Clinical Practice Management of Primary Open-Angle Glaucoma in the United States: An Analysis of Real-World Evidence Patient

Purpose: To investigate clinical management of primary open-angle glaucoma (POAG) in the United States using real-world evidence and to examine healthcare resource utilization (HCRU), medication adherence/persistence, and procedure use. Design: A cross-sectional, retrospective analysis of Optum’s de-identified Market Clarity Dataset (July 1, 2013–December 31, 2019). Patients and Methods: Patients ≥18 years with POAG diagnosis and continuous enrollment for 1-year pre- and post-index were eligible and categorized into four mutually exclusive cohorts: CH1, treated with antiglaucoma medication(s) only; CH2, underwent glaucoma procedure(s) only; CH3, treated with antiglaucoma medication(s) and underwent procedure(s); and CH4, received no treatment for POAG. Adherence and persistence with antiglaucoma medications, and disease-specific HCRU were analyzed. Pairwise two-sample comparisons and multivariate regressions were conducted. Results: Examined 232,572 eligible patients (CH1=60,895; CH2=4330; CH3=6027; CH4=161,320). Prostaglandin analogs were most prescribed antiglaucoma medications (CH1: 69.7%; CH3: 62.7%), of which latanoprost was most common (CH1: 51.3%; CH3: 46.1%). Disease-specific office visits occurred in 26.3%, 78.2%, 75.0%, 23.8%, and surgical services visits occurred in 3.8%, 36.3%, 42.5%, 3.3%, in CH1-CH4, respectively. Adherence was higher (medication possession ratio: 47.1% vs 39.4%; P<0.0001), and more patients remained persistent across 1-year post-index period in CH1 vs CH3 (25.4% vs 16.1%; P<0.0001). Positive predictors of medication persistence included being female, ≥55 years, and history of dyslipidemia or thyroid disease (all P≤0.0003). Conclusion: Overall, 70% POAG patients might not have received antiglaucoma treatment. Since POAG is a slowly progressive blinding disease, the lack of antiglaucoma treatment and suboptimal adherence/persistence with medications are of major concerns. Targeted screening and educational approaches are needed to improve POAG management. analyses by clinical and demographic characteristics and by disease-specific HCRU. Adherence and persistence with therapy were compared between CH1 versus CH3. A subgroup analysis was carried out to compare adherence or persistence by antiglaucoma medication type (CH1 vs CH3), including patients on multiple antiglaucoma medications. For continuous variables, the two-sample t -test and/or Wilcoxon’s rank-sum test were used. For categorical variables, the Chi-square test or Fisher’s exact test was used. To account for multiple comparisons, a Bonferroni correction was used. A binary logistic regression analysis was conducted to predict the odds of full-year’s persistence with antiglaucoma medications during 1-year post-index period as an outcome variable. Predictors of persistence were examined for CH1 vs CH3 using a backward elimination process via stepwise logistic regression. Odds ratio (OR) and two-sided P-value were calculated, with 95% CIs. Binary logistic regression analysis was also conducted for occurrence of any disease-specific diagnostic procedures in the 1-year post-index period, to identify predictors of these diagnostic procedures in each cohort (CH2 or CH3). In both logistic regression analyses, diabetes was excluded as a predictor due to collinearity with Charlson Comorbidity Index (CCI) score category. Hypertension was also excluded due to collinearity with dyslipidemia. A Kaplan–Meier survival analysis was finally conducted on persistence with index antiglaucoma medication to determine the probability of remaining persistent for the entire 1-year post-index period for patients in CH1 versus CH3. Two-sided P-value <0.05 was considered statistically significant for all analyses.