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T. J. Zimmerman, S. Hahn, L. Gelb, H. Tan, E. E. Kim, S. N. Shah; The Impact of Hyperemia on Glaucoma Treatment. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4345.
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Because many open-angle glaucoma (OAG) patients prescribed topical glaucoma medications may be switched (discontinued) from their initial medication, we studied the impact of ocular adverse events (AEs; hyperemia) on continuation of treatment with prostaglandin analogs (PGs).
Medical and pharmacy claims of a private US health network identified patients filling initial topical ocular hypotensive prescriptions from 2001-2004. In all, 300 OAG patients prescribed a PG and 103 ophthalmologists were selected by algorithm (maximized likelihood of linkage) for telephone interviews. Medical charts for 225/300 interviewed patients cross-validated claims and survey data. Patient and physician reports of PG-related AEs and reasons for PG discontinuations were correlated with chart data of the frequency and impact of ocular AEs. The medication possession ratio, an indicator of patient adherence, was correlated to ocular AEs.
Initial claims for 13,977 patients were latanoprost (41%), timolol (23%), alpha adrenergics (12%), bimatoprost (12%), travoprost (10%), and CAIs (3%). The discontinuation rate of index medication in the first 90 days was 55.4%. For the 65% of charts of patients receiving PGs that noted an AE, hyperemia was the most cited (70%); hyperemia was noted beyond the first visit in 57% of these charts, and 27.4% of patients with hyperemia were discontinued from their medication. PG-treated patients reporting AEs as a "significant problem" had poorer adherence (p=.04). Only 69% of patients reporting hyperemia recalled mentioning the problem to a physician, and 10% acknowledged skipping doses due to hyperemia (likely underreported). AEs were seen as an adherence barrier by 97% of physicians; 94% used AE reports to detect nonadherence. Physicians cited hyperemia as the AE most affecting adherence (mean=18%), and 72% felt that adherence differs across PG due to AEs.
With PGs, hyperemia accounts for the majority of discontinuations attributable to ocular AEs. Hyperemia may limit adherence and frequently is cited by ophthalmologists as a differentiating factor in cooperation with PG therapy.
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