Adherence and Persistence on Prostaglandin Analogues for Glaucoma: A Systematic Review and Meta-Analysis

Area of Science:

• Ophthalmology
• Pharmacology
• Public Health

Background:

• Glaucoma is a leading cause of irreversible blindness worldwide.
• Prostaglandin analogues (PGAs) are commonly prescribed topical medications for glaucoma management.
• Patient adherence and persistence with long-term topical medication regimens are often suboptimal.

Purpose of the Study:

• To systematically review, synthesize, and quantify studies on adherence and persistence with PGAs.
• To understand real-world treatment behavior in glaucoma patients using PGAs.
• To inform treatment decisions between topical PGAs and procedural interventions.

Main Methods:

• Systematic literature review (SLR) and meta-analysis (MA) of observational studies.
• Inclusion of studies reporting objective measures of adherence and persistence in adult glaucoma patients.
• Analysis of medication possession ratio (MPR) or proportion of days covered (PDC) for adherence and duration of therapy for persistence.

Main Results:

• The meta-analysis included 47 studies with 961,000 patients.
• Mean adherence to PGAs at Year 1 was 44%; mean MPR/PDC was 54% at Year 1 and 60% at Year 2.
• Persistence with PGAs decreased from 75% at 6 months to 31% at Year 3.

Conclusions:

• Suboptimal adherence and persistence with prostaglandin analogues are prevalent in glaucoma patients.
• Adherence and persistence significantly decrease with longer treatment durations.
• Findings suggest procedural glaucoma treatments may offer advantages over daily topical medications.