Albert Einstein College of Medicine, Bronx, NY, USA.
Curr Med Res Opin. 2010 Apr;26(4):957-63. doi: 10.1185/03007991003659012.
Uninterrupted use of ocular hypotensive medication by glaucoma patients is important to prevent vision loss, but medication persistence is poor. Efficacy and tolerability influence physicians' decisions and patient persistence, and differences between medications may impact persistence.
To examine differences in physician's decisions to continue, switch, or discontinue therapy across three prostaglandin analogs (PGAs) latanoprost, bimatoprost, and travoprost using claims data supplemented by evaluation of physicians' charted therapeutic decisions.
A year of pharmacy claims data for 6271 patients with a first (index) fill between 5/1/2001 and 11/30/2004 for PGA monotherapy were classified as 'persistent', 'switched', 'restarted', or 'discontinued' with initial PGA use. An analysis of index therapy continuation during the first 2 years reflected chart reviews for 223 patients with PGA monotherapy as the index prescription.
Ten percent of patients had uninterrupted use of the initial PGA alone or in combination for a year. More than half (56%) stopped and then restarted, 16% switched, and 19% discontinued the initial PGA. Patients using latanoprost were more likely to be persistent (11%) compared to bimatoprost (9%) or travoprost (5%; p < 0.0001 overall comparison). Overall, 68% of patients on latanoprost persisted or restarted after a gap compared to 61% for bimatoprost and 58% for travoprost (p < 0.0001). Patient charts demonstrated a parallel pattern in physicians' decisions to continue latanoprost (56%), bimatoprost (45%), and travoprost (40%). Study limitations included the inability to establish causal links between variables, to account for sample use, or to document reasons for patient-driven changes in therapy. The study should be replicated in a more recent database including a larger population.
Uninterrupted use of ocular hypotensive therapy for a full year is relatively rare. Differences in physicians' decisions to continue, switch, or discontinue PGAs were observed in claims data, and parallel trends were observed in patient medical records.
青光眼患者持续使用降眼压药物对于预防视力丧失非常重要，但药物的持久性很差。疗效和耐受性会影响医生的决策和患者的持久性，药物之间的差异也可能影响持久性。
使用索赔数据并结合对医生记录的治疗决策进行评估，研究三种前列腺素类似物（PGAs）拉坦前列素、比马前列素和曲伏前列素在医生决定继续、转换或停止治疗方面的差异。
对 2001 年 5 月 1 日至 2004 年 11 月 30 日期间首次（索引）使用 PGA 单一疗法的 6271 名患者的一年药物治疗记录进行分类，根据初始 PGA 使用情况分为“持续”、“转换”、“重新开始”或“停止”。对 223 名接受 PGA 单一疗法治疗的患者的索引治疗进行了为期 2 年的分析，以反映图表审查结果。
10%的患者在一年内持续使用单一 PGA 或联合用药。超过一半（56%）的患者停止后又重新开始，16%的患者转换了药物，19%的患者停止了初始 PGA 的使用。使用拉坦前列素的患者持续用药（11%）的可能性高于比马前列素（9%）或曲伏前列素（5%；总体比较差异有统计学意义（p < 0.0001）。总体而言，与比马前列素（61%）和曲伏前列素（58%）相比，拉坦前列素在有间隔期后继续或重新开始治疗的患者比例（68%）更高（p < 0.0001）。患者图表显示，医生决定继续使用拉坦前列素（56%）、比马前列素（45%）和曲伏前列素（40%）的决策存在平行趋势。研究的局限性包括无法建立变量之间的因果关系，无法说明样本的使用情况，也无法记录导致患者驱动治疗变化的原因。应在包含更大人群的最近数据库中重复该研究。
持续使用眼部降眼压药物治疗一整年的情况相对较少。在索赔数据中观察到医生在继续、转换或停止使用 PGAs 方面的决策存在差异，在患者病历中也观察到了相似的趋势。
