost
• Glaucoma
• Latanoprost
• Persistence
• Prostaglandin analog
• Travoprost

Transparency

Declaration of funding

This research was supported by Pfizer Inc., New York, NY, USA.

Declaration of financial/other relationships

S.R.H. has disclosed that he is a paid consultant to Pfizer and GlaxoSmithKline PLC, AstraZeneca International, Astellas Pharma Inc. and Ortho-McNeil. He also has received honoraria/reimbursement from Ortho-McNeil. S.K. and E.K. have disclosed that they are employees of Pfizer. J.T. has disclosed that he is employed by HealthCore Inc., a consultancy whose activities on the project were funded by Pfizer.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgment

Editorial support, including contributing to the first draft of the manuscript, revising the paper based on author feedback and styling the paper for journal submission, was provided by Jane G. Murphy, PhD, of Zola Associates and was funded by Pfizer.

The sponsor participated in the study design, data analysis and interpretation, and preparation and review of the manuscript.