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Menino J, Camacho P, Coelho A. Persistence with medical glaucoma therapy in newly diagnosed patients. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2024; 13:63-69. [PMID: 39206081 PMCID: PMC11347956 DOI: 10.51329/mehdiophthal1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/04/2024] [Indexed: 09/04/2024]
Abstract
Background Monotherapy, age, and side effects are significant risk factors for the discontinuation of antiglaucoma therapy. Long-term therapy persistence is crucial for slowing disease progression and preventing irreversible blindness. Therefore, it is essential to identify patients at higher risk of discontinuation. In this study, we aimed to evaluate the real-world persistence of antiglaucoma therapy in patients diagnosed with glaucoma in the primary healthcare units of the Lisbon and Tagus Valley regions. Methods We conducted a retrospective longitudinal study by collecting data from the prescription records of new antiglaucoma drug users diagnosed with glaucoma between 2012 and 2013 in the Primary Health Care Units of the Lisbon and Tagus Valley Region. These patients were followed over 3 years. Therapy persistence was measured as the proportion of patients remaining on any antiglaucoma drug, regardless of any modifications or switching of drugs over time. Persistence was assessed at three time points: the end of the first, second, and third years of the observation period. Results A total of 2138 patients treated using new antiglaucoma drugs (867 [40.6%] male patients; 1271 [59.4%] female patients) were included in the study. Over the observation period, the overall persistence rate decreased from 91.9% (n = 1965) in the first year to 67.3% (n = 1439) in the third year. Older patients (≥ 65 years) showed higher persistence rates, although there was a decrease over the 3-year follow-up period (from 1481 [92.7%] to 1124 [70.4%]). Additionally, participants initially treated with monotherapy showed higher persistence rates, ranging from 92.4% (n = 1186) in the first year to 70.2% (n = 901) in the third year. Conclusions The findings highlight the importance of patient follow-up over time, as almost one in three new antiglaucoma therapy users completely discontinued treatment, potentially risking disease progression. This could be mitigated with proper use of these drugs. Further studies should utilize recent health information systems to explore the impact of medication adherence and persistence on the functional and structural outcomes in patients with glaucoma.
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Affiliation(s)
- Joana Menino
- H&TRC- Health and Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saude, Instituto Politecnico de Lisboa, Lisbon, Portugal
| | - Pedro Camacho
- H&TRC- Health and Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saude, Instituto Politecnico de Lisboa, Lisbon, Portugal
- iNOVA4Health, NOVA Medical School, Faculdade de Ciencias Medicas, NMS, FCM, Universidade NOVA de Lisboa; Lisbon, Portugal
- Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
| | - Andre Coelho
- H&TRC- Health and Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saude, Instituto Politecnico de Lisboa, Lisbon, Portugal
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George R, Mishra P, Shantha B, Vijaya L, Maksane N, Gurha N. Understanding the treatment paradigm and the sequencing of antiglaucoma fixed-dose combinations in a tertiary center in South India. Indian J Ophthalmol 2024; 72:896-901. [PMID: 38623708 PMCID: PMC11232873 DOI: 10.4103/ijo.ijo_694_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 04/17/2024] Open
Abstract
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.
