Adherence and Persistence with Glaucoma Therapy: Brimonidine/Timolol versus Dorzolamide/Timolol and Various Two-Bottle Combinations
|Gail F. Schwartz1,2*, Caroline Burk3, Teresa Bennett4 and Vaishali D. Patel5|
|1Greater Baltimore Medical Center, Baltimore, MD, USA|
|2Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA|
|3Health Outcomes Consultant, Laguna Beach, CA, USA|
|4Source Healthcare Analytics, Phoenix, AZ, USA|
|5Allergan, Inc., Irvine, CA, USA|
|Corresponding Author :||Gail F. Schwartz, MD
GBMC Physicians Pavilion East,
6565 N. Charles St, Suite 302
Baltimore, MD 21204, USA
Tel: (410) 825-9225
Fax: (410) 825-9229
E-mail: [email protected]
|Received August 16, 2012; Accepted October 10, 2012; Published October 17, 2012|
|Citation: Schwartz GF, Burk C, Bennett T, Patel VD (2012) Adherence and Persistence with Glaucoma Therapy: Brimonidine/Timolol versus Dorzolamide/Timolol and Various Two-Bottle Combinations. J Clin Exp Ophthalmol 3:248. doi:10.4172/2155-9570.1000248|
|Copyright: © 2012 Schwartz GF, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Purpose: Patients with glaucoma often require multiple topical medications to reach target intraocular pressure. This database analysis examined persistence and adherence in patients’ prescribed fixed-combination brimonidine/ timolol, fixed-combination dorzolamide/timolol, or various commonly used two-bottle combinations.
Participants: Glaucoma patients (ICD-9 code: 365.xx; n=7883) from the Source Healthcare Analytics Source®; Lx database with an index prescription for fixed-combination brimonidine/timolol, fixed-combination dorzolamide/timolol, or various commonly used two-bottle combinations during the 6-month qualifying period (January 2008–June 2008), but not the 12 months before, were included.
Methods: In this retrospective prescription database analysis, adherence and persistence for fixedcombination brimonidine/timolol were compared to fixed-combination dorzolamide/timolol and various commonly used two-bottle combinations. The two-bottle arms were: β-blocker+brimonidine; β-blocker+carbonic anhydrase inhibitor; β-blocker+prostaglandin analogue; carbonic anhydrase inhibitor+brimonidine; carbonic anhydrase inhibitor+prostaglandin analogue; and prostaglandin analogue+brimonidine.
Main outcome measures: Persistence for brimonidine/timolol was compared with each of the comparators using Kaplan-Meier survival analysis for 12 months after the index prescription. Adherence was assessed using the medication possession ratio.
Results: Kaplan-Meier analyses found that a significantly greater proportion of patients remained on treatment with brimonidine/timolol (34.9%) compared with each of the other treatments (13.4%–20.8%; p<0.0001) at the end of the study period. In addition, the 12-month medication possession ratio was significantly higher for brimonidine/ timolol (42.7%) than for each of the two-bottle arms (23.3%–34.9%; p<0.0001 for all comparisons). The medication possession ratio for brimonidine/timolol was also slightly, but significantly, higher than that for dorzolamide/timolol (40.6%; p=0.0208).
Conclusions: Persistence and adherence are higher with a fixed-combination single bottle of brimonidine/timolol than with fixed-combination dorzolamide/timolol and commonly used two-bottle combinations.