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E. Sellem, J. Rouland, E. Piriou, C. Le Pen, Glaucoma Study Group; Naturalistic, Prospective Study of Glaucoma and Ocular Hypertension Treatment in France: Strategies, Clinical Outcomes, and Costs at 1 Year . Invest. Ophthalmol. Vis. Sci. 2003;44(13):174.
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Purpose: To prospectively observe second-line treatment strategies, their clinical outcomes, and treatment costs in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH) in France. Methods: 500 patients were recruited between 1998 and 2000 in 37 centers and were followed for up to two years. Outcomes were numbers of and reasons for treatment changes, changes in clinical parameters (intraocular pressure [IOP] levels, visual field defects, and optic nerve excavation), and direct medical costs associated with glaucoma management in patients receiving monotherapy or combination therapy. This work reports results of an interim analysis of one-year follow-up data for patients having at least two contacts with a study ophthalmologist. Results: Data were analyzed for 410 patients and 799 treated eyes. Ocular hypotensive monotherapy was used as first-line therapy in 93.0% of eyes. Second-line treatment was initiated an average of 2.8 ± 0.3 years after diagnosis, primarily due to insufficient IOP control (61.7%). Mean IOP reductions after one year of second-line therapy were 3.5 mmHg in eyes treated with latanoprost monotherapy versus 1.9 mmHg in those receiving beta-blocker monotherapy (p<0.001) and 4.6 mmHg in eyes treated with the latanoprost + timolol combination versus 3.0 mmHg in those receiving combination therapies that did not include latanoprost (p=0.011). The annual cost of treatment was 262 euros per eye. The average daily cost for latanoprost monotherapy (0.65 euro/day) was similar to that for patients who failed beta-blocker monotherapy (0.68 euro/day, p=0.26); latanoprost + timolol was less costly (0.88 euro/day) than therapeutic combinations without latanoprost (0.98 euro/day, p=0.014). Conclusion: Insufficient IOP control is the main reason for changing first-line treatment in patients with POAG or OH. After one year, second-line treatment with latanoprost, as monotherapy or combined with timolol, provides superior IOP control at an acceptable cost.
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