Persistence on prostaglandin ocular hypotensive therapy: an assessment using medication possession and days covered on therapy

BACKGROUND:Prior research has demonstrated that medication persistence (continued acquisition of therapy over time) is far from optimal among patients with glaucoma. The purpose of the present study was to evaluate persistence with prostaglandin analogs among glaucoma patients in the first therapy year using a modification of a previously published technique.METHODS:This retrospective analysis of medical and pharmacy claims database included treatment-naive patients dispensed bimatoprost, latanoprost, or travoprost between 1/1/04-12/31/04. "Index agent" was defined as the first agent filled; "index date" was defined as the fill date. Follow-up continued for 358 days. Persistence measures for first therapy year were: (1) whether last fill had sufficient days supply to achieve medication possession at year's end, and (2) number of days for which the index agent was available (days covered). Associations between index agent and medication possession (logistic regression) and days covered (linear regression) were evaluated. Models were adjusted for gender, age, and previous ocular hypertension diagnosis.RESULTS:7873 patients met inclusion criteria (bimatoprost, n = 1464; latanoprost, n = 4994; travoprost, n = 1415). Medication possession was 28% and days covered was 131 when using the unadjusted (pharmacy-reported) days supply estimates and rose to 47-48% and days covered to 228-236 days when days supply was imputed. Compared to latanoprost, odds of achieving medication possession at first year's end were 26-34% lower for bimatoprost and 34-36% lower for travoprost (p [less than or equal to] 0.001 for all comparisons). Days covered in the first year were 21-29 days lower for bimatoprost and 33-42 days lower for travoprost (p [less than or equal to] 0.001 for all comparisons). Failure to refill the index agent within the initial 90 days was a strong predictor of poor persistence. CONCLUSIONS:Persistence with ocular prostaglandin therapy remains a problem. Latanoprost users had greater odds of achieving medication possession and had more days covered during the first therapy year.The results of this study were presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, April 27 to May 1, 2008, in Fort Lauderdale, Florida, USA and at the International Society for Pharmacoeconomics and Outcomes Research 13th Annual International Meeting, May 3 to May 7, 2008, in Toronto, Canada. The research was supported by Pfizer Inc, New York, New York, USA. Assistance in styling the paper for journal submission was provided by Jane G. Murphy, PhD, of Zola Associates and was funded by Pfizer Inc, New York, New York, USA. Sonali Shah, BS Pharm, RPh, MPH provided the impetus and helpful support and advice for design of this study

Remote Video-to-Video Eye Telemonitoring Use Case for Glaucoma Patients

Part 1: IIVC WorkshopInternational audienceGlaucoma is the second leading cause of blindness globally and the second most common cause of avoidable visual impairment. It also holds a record in noncompliance to therapy from the patients in up to 50% of the subjects treated with anti-glaucoma eye drops. LiveCity e-Health is a European research program, which aims to provide better treatment and follow up of glaucoma patients at their home, through telemonitoring with high definition video-to-video (v2v) communication from the University Hospital. Secondly, it aims to reduce the cost of health and improve the city environment by decreasing the number of visits to the Hospital. For this purpose, a software application has been developed; the latter is easy to use for elderly people at home, and capable of keeping the medical history and digital records of every patient in the Glaucoma Department. In addition, a specific web camera with snapshot ability of high quality photo of the eye has utilised. Two patients have been initially enrolled in the study and the preliminary results are so presented

Unique Tracheal Fluid MicroRNA Signature Predicts Response to FETO in Patients With Congenital Diaphragmatic Hernia

Objective and Background:Our objective was to determine the fetal in vivo microRNA signature in hypoplastic lungs of human fetuses with severe isolated congenital diaphragmatic hernia (CDH) and changes in tracheal and amniotic fluid of fetuses undergoing fetoscopic endoluminal tracheal occlusion (FETO) to reverse severe lung hypoplasia due to CDH.Methods:We profiled microRNA expression in prenatal human lungs by microarray analysis. We then validated this signature with real-time quantitative polymerase chain reaction in tracheal and amniotic fluid of CDH patients undergoing FETO. We further explored the role of miR-200b using semiquantitative in situ hybridization and immunohistochemistry for TGF-2 in postnatal lung sections. We investigated miR-200b effects on TGF- signaling using a SMAD-luciferase reporter assay and Western blotting for phospho-SMAD2/3 and ZEB-2 in cultures of human bronchial epithelial cells.Results:CDH lungs display an increased expression of 2 microRNAs: miR-200b and miR-10a as compared to control lungs. Fetuses undergoing FETO display increased miR-200 expression in their tracheal fluid at the time of balloon removal. Future survivors of FETO display significantly higher miR-200 expression than those with a limited response. miR-200b was expressed in bronchial epithelial cells and vascular endothelial cells. TGF-2 expression was lower in CDH lungs. miR-200b inhibited TGF--induced SMAD signaling in cultures of human bronchial epithelial cells.Conclusions:Human fetal hypoplastic CDH lungs have a specific miR-200/miR-10a signature. Survival after FETO is associated with increased miR-200 family expression. miR-200b overexpression in CDH lungs results in decreased TGF-/SMAD signaling