Elsevier

Ophthalmology

Volume 114, Issue 4, April 2007, Pages 648-652
Ophthalmology

Original Article
Accounting for Restart Rates in Evaluating Persistence with Ocular Hypotensives

https://doi.org/10.1016/j.ophtha.2006.09.025Get rights and content

Purpose

Persistence with ocular hypotensive medication is important as a long-term outcome, and rates of persistence typically are low. This study assessed restart rates for 3 prostaglandin analogs by determining the percentage of patients who discontinued and then restarted therapy.

Design

Retrospective cohort study of pharmacy claims submitted to a large national administrative claims database.

Participants

In all, 4356 patients initiating prostaglandin therapy were identified.

Methods

Claims for 3 prostaglandin analogs (bimatoprost, latanoprost, travoprost [index prostaglandin]) submitted between 2001 and 2002 were analyzed. Patients were excluded if they did not have coverage in the plan for the preceding 180 days or had been prescribed any ocular prostaglandin in the prior 180 days.

Main Outcome Measures

Persistence was defined as neither discontinuing nor changing the index prostaglandin. The number of current users of the index prostaglandin at day 180 was the sum of patients who persisted with the index prostaglandin plus patients who restarted the index prostaglandin after a discontinuation.

Results

Of the 4356 patients initiating prostaglandin therapy, 2503 (57%) were potential current users (were still plan members and had not switched ocular hypotensive therapies after 180 days). Just over half, (1356/2503 [54%]) were current users, including 879 (35%) who persisted with their index prostaglandin and 477 (19%) who restarted their index prostaglandin. Of patients discontinuing their index prostaglandin, more than half failed to restart any topical therapy (827/1624 [51%]).

Conclusions

Previous studies showing low persistence rates for glaucoma therapy failed to evaluate restarts. Restart analyses are crucial for assessing long-term treatment of chronic diseases such as glaucoma. In general, persistence remains a challenge, and our findings demonstrate the importance of clinicians’ identifying patients who are not persistent and encouraging them either to restart or to initiate treatment with an alternative therapy.

Section snippets

Sample

Data were derived from a retrospective cohort analysis using a large national administrative medical care claims database with an annual enrollment of approximately 3 million members enrolled in commercial health maintenance organizations, preferred provider organizations, and Medicare risk plans. Patient and physician information was encrypted appropriately and qualifies as deidentified in accordance with the privacy regulations of the United States Department of Health and Human Services,

Results

In all, 4356 patients initiated treatment with an ocular prostaglandin. Patient demographic and ocular characteristics are summarized in Table 1. In brief, 74% of patients were older than 64 years, 58% were female, and 65% of those for whom a diagnosis was recorded had open-angle glaucoma.

Of the 4356 patients initially treated with a prostaglandin (Fig 1) and who met eligibility criteria for defining the index therapy, 2503 (57%) were eligible for final inclusion (were still plan members and

Discussion

Physicians need to monitor closely patients’ actual use of therapies to distinguish between a lack of clinical response to a medication taken as prescribed and a lack of persistence with the therapeutic regimen. Incomplete information concerning persistence may result in inappropriate changes in therapy. Current users include both those who persist in using the index agent and those who, after discontinuation, restart their index therapy. We have described a method of calculating current use

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Manuscript no. 2006-560.

This research was supported by Pfizer Inc.

The authors have no conflicting relationship with regard to the article’s content.

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