BLOG: Study examines duration to IOP measurement following prostaglandin analog therapy
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Key takeaways:
- A study looked at the time interval for IOP follow-up after initiation of prostaglandin analog therapy.
- Understanding treatment patterns of clinicians yields insights into real-world modern practice.
At the 2023 American Glaucoma Society annual meeting, my colleagues and I shared the findings of a study on IOP follow-up and prostaglandin analog therapy.
We conducted the study to more accurately measure the time interval for follow-up IOP measurement after initiation of a prostaglandin analog (PGA) or switch to a new PGA in real-world patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT).
My colleagues and I relied on clinical data from the American Academy of Ophthalmology IRIS Registry, one of the largest specialty society clinical data registries in all of medicine. Verana Health is the AAO’s exclusive end-to-end data curation and analytics partner for the IRIS Registry. Deidentified data from the IRIS Registry were linked to a medication claims database maintained by Komodo Health, which enabled us to calculate the duration between the initiation or switch to a new PGA and the first in-office IOP measurement thereafter.
Patient index dates were defined as the date of the first PGA claim. PGAs included in the study were Vyzulta (latanoprostene, Bausch + Lomb), Lumigan (bimatoprost, Allergan) and latanoprost (multiple manufacturers). All patients had bilateral POAG or OHT, and none had a recent history of laser, MIGS or incisional glaucoma surgery.
Results
After filtering patients who fit the strict inclusion criteria for this study, a search of the IRIS Registry returned 65,500 POAG or OHT patients undergoing PGA therapy. (All figures in this summary are rounded for brevity.) Of those eligible patients, more than 46,000 (89%) of them were new to PGA treatment, with the remaining contingent comprising patients who switched to a new PGA. Only 101,000 (77%) eyes had their baseline IOP recorded, but 52,000 (79%) patients had recorded IOP within the first year of starting PGA therapy or switching to a new PGA treatment.
It is recommended that clinicians capture IOP measurements within 8 weeks (56 days) of starting PGA therapy or when switching a patient to a new PGA agent to monitor treatment efficacy and/or assess for adverse events. We found just more than half (51%) of new PGA patients received an IOP reading within the recommended 8-week period, and only 39% of patients who were switched to a new PGA therapy received an in-office IOP measurement within 8 weeks.
Among the patients whose IOP was captured within the 8-week time frame, mean time to IOP measurement ranged from 28 to 29 days among new PGA patients and 28 to 30 days among PGA switch patients. Those whose IOP measurements were captured beyond 8 weeks took a mean of 133 to 139 days for new PGA patients and 125 to 142 for switch patients.
In other words, patients whose IOP was assessed within the guidelines were measured at roughly a mean of 4 weeks after their index date (ie, 4 weeks earlier than the recommended threshold), whereas those whose IOP measurements were captured outside the guidelines were measured at approximately a mean of 18 to 20 weeks (ie, 10 to 12 weeks beyond the recommended threshold).
The larger picture
Understanding the treatment patterns of clinicians in real-world settings yields insights into the disconnect between by-the-book clinical care and the realities of modern practice. Sometimes, these disconnects set the stage for surprising outcomes relative to expectations set by ideal conditions (eg, tightly controlled clinical trials, accepted guidelines for follow-up), and an objective review of data can be enlightening.
The reason for those disconnects may be varied — perhaps patients encounter difficulty when scheduling appointments, perhaps experienced clinicians trust their own judgment over those found in guidelines — and exploring the nature of the incongruencies may allow us to better understand the mindset of clinicians tasked with treating and monitoring patients.
Elucidating reasons for IOP capture within or beyond the recommended time intervals are an area for future investigation. As more light is shed upon real-world treatment patterns, clinicians, researchers and innovators can more confidently understand the conditions of the landscape they wish to improve.
Reference:
- Mbagwu M, et al. Timing of intraocular pressure measurements for patients with primary open-angle glaucoma or ocular hypertension treated with prostaglandin analogs: An IRIS Registry analysis. Presented at: American Glaucoma Society annual meeting; March 2-5, 2023; Austin, Texas.
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