Persistence and treatment patterns of fixed combination drugs for glaucoma: a retrospective claims database study in Japan

Understanding the treatment paradigm and the sequencing of antiglaucoma fixed-dose combinations in a tertiary center in South India

PURPOSE

To analyze the medical management of primary open-angle glaucoma (POAG) and ocular hypertension (OHT) and the placement of fixed-drug combination drugs (FDC) in the treatment paradigm at a tertiary eye care center in South India.

METHODS

Retrospective study (January 2011-December 2015) of newly diagnosed POAG and OHT patients (≥18 years) with ≥5 years follow-up. Primary outcome included percentage use of different antiglaucoma drugs (at initiation) and FDCs at the first, second, and third progression (sequencing). Secondary outcomes: Percentage discontinuation for different FDCs, efficacy parameters (decrease in intraocular pressure (IOP)/visual field), adverse events, and the median number of antiglaucoma medications (AGMs) after 5 years.

RESULTS

Three hundred and seventy eyes (198 patients) were analyzed; 84% of them had POAG. Prostaglandin analogs (PGAs) were the most common (66.2%). FDCs were started in 48 eyes (12.9%), with brimonidine + timolol combination being the most common. FDC usage at subsequent modifications was 10.1%, 24.04%, and 30.0%. Beta-blockers and PGAs were the most frequently prescribed AGMs in our practice pattern, with β-blockers being the most consistent one.

CONCLUSION

This study is a fairly large study with a minimum of a 5-year follow-up of patients with POAG and OHT and gives insights into the treatment patterns, use of FDCs, and the need for multiple medications over time.

The use of fixed dose drug combinations for glaucoma in clinical settings: a retrospective, observational, single-centre study

BACKGROUND

The aim of study was to understand anti-glaucoma fixed dose drug combination use in real-world settings, focussing on drug selection, repeated prescription of the same active ingredient, and administration of fixed dose combinations, thus providing a reference for doctors during prescription and pharmacists during prescription review, ultimately educating patients on medication.

METHODS

A retrospective, observational, single-centre study was conducted. Outpatient prescriptions for anti-glaucoma eye drops from 01 January to 31 March 2021 were extracted. The prescriptions containing anti-glaucoma fixed dose combinations were analysed, and the rationale for each prescription was reviewed.

RESULTS

There were 10,947 ophthalmic patients with anti-glaucoma eye drop prescriptions in the study period. Of these, 4002 (36.5%) were prescribed anti-glaucoma fixed dose drug combinations. Approximately 80% of the patients were prescribed brinzolamide/timolol, while about 10% received prostaglandin analogues/timolol eye drops. Less than 40% of prescriptions were for monotherapy with fixed dose combinations. The most commonly duplicated drug class was β-receptor antagonists. An increase in prescribing drugs containing the same ingredient was observed for regimens containing various medicines.

CONCLUSION

More than 60% of the combinations were used together with other anti-glaucoma drugs. The advantages of these fixed dose combinations in improving patient compliance need to be reassessed in real-word settings. Prescriptions containing duplicated ingredients were common. However, they were not necessarily considered unreasonable because the dosage forms were administered at different times. For prescriptions containing repetitive ingredients, pharmacists should judge the rationale by evaluating the dosing frequency and drug indications and explain the appropriate administration to patients.

Association between topical β-blocker use and asthma attacks in glaucoma patients with asthma: a cohort study using a claims database

PURPOSE

To investigate the association between the use of topical β-blockers and subsequent asthma attacks in glaucoma patients with asthma.

METHODS

This was a retrospective longitudinal cohort study using an administrative claims database. All patients aged 20 years or older who were registered in the health insurance claims database updated and managed by JMDC Inc. (Tokyo, Japan). Patients who were newly prescribed eye drops for glaucoma treatment were identified between 2011 and 2017. The patients with glaucoma were divided into two groups: β-blocker users and non-β-blocker users, based on the presence of a β-blocker in the prescribed eye drops. We investigated whether the incidence of asthma attacks in patients with previously treated asthma differed between the two groups.

RESULTS

We categorized 17,666 patients in the β-blocker-user group and 12,609 patients in the non-β-blocker-user group. A total of 580 patients in the β-blocker group (3.28%) and 847 in the non-β-blocker group (6.72%) underwent asthma treatment before the prescription of anti-glaucoma eye drops (P < 0.001). Furthermore, 94 patients in the β-blocker-user group (0.53%) and 278 in the non-β-blocker user group (2.20%) were undergoing current treatment for asthma (P < 0.001). The adjusted hazard ratios of asthma attacks were 0.73 (95% confidence interval, 0.46-1.16, P = 0.18) in patients with a history of asthma treatment and 1.22 (95% confidence interval, 0.56-2.70, P = 0.62) in patients with current asthma treatment, compared to the non-β-blocker-user group.

CONCLUSION

Our results clarified that several patients with asthma were prescribed topical β-blockers for glaucoma treatment. However, asthma attacks may not be significantly attributed to topical β-blockers, even in glaucoma patients under current asthma treatment. The administration of topical β-blockers to asthma patients could be a treatment option in the absence of other treatment options, if adequate informed consent is obtained. Further studies are needed to draw a firm conclusion on this clinical question.