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First-year behavior predicts long-term compliance with glaucoma therapy
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For most patients with newly prescribed glaucoma medications, adherence patterns during the first year of treatment indicated adherence patterns over the next 3 years, according to Paula Anne Newman-Casey, MD, MS, and colleagues from the journal Ophthalmology.
The retrospective cohort included 1,234 adults with newly diagnosed and treated open-angle glaucoma.
After 1-year of follow-up, 7.5% of patients were in the “never adherent” group, 14.9% were in the “persistently very poor adherence” group, 9.5% were in the “declining adherence” group, 48.1% were in the “persistently moderate adherence” group, and 20% were in the “persistently good adherence” group.
After 4 years, 15.6% were in the never adherent group, 23.4% were in the persistently very poor adherence group, 9.1% were in the declining adherence group, 37% were in the persistently moderate adherence group, and 15% were in the persistently good adherence group.
Patients in the never adherent group and those in the declining adherence group more often had lower personal income and used in-store pickup only for their prescriptions, according to researchers.
Older age and a higher income indicated better adherence. Black race predicted a lower medication possession ratio.
The researchers reported that nearly all of those with persistently good adherence in year 1 continued to have good adherence over the 4 years.
They also identified three modifiable factors that may contribute to better adherence longevity: increased number of visits with an eye care provider, decreasing medication copayment cost and not relying exclusively on in-store pharmacy pickup.
“Our findings suggest that to facilitate more targeted delivery of additional services for those who are at risk for poor adherence, it may be helpful to use prescription refill data to monitor patients’ adherence for at least their first year of glaucoma treatment,” the researchers wrote. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Blair Lonsberry, OD, FAAO
Adherence to glaucoma medications is a major issue for both patient and clinician. This multifactorial issue is related in part to lack of knowledge on glaucoma and importance of taking medications, side effects, forgetfulness, difficulty taking drops and medication cost.
With the introduction of generic latanoprost, the authors found that adherence improved with this medication compared to brand-name agents.
The improved adherence noted in patients switching to a generic is an important consideration for our patients who are struggling to afford their medications. However, one should be cautioned that this study only addressed the medication refill rate; no data is presented on the effectiveness of the generic to the brand name medications and whether there was increased adherence due to being “observed” by the health care professional after switching to the generic.
Interestingly, a sizable group of patients (more than 7%) simply stopped taking glaucoma medications altogether at the time generic latanoprost came to market. No identifiable reason was determined for his finding, but it is a cautionary note to clinicians to monitor patients who are switched to a generic.
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