Patient persistency with pharmacotherapy in the management of glaucoma.
OBJECTIVE
To evaluate persistency with monotherapy in the treatment of glaucoma in patients new to pharmacological management.


METHODS
This population-based, retrospective cohort study, using managed care administrative claims data, included patients who were 20 years of age and older and who initiated monotherapy with betaxolol, brimonidine, dorzolamide, latanoprost, or timolol between May 1999 and January 2001. Follow-up continued through January 31, 2001, and prescription refill records for all ocular hypotensive medications were extracted for the full 21-month study period. The primary outcome measures were discontinuation and change (switching/adding on) of the index ocular hypotensive medication. Rates of discontinuation and discontinuation/change were compared using Cox regression methods; survival curves were generated.


RESULTS
In all, 14,539 patients were prescribed any ocular hypotensive drug during the study period, and 2850 patients met all inclusion criteria. Patients treated with betaxolol, brimonidine, dorzolamide, or timolol were significantly (p < 0.05) more likely to discontinue and to discontinue/change the index therapy than were those treated with latanoprost. Results were confirmed in analyses adjusted for age and sex.


CONCLUSIONS
Patients initially treated with latanoprost monotherapy are more persistent than those who begin treatment with beta-blockers, brimonidine, or the carbonic anhydrase inhibitor dorzolamide. Greater persistency with an initial ocular hypotensive therapy may improve health outcomes and reduce long-term costs to patients and health plans by limiting the increased resource use associated with discontinuations or changes in therapy.
Reardon
G
G
Informagenics, LLC, Worthington, OH 43085, USA. greardon@informagenics.com
Schwartz
G F
GF
Mozaffari
E
E
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D000068438:Brimonidine Tartrate; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005901:Glaucoma / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D000077338:Latanoprost; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy / Q000191:economics; D010349:Patient Compliance; D011461:Prostaglandins F, Synthetic / Q000627:therapeutic use; D011810:Quinoxalines / Q000627:therapeutic use; D012189:Retrospective Studies; D013449:Sulfonamides / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D011461:Prostaglandins F, Synthetic; D011810:Quinoxalines; D013449:Sulfonamides; D013876:Thiophenes; D000068438:Brimonidine Tartrate; D000077338:Latanoprost; C062765:dorzolamide