title: [Early adherence to anti-glaucoma therapy: An observational study].
abstract: OBJECTIVE
  Glaucoma is a major cause of blindness, preventable by a regular therapy. Thus, a good knowledge of patients' adherence to preventive therapy is critical to improve disease management. Early persistence to first-line glaucoma therapy is poorly documented in France. We verified to what extent first-line glaucoma therapy was interrupted within the 12 months following initiation and how this interruption varied with patients' characteristics and drug classes.
  
  
  METHODS
  Patients newly-treated with chronic glaucoma therapy (prostaglandins, beta-blockers alone or combined with another therapy, and topical carbonic anhydrase inhibitors) between 2005 and 2008 were identified in the French National Claims data (1/97th random sample). Twelve-month persistence was defined by the presence of the first-line drug class (≥1dispensation) between the 12th and 24th months following initiation. Twelve-month persistence was compared between patients according to the first-line drug classes and baseline characteristics. Proportion of days covered (12 months) and number of quarters with initiated drug class (24 months) were also studied.
  
  
  RESULTS
  Among 5331 patients initiated with chronic glaucoma therapy in monotherapy (63% aged ≥60 years old, 57% females), initiated therapy mainly consisted of prostaglandins (43%) and beta-blockers alone (32%). Only 45% of the patients were persistent to first-line therapy 12 months after initiation. Salient differences in persistence rates appeared between drug classes (P<0.0001): from 59% with prostaglandins to 26% for topical carbonic anhydrase inhibitors. Better results also appeared for prostaglandins with other dimensions of adherence. Non-persistent patients were more likely younger than 40, or conversely aged≥80 (P<0.0001). They were also more likely to necessitate social assistance for therapy (P=0.0007). No salient difference appeared as to gender.
  
  
  CONCLUSIONS
  Our findings confirm the low early persistence of first-line therapy, despite better results for prostaglandins. Education of patients and identification of barriers to adherence could contribute to improve quality of care.
authors.affiliation: HESPER 7425, Health Services and Performance Research, université Claude-Bernard Lyon-1, Lyon, France; PELyon, Lyon, France.
authors.forename: Manon
authors.initials: M
authors.lastname: Belhassen
authors.affiliation: HESPER 7425, Health Services and Performance Research, université Claude-Bernard Lyon-1, Lyon, France; PELyon, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Laforest
authors.affiliation: HESPER 7425, Health Services and Performance Research, université Claude-Bernard Lyon-1, Lyon, France; PELyon, Lyon, France.
authors.forename: Idlir
authors.initials: I
authors.lastname: Licaj
authors.affiliation: HESPER 7425, Health Services and Performance Research, université Claude-Bernard Lyon-1, Lyon, France; PELyon, Lyon, France; Service de pneumologie, hôpital universitaire de la Croix-Rousse, Lyon, France. Electronic address: eric.van-ganse@univ-lyon1.fr.
authors.forename: Éric
authors.initials: É
authors.lastname: Van Ganse
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use; D005260:Female; D005602:France; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011453:Prostaglandins / Q000627:therapeutic use; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D002257:Carbonic Anhydrase Inhibitors; D011453:Prostaglandins
keywords: Glaucoma; Glaucome; Medication adherence; Observance du traitement médicamenteux; Primary prevention; Prostaglandines; Prostaglandins; Prévention primaire