Abstract
Purpose :
To evaluate the treatment journey of patients receiving multiple topical glaucoma medications (TGMs) for management of open-angle glaucoma (OAG) or ocular hypertension (OHT).
Methods :
This was a retrospective analysis of administrative claims data (Jan 2011 - July 2017) from the IQVIA PharMetrics Plus database. The study included patients ≥40 years with a diagnosis of OAG/OHT who underwent treatment intensification with ≥1 TGM of a different drug class during Jan 2012 - July 2015 (index period). For inclusion, patients had to be continuously enrolled for ≥12 months before and ≥24 months after the start (‘index’) date of their first intensified treatment regimen. Patients with prior OAG surgery, or the same or higher number of TGMs during the pre-index period, were excluded.
Results :
In total, 48,402 patients (mean [SD] age 61.4 [9.6] years) underwent treatment intensification during the index period; of these, 22,874 (47.3%), 16,214 (33.5%), 7,137 (14.7%) and 2,177 (4.5%) received a 1st, 2nd, 3rd or 4th TGM class, respectively, as their first observed intensified regimen (‘index drop combination’). Among the cohorts receiving 1, 2, 3 or 4 TGMs as their index drop combination, 7.8%, 12.2%, 17.1% and 22.5% of patients, respectively, had subsequent treatment augmentation (TGM addition or glaucoma procedure, laser or surgical) during the first 12 months post-index, rising to 12.6%, 18.5%, 25.9% and 33.6%, respectively, during the first 24 months. Conversely, 20.7% and 26.4% of all patients, respectively, had discontinued TGM treatment but had not had a glaucoma procedure at 12 and 24 months post-index. Median time to TGM augmentation declined with each additional TGM in the index drop combination: 176, 136, 106 and 106.5 days for the 1st, 2nd, 3rd and 4th TGM, respectively. Overall, 19.6% and 29.1% of patients had de novo ocular surface disease (OSD) diagnosis and/or treatment in the first 12 and 24 months, respectively.
Conclusions :
Multiple drop therapy brings shorter-lasting benefit with each additional agent and often quickly escalates to encompass surgical and laser procedures. Drop therapy is also associated with a substantial incidence of OSD.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.