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William Wong, Ashley L Cole, Jenny Chia; Real-World Analysis of the Time Associated with Adding a Second Glaucoma Therapy in Newly Diagnosed OAG/OHT Patients. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5551.
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Determine the time associated with moving from monotherapy (1 glaucoma drug class) to adding a 2nd glaucoma drug class in newly diagnosed patients.
Patients with at least 2 diagnoses at least 1 week apart of ocular hypertension or open-angle glaucoma between 2009-2011, initiated on monotherapy, with at least 12 months continuous enrollment before and after initial diagnosis were identified from a longitudinal database (MarketScan®) of medical and pharmacy claims for >43 million patients. Newly diagnosed patients were identified as those having no glaucoma drug, procedure or diagnosis 1 year prior to the index diagnosis. Kaplan-Meier survival analyses were used to assess the time to failure, defined as prescription drug fills for 2 different glaucoma drug classes ≤15 days apart. Drug classes were defined as follows: Prostaglandin analog or prostamide (PGA), beta blocker (BB), carbonic anhydrase inhibitor (CAI) and alpha agonist (AA). Patients were followed until addition of a 2nd drug class or the end of enrollment (max of 4 years).
Among newly diagnosed patients, 53% did not fill a prescription for a glaucoma drug within 1 year of initial diagnosis, leaving in total, 34,165 patients included in the base case analysis. By 4 years, 27.5% of at risk patients added a 2nd drug class. This proportion differed by initial therapy (PGA: 26.5%, BB: 29.5%, AA: 32.1%, CAI: 48.0%, p<0.0001 for log-rank test). Among those patients adding a 2nd drug class, 50% added a 2nd class by 8.7 months (mean of 11.7 months). The mean and median time to adding a 2nd drug class also differed by the initial therapy (Drug class: mean/median (months), PGA: 11.8/9.5, BB: 11.1/8.7, AA: 8.6/6.5, CAI: 6.8/3.2). PGAs and fixed combination products were most commonly used in multiple medication regimens.
Clinical studies have shown a benefit for early treatment however in this analysis >50% of patients were not receiving medications within a year of diagnosis, suggesting many may be at increased risk of disease progression. This study also suggests that in the real-world, patients may be receiving fewer medications than required to control intraocular pressure as demonstrated in clinical trials. Of those patients who add a 2nd drug class, a majority require the additional therapy within 1 year emphasizing the importance of choosing the most effective initial treatment regimen.
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