Patient persistency with topical ocular hypotensive therapy in a managed care population

PURPOSE: To evaluate persistency with topical ocular hypotensive therapies in patients new to pharmacological management of elevated intraocular pressure (IOP). DESIGN: Retrospective, cohort study; Protocare Sciences managed care databases; approximately 3 million members in commercial health maintenance organizations and preferred provider organizations and in Medicare risk plans. METHODS: Patients were at least 20 years of age initiating therapy between July 1, 1996, and June 30, 2002, with betaxolol, bimatoprost, brimonidine, dorzol, amide, latanoprost, timolol, or travoprost as monotherapy. Patients must have been continuously enrolled and not have received glaucoma surgery in the 180 days before the index prescription fill. Prescription refill records for all ocular hypotensive drugs were extracted through June 30, 2002. Outcome measures were (1) discontinuation of index drug, and (2) either discontinuation or change in index drug. Changing therapy was defined as switching to or adding another ocular hypotensive. Rates of discontinuation and discontinuation/ change were compared using Cox regression models. RESULTS: In all, 28,741 patients met the inclusion criteria. Compared with latanoprost, those treated with other drugs were from 37% (timolol) to 72% (bimatoprost) more likely to discontinue and from 20% (timolol) to 58% (dorzolamide) more likely to discontinue/change therapy (P <.001 for all comparisons). At 12 months, 33% of patients treated with latanoprost and 19% of those receiving other ocular hypotensives had not discontinued therapy; 23% and 13%, respectively, had not discontinued or changed therapy. Compared with latanoprost, significantly higher percentages of patients treated with each alternate agent had only one fill of their index drugs (P <.001). CONCLUSIONS: Although persistency rates were low across agents, latanoprost-treated patients demonstrated significantly greater persistency than did those treated with other topical ocular hypotensive therapies. (Am J Ophthalmol 2004;137:S3-S12. (C) 2004 by Elsevier Inc. All rights reserved.)