Persistency with medical treatment for glaucoma and ocular hypertension in the United Kingdom: 1994-2005.
OBJECTIVE
To examine trends and demographic factors affecting persistence with ocular hypotensive therapy, from a period before prostaglandins were available to when they were the most common therapy.


METHODS
Computerised patient records from 94 general practices across the United Kingdom, identified 5670 registered patients newly prescribed an ocular hypotensive drug (1993-2005). Persistence was defined as continuing therapy without a 90-day gap in prescription for (i) any ocular hypotensive and (ii) initial monotherapy. Time to failure with the treatment was compared using proportional hazard analyses, adjusted for age, gender, practice, year of initial treatment, and a sociodemographic indicator. Study findings were set in the context of a review of the literature.


RESULTS
Percentage persistent at 1-year rose after 1997 when prostaglandins were introduced; from 61% in 1994-1996 to 70% in 2002-2004. Persistence with any treatment did not differ between those initiated on beta-blockers compared to prostaglandins (1.05, 95% CI 0.93-1.17). However, 20% of subjects initiated on beta-blockers received a prostaglandin by 1 year. Conversely, 8% of those initiated on prostaglandins received a beta-blocker. When failure with initial therapy was considered, beta-blockers appeared worse (1.35, 95% CI 1.21-1.50); this was consistent with findings from six studies in the review (1.40, 95% CI 1.34-1.46). Neither gender nor social factors were associated with persistence, but younger subjects (35-64 years) were significantly more likely to fail as were those over 85 years.


CONCLUSIONS
Introduction of prostaglandins may explain an improvement in persistence over a decade. However, whether the higher cost of initiating patients on prostaglandins is justified remains questionable unless clinically indicated.
Owen
C G
CG
Division of Community Health Sciences, St George's, University of London, Cranmer Terrace, London, UK. cowen@sgul.ac.uk
Carey
I M
IM
de Wilde
S
S
Whincup
P H
PH
Wormald
R
R
Cook
D G
DG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy*; D016016:Proportional Hazards Models; D011453:Prostaglandins / Q000627:therapeutic use*; D006113:United Kingdom; D016903:Drug Monitoring
D000319:Adrenergic beta-Antagonists; D011453:Prostaglandins