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G.F. Schwartz, G. Reardon, S.N. Shah; Persistence on Ocular Prostaglandin Therapy: A Comparison of Medicare–Aged Patients to the General Glaucoma Patient Population . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4395.
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This study compared time on therapy prior to discontinuation and risk of discontinuation between Medicare–aged patients and patients of all ages who are new to prostaglandin (PG) therapy.
Data was derived from the Constella managed care database. Patients 20 years of age or older who initiated therapy with latanoprost (LAT), bimatoprost (BIM), or travoprost (TRA) between 4/01 and 6/02 were included. Patients were required to be continuously enrolled and have no previous PG therapy for the 180 days prior to the index PG fill. Follow–up continued through 6/30/02. Patients were deemed persistent until they discontinued their initial therapy. Age comparison estimates were derived from Kaplan–Meier (for unadjusted medians) and Cox regression (for relative risk of discontinuation adjusted for sex, prior ocular hypotensive therapy and index PG therapy).
4356 patients met the inclusion criteria (BIM, n=993; LAT, n=2376; TRA, n=987). 74% of patients were 65 years or older. For adult patients of all ages, median time on therapy prior to discontinuation for all PG therapies was 5.01 months (BIM, 4.12 months; LAT, 5.61 months; TRA, 4.15 months). For patients 65 years and older, median time on therapy prior to discontinuation was 4.98 months (BIM, 4.15 months; LAT, 5.54 months; TRA, 4.22 months). Relative risk of discontinuation was not significantly higher for patients who were >65 years or male but was 15% lower for those with a prior ocular hypotensive (p<0.001), 39% higher with a bimatoprost (p<0.001), and 36% higher with a travoprost (p<0.001) index PG.
The experience of Medicare–aged patients largely described the general glaucoma population. Patients over 65 years accounted for the majority of adults receiving prostaglandins and had similar persistence on therapy compared to all adult patients studied. However, adverse effects from therapy may be of greater concern with Medicare–aged patients when considering the higher prevalence of comorbid conditions and multiple medications used by this group.
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