Glaucoma refers to a group of chronic, progressive eye diseases caused primarily by elevated intraocular pressure (IOP), which left untreated can lead to damage of the optic nerve and eventual blindness. Treatment focuses on reducing and controlling IOP through the use of prostaglandin analogues, beta blockers, and alpha agonists, as well as other drug classes. The need to use multiple mechanisms to control IOP has led to increased use of fixed-dose combinations in the most severe patients in an effort to reduce drug burden and increase compliance. The large variety of available treatment options, plus the recent availability of popular generics, has created a competitive market that will pose challenges for both established players and new entrants.

Using national patient-level claims data, this report analyzes physician adherence to the treatment guidelines by exploring the use of key therapies in the newly diagnosed and recently treated glaucoma patient populations. Among the newly diagnosed patients, we provide 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. Among 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 16% of glaucoma patients 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: Prostaglandin analogues claim the highest patient share in the glaucoma market. 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; however, a variety of new drugs and generics have launched for glaucoma in the last three years. What has been the impact of recently approved drugs or generic availability on the glaucoma market? 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?

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. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet, and presents claims that are between 6-12 months old at 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 glaucoma (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 365.00, 365.04, 365.05, 365.10, 365.11, 365.12, 365.90) during the study period.

Quantified lines of therapy analyses show 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 flowcharts 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 trending of 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.

Author(s): Virginia Schobel, MSc

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