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Affiliation(s)
- Ronnie George
- Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nerthralaya, Chennai, Tamil Nadu, India
| | - Praggya Mishra
- Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nerthralaya, Chennai, Tamil Nadu, India
| | - Balekudaru Shantha
- Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nerthralaya, Chennai, Tamil Nadu, India
| | - Lingam Vijaya
- Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nerthralaya, Chennai, Tamil Nadu, India
| | - Nitin Maksane
- Medical Affairs, Novartis Healthcare Private Limited, Mumbai, Maharashtra, India
| | - Neha Gurha
- Medical Affairs, Novartis Healthcare Private Limited, Mumbai, Maharashtra, India
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Igarashi A, Ishida K, Shoji N, Chu A, Falvey H, Han R, Ueyama M, Onishi Y. iStent inject® and cataract surgery for mild-to-moderate primary open angle glaucoma in Japan: a cost-utility analysis. Int J Ophthalmol 2022; 15:954-961. [PMID: 35814897 PMCID: PMC9203480 DOI: 10.18240/ijo.2022.06.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the cost-utility of iStent inject® with cataract surgery vs cataract surgery alone in patients with mild-to-moderate primary open angle glaucoma (POAG) in the Japanese setting from a public payer's perspective. METHODS A Markov model was adapted to estimate the cost-utility of iStent inject® plus cataract surgery vs cataract surgery alone in one eye in patients with mild-to-moderate POAG over lifetime horizon from the perspective of Japanese public payer. Japanese sources were used for patients' characteristics, clinical data, utility, and costs whenever available. Non-Japanese data were validated by Japanese clinical experts. RESULTS In the probabilistic base case analysis, iStent inject® with cataract surgery was found to be cost-effective compared with cataract surgery alone over a lifetime horizon when using the ¥5 000 000/quality-adjusted life year (QALY) willingness-to-pay threshold. The incremental cost-utility ratio (ICUR) was estimated to be ¥1 430 647/QALY gained and the incremental cost-utility ratio (ICER) was estimated to be ¥12 845 154/blind eye avoided. iStent inject® with cataract surgery vs cataract surgery alone was found to increase costs (¥1 025 785 vs ¥933 759, respectively) but was more effective in increasing QALYs (12.80 vs 12.74) and avoiding blinded eyes (0.133 vs 0.141). The differences in costs were mainly driven by costs of primary surgery (¥279 903 vs ¥121 349). In the scenario analysis from a societal perspective, which included caregiver burden, iStent inject® with cataract surgery was found to dominate cataract surgery alone. CONCLUSION The iStent inject® with cataract surgery is a cost-effective strategy over cataract surgery alone from the public payer's perspective and cost-saving from the societal perspective in patients with mild-to-moderate POAG in Japan.
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Affiliation(s)
- Ataru Igarashi
- Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Yokohama 236-0027, Japan
| | - Kyoko Ishida
- Ohashi Medical Center, Toho University, Tokyo 153-8515, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University Hospital, Kanagawa 252-0375, Japan
| | - Alice Chu
- Market Access and Medical Marketing, Glaukos Singapore, Singapore 068896, Singapore
| | - Heather Falvey
- Global Health Economics, Glaukos Corp, California 92672, USA
| | - Ru Han
- Health Economics and Outcomes Research, Creativ-Ceutical, Paris 75008, France
| | - Maki Ueyama
- Health Economics and Outcomes Research, Creativ-Ceutical, Tokyo 108-6028, Japan
| | - Yoshie Onishi
- Health Economics and Outcomes Research, Creativ-Ceutical, Tokyo 108-6028, Japan
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Yan J, Xiong X, Shen J, Huang T. The use of fixed dose drug combinations for glaucoma in clinical settings: a retrospective, observational, single-centre study. Int Ophthalmol 2021; 42:945-950. [PMID: 34635957 DOI: 10.1007/s10792-021-02076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Jingchao Yan
- Department of Pharmacy, Eye Ear Nose Throat Hospital of Fudan University, No. 83, Fenyang Road, Shanghai, 200031, China.
| | - Xiaomei Xiong
- Department of Pharmacy, Eye Ear Nose Throat Hospital of Fudan University, No. 83, Fenyang Road, Shanghai, 200031, China
| | - Jianwen Shen
- Department of Pharmacy, Eye Ear Nose Throat Hospital of Fudan University, No. 83, Fenyang Road, Shanghai, 200031, China
| | - Taomin Huang
- Department of Pharmacy, Eye Ear Nose Throat Hospital of Fudan University, No. 83, Fenyang Road, Shanghai, 200031, China
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Kido A, Miyake M, Akagi T, Ikeda HO, Kameda T, Suda K, Hasegawa T, Hiragi S, Yoshida S, Tsujikawa A, Tamura H, Kawakami K. Association between topical β-blocker use and asthma attacks in glaucoma patients with asthma: a cohort study using a claims database. Graefes Arch Clin Exp Ophthalmol 2021; 260:271-280. [PMID: 34370066 DOI: 10.1007/s00417-021-05357-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/16/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Ai Kido
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadamichi Akagi
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hanako Ohashi Ikeda
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takanori Kameda
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Suda
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoko Hasegawa
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shusuke Hiragi
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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