Comparison of latanoprost, travoprost, and bimatoprost on adherence, persistence, and pattern of initial and second-line therapy in glaucoma and ocular hypertension : an administrative claims database analysis

The aims of the study were to assess the treatment patterns, healthcare utilization, and costs for patients with glaucoma or ocular hypertension during a 24-month period using Humana data from 2007 to 2012. Adults (aged ≥40 years) diagnosed with glaucoma or ocular hypertension, enrolled for at least 36-month, and who used latanoprost, travoprost, or bimatoprost as an initial therapy were included. Index prostaglandin analog (PGA) was defined a PGA that was used in the first-line therapy. Discontinuation of first-line therapy was the non-persistence of index medication or any change in therapy. A retrospective cohort study design was employed using propensity score matching. A total of 3,888 matched patients (n=1,296 per group) were identified. Compared to the latanoprost group, the bimatoprost group was significantly less adherent by 7.2% (p<0.0001). The travoprost and bimatoprost groups had about a 40.0 higher risk of non-persistent of their index PGA than the latanoprost group (p<0.0001). The travoprost and bimatoprost groups had a 40.8% and 48.1% higher risk of discontinuing the first-line therapy, respectively, compared to the latanoprost group (p<0.0001). After 24-month follow-up, 69.6% of patients in the latanoprost group stayed in first-line therapy, followed by 67.5% in the bimatoprost and 63.7% in the travoprost group (p=0.0049). The number of glaucoma-related prescriptions was highest for the latanoprost group (13.3±7.5, p<0.0001), and latanoprost users had lower prescription costs ($1,011±601) than either travoprost ($1,140\pm 662)orbimatoprost($ 1,136±661) groups (p<0.05). The study results showed that patients who used latanoprost as their initial therapy were more likely to adhere and persist to the index PGA compared to the travoprost or bimatoprost groups. In the 24-month of follow-up, the latanoprost group showed a lower risk of discontinuing first-line therapy, and was less likely to change therapy. Although latanoprost users had a significantly higher number of glaucoma-related prescriptions, they showed lower costs than other groups due to the lower cost of latanoprost eye-drops. The results may assist ophthalmologists in determining the optimal management of this patient population with respect to treatment patterns.