Glaucoma refers to a group of chronic, progressive eye diseases caused primarily by elevated intraocular pressure (IOP) resulting from the blockage or decreased drainage of the aqueous humor through the eye’s trabecular meshwork in the drainage angle. Patients with ocular hypertension (OHT), who present with elevated IOP but have no other signs of glaucomatous damage, are at increased risk of developing primary open-angle glaucoma (POAG), the most common type of glaucoma. Treatment focuses on reducing and controlling IOP and preserving visual function by stabilizing optic nerves. Although prostaglandin analogues and beta blockers are the most frequently prescribed therapies, alpha agonists, carbonic anhydrase inhibitors, and parasympathomimetics (cholinergic agents) are also commonly prescribed. Patients are often treated with multiple mechanisms of action, either through polypharmacy or a fixed-dose combination therapy. Increased generic competition within the prostaglandin analogue, alpha agonist, and fixed-dose combination classes has put pressure on many of the more well-known brands in this market.

Using longitudinal U.S. claims data, this report examines current trends in the treatment of glaucoma (OHT and POAG) for both newly diagnosed patients and patients filling a prescription for a key therapy in the third quarter of 2013. For newly diagnosed patients, the report provides a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. For recently treated patients, the report quantifies a drug’s source of business compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.

Questions Answered in This Report:

  • Newly diagnosed patients: Approximately 27% of patients with POAG or OHT begin treatment with a key therapy within a year of their initial diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?

  • Recently treated patients: More than 70% of prescriptions for recently treated patients are for prostaglandin analogues; beta blockers and fixed-dose combinations make up most of the remaining prescriptions. Which specific drugs garner the most patient share for recently treated glaucoma patients? When do patients progress from one therapy to the next in glaucoma, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming from new (adds/switches) or continuing business?

  • Pathways to key therapies: Longitudinal claims data reveal relatively consistent use patterns of key therapies among recently treated patients. Use of prostaglandin analogues is dominant in earlier lines of therapy; polypharmacy—via switching to a fixed-dose combination or to a multidrug regimen with beta blockers, alpha agonists, or carbonic anhydrase inhibitors—is instituted in later lines. Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients? What has been the impact of recently approved drugs for glaucoma? What has been the impact of recently approved generic drugs for glaucoma?

Scope:

Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. The report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet and presents claims that are less than six months old at the time of publication.

Patient Sample:

Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least one claim with a diagnosis code for POAG or OHT (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 365.04, 365.05, 365.10-365.12, 365.90) during the study period.

Quantified lines of therapy analysis shows exact share of each agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.

Newly Diagnosed Patients:

- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.

- Patient flowchart through one year of treatment for all first-line products, including progression rates and add/switch behavior.

- Polypharmacy and key concomitant therapies by line of therapy.

- Quarterly trends in patient share by line of therapy.

Recently Treated Patients:

- Quarterly snapshot of patient share by drug class and key products.

- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.

- Brand source of business, including share for continuing, new (switches/adds), and new (initial therapy) business.

- Polypharmacy and key concomitant therapies.

- Drug persistence and compliance.

- Quarterly trends in patient share for all key therapies.


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