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

To systematically review, synthesize and quantify studies reporting patterns of adherence and persistence with prostaglandin analogues (PGAs) in order to comprehensively understand real-world treatment behavior among patients with glaucoma who are prescribed PGAs. These data can inform the decision between a glaucoma therapy based on either topical PGA medications or procedural PGA-based intervention.

Systematic literature review (SLR) and meta-analysis (MA).

We updated a 2011 SLR using electronic database searches (MEDLINE, Embase and the Cochrane Database of Systematic Reviews [CDSR]), supplemented by hand searches of SLR and MA bibliographies. We included observational studies conducted in adult glaucoma patients treated with PGAs that reported objective measures of persistence or adherence. In addition to estimated rates of adherence and persistence, adherence among patients on any/unspecified PGA was characterized by mean MPR/PDC (medication possession ratio/proportion of days covered, where values >80% indicate good adherence). Duration of therapy was defined as the time period between initial therapy prescription and time of therapy discontinuation or switch.

The SLR included 50 publications reporting on 47 unique studies and involving 961,000 patients. The subsequent MA included all but four studies which did not report the age distribution of patients. The mean proportion of patients on any/unspecified PGA who were adherent at Year 1 was 44% (95% CI: 31%-58%). Among patients on any/unspecified PGA, the mean MPR/PDC was 54% (95% CI: 38%-75%) at Year 1 and 60% at Year 2 (95% CI: 39%-94%). The mean proportion of patients on any/unspecified PGA who were persistent fell from 75% (95% CI: 66%-85%) at Month 6 to 31% (95% CI: 12%-55%) at Year 3, with a smaller decrease observed between Year 1 (56%; 95% CI: 45%-66%) and Year 2 (53%; 95% CI: 45%-62%), and a larger decrease between Years 2 and 3. The mean duration on therapy was 315.7 days (95% CI: 190.0%-441.5 days).

Suboptimal adherence and persistence with PGAs are common, with further decreases as duration lengthens. These findings may underscore the value of procedural glaucoma treatments that do not depend on daily patient engagement with topical medications.