Comparison of adherence between fixed and unfixed topical combination glaucoma therapies using Japanese healthcare/pharmacy claims database: a retrospective non-interventional cohort study.

BACKGROUND: Adherence to chronic therapies is crucial to prevent the progression of disease, such as glaucoma. However, only a limited number of studies have investigated them using real-world data in Japan. This study aimed to evaluate Japanese patients' adherence to fixed- and unfixed-combination eye drops as a second-line therapy for glaucoma in real-world practice. METHODS: This retrospective, non-interventional cohort study utilized a commercially available Japanese healthcare database (MinaCare database). Medical/pharmacy claims data were collected from 2011 to 2016. The primary endpoint was adherence to medications, assessed by proportion of days covered (PDC) with medication during a 12-month post-index period. Meanwhile, the secondary endpoints included the persistence rate. RESULTS: A total of 738 patients were included in this study: 309 and 329 in the fixed- and unfixed-combination cohorts, respectively. Prostaglandin analog (PG)/ß-blocker (BB) was most commonly claimed in 241/309 (78.0%) patients in the fixed-combination cohort. In the unfixed-combination cohort, PG and BB were claimed in 130/329 (39.5%) patients, whereas PG and α2-agonist were claimed in 87/329 (26.4%) patients. Patients were more adherent to the fixed-combination than the unfixed-combinations (mean PDCs [SD], 79.1% [32.1] vs. 62.2% [38.0]; P < 0.0001). The proportion of patients with good adherence (PDC ≥ 80%) was also higher in the fixed-combination cohort (69.6%) than in the unfixed-combination cohort (48.6%) (P < 0.0001). During the 12-month post-index period, the persistence rate was higher in the fixed-combination cohort than in the unfixed-combination cohort (47.6% [95% confidence intervals (CI): 41.9-53.0] vs. 24.9% [95% CI: 20.4-29.7], P < 0.0001). CONCLUSIONS: Japanese patients with glaucoma preferred the fixed-combination therapies over the unfixed-combination therapies. Hence, fixed-combination therapies would contribute to the improvement of adherence.

Risk factors leading to trabeculectomy surgery of glaucoma patient using Japanese nationwide administrative claims data: a retrospective non-interventional cohort study.

BACKGROUND: Early recognition and management of baseline risk factors may play an important role in reducing glaucoma surgery burdens. However, no studies have investigated them using real-world data in Japan or other countries. This study aimed to clarify the risk factors leading to trabeculectomy surgery, which is the most common procedure of glaucoma surgery, of glaucoma patient using the Japanese nationwide administrative claims data associated with the diagnosis procedure combination (DPC) system. METHODS: It was a retrospective, non-interventional cohort study. Data were collected from patients who were admitted to DPC participating hospitals, nationwide acute care hospitals and were diagnosed with glaucoma between 2012 to 2018. The primary outcome was the risk factors associated with trabeculectomy surgery. The association between baseline characteristics and trabeculectomy surgery was identified using multivariable logistic regression analysis by comparing patients with and without trabeculectomy surgery. Meanwhile, the secondary outcomes included the rate of comorbidities, the rate of concomitant drug use and the treatment patterns of glaucoma eye drops at the index admission. Among patients with trabeculectomy surgery, the risk factors leading to cataract surgery were also evaluated as subgroup analysis. RESULTS: A total of 29,599 patients included in the analysis, 12,038 and 17,561 patients were in the glaucoma surgery and non-glaucoma surgery cohorts, respectively. The factors associated with the increase in trabeculectomy surgery were having allergies, taking concomitant drugs including cancer, depression, ischemic heart disease and peptic ulcer, being diagnosed with primary open-angle glaucoma and longer length of stay in hospital. In contrast, the factors associated with the decrease in trabeculectomy surgery were having hypertension, taking hypertension drug, age ≥ 80 and female. CONCLUSIONS: Special focus on Japanese patients with glaucoma who have allergy-related comorbidities or take immune, nervous, circulatory or gastrointestinal system-related concomitant drugs seems to be desirable.

The Use of a Network Analysis to Identify Associations and Temporal Patterns Among Non-communicable Diseases in Japan Based on a Large Medical Claims Database.

BACKGROUND: Reducing the considerable non-communicable disease (NCD) burden in the aging Japanese population depends on better understanding of the comorbid and temporal relationships between different NCDs. OBJECTIVE: We aimed to identify associations between NCDs and temporal patterns of NCDs in Japan using data from a large medical claims database. METHODS: The study used three-digit International Classification of Diseases, Tenth Revision codes for NCDs for employees and their dependents included in the MinaCare database, which covers the period since 2010. Associations between pairs of NCDs were assessed by calculating risk ratios. The calculated risk ratios were used to create a network of closely associated NCDs (risk ratio > 15, statistically significant) and to assess temporal patterns of NCD diagnoses (risk ratio ≥ 5). The Infomap algorithm was used to identify clusters of diseases for different sex and age strata. RESULTS: The analysis included 4,200,254 individuals (age < 65 years: 98%). Many of the temporal associations and patterns of the diseases of interest identified in this study were previously known. Regarding the diseases of interest, these associations can be classified as comorbidities, early manifestations initially diagnosed as something else, diseases attributable to or that cause the disease of interest, or caused by pharmacological treatment. International Classification of Diseases, Tenth Revision chapters that were most associated with other chapters included L Diseases of the skin and subcutaneous tissue. In the age-stratified and gender-stratified networks, clusters with the highest numbers of International Classification of Diseases, Tenth Revision codes included I Diseases of the circulatory system and F Mental and behavioral disorders. CONCLUSIONS: Our findings reinforce established associations between NCDs and underline the importance of comprehensive NCD care.

Adherence and Persistence with First-Line Therapy and Compliance with Glaucoma Guidelines Using Japanese Health Care/Pharmacy Claims Database.

Purpose: This study evaluated Japanese patients' adherence to first-line therapy and physicians' compliance with the guidelines (GLs) for glaucoma in daily practice. Methods: This retrospective, noninterventional cohort study used a Japanese health care/pharmacy claims database from 2011 to 2016. We compared adherence based on the primary outcomes assessed as proportion of days covered (PDC) and persistence between patients who received first-line monotherapy followed by second-line fixed-combination therapy (GL-compliant cohort) and those who received first-line fixed-combination therapy (GL-noncompliant cohort). Furthermore, we explored treatment patterns, glaucoma consultation, and key factors associated with GL noncompliance. Results: Among 11,666 patients who received first-line therapy, 1,183 (10.1%) and 542 (4.6%) were in the GL-compliant and GL-noncompliant cohorts, respectively. Prostaglandin (70.7%) and subsequent prostaglandin/ß blocker (BB) (20.9%) within 12 months were most used by the GL-compliant cohort. Prostaglandin/BB (48.9%) and carbonic anhydrase inhibitor/BB (51.1%) were prescribed for the GL-noncompliant cohort. The mean PDC [standard deviation (SD)], persistence rate (95% confidence interval), and consultation (SD) over 12 months were 60.9% (34.0), 16.0% (14.0-18.1), and 5.23 (3.21) times, respectively, in the GL-compliant cohort and 59.7% (35.8), 22.0% (18.6-25.5), and 4.76 (3.19) times, respectively, in the GL-noncompliant cohort. No significant differences were observed between the 2 cohorts. No clinically relevant factor associated with GL noncompliance was found. Conclusions: Around 5% of patients were prescribed a fixed-combination eye drop as first-line therapy not in accordance with GLs. The similarity of adherence and persistence between the 2 cohorts indicates that first-line fixed-combination therapy could be considered for glaucoma treatment.