PMID- 28726170
OWN - NLM
STAT- MEDLINE
DCOM- 20180201
LR  - 20181202
IS  - 1865-8652 (Electronic)
IS  - 0741-238X (Linking)
VI  - 34
IP  - 8
DP  - 2017 Aug
TI  - Prescribing Trends in a Glaucoma Clinic and Adherence to EGS Guidelines: A 
      Retrospective, Non-Interventional, Single-Center UK Study.
PG  - 2033-2042
LID - 10.1007/s12325-017-0593-9 [doi]
AB  - INTRODUCTION: The purpose of this study was to determine prescribing trends in a 
      specialist glaucoma clinic in the UK. Specifically, the aims were to determine 
      which drugs were prescribed as first-, second-, and third-line treatment, the 
      persistence of first-, second-, and third-line treatment regimens, and the 
      proportion of treatment decisions conforming to the European Glaucoma Society 
      (EGS) guidelines. METHODS: A retrospective, non-interventional, single-center, 
      case-note review was performed on a cohort of consecutive patients presenting to 
      a specialist glaucoma clinic for follow-up. Inclusion criteria for the study were 
      (1) a diagnosis of primary open-angle glaucoma or ocular hypertension, (2) 
      glaucoma management entirely within the unit, and (3) minimum of 2 years of 
      follow-up. RESULTS: A total of 114 case notes met the inclusion criteria. Mean 
      age was 71 years (range 40-95 years). Mean length of follow-up was 56 months 
      (range 24-180 months). Prostaglandin analogues (PGA) were the most popular 
      first-line treatment in 73% of patients. As second-line treatment, PGA were again 
      the predominant class, prescribed in 87% of cases, whereas beta-blockers (BB) 
      were prescribed in 70% of cases. Carbonic anhydrase inhibitors (CAI) and alpha-2 
      agonists (AA) were more popular in third-line regimens. Second-line treatment was 
      introduced at a mean of 28.0 months after first-line treatment (range 
      1-120 months, 95% CI 22.1-33.9 months). Third-line treatment was introduced at a 
      mean of 22.9 months after second-line treatment (range 1-96 months, 95% CI 
      17.1-28.8 months). Breaches to EGS guidelines were most common for third-line 
      treatment and included duplication of drug classes. DISCUSSION: There was a clear 
      hierarchy of PGA as first-line, BB as second-line, while CAI and AA were 
      considered third-line choices. First-line choices were generally in line with EGS 
      guidelines. There was a tendency to breach guidelines by escalating treatment in 
      dual steps rather than single steps (especially in third-line treatment). 
      Combination drops were popular. In third-line treatment there was an increased 
      incidence of prescribing errors. This data is important in terms of informing 
      patients of the expected treatment course, to remind clinicians about best 
      practice, and also to guide comparisons of cost-effectiveness with other 
      treatment modalities.
FAU - Fajgenbaum, Mark
AU  - Fajgenbaum M
AD  - Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
FAU - Ansari, Ejaz
AU  - Ansari E
AUID- ORCID: 0000-0001-8943-8209
AD  - Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK. e.ansari@nhs.net.
AD  - University of Kent at Canterbury, Canterbury, UK. e.ansari@nhs.net.
LA  - eng
PT  - Journal Article
DEP - 20170719
PL  - United States
TA  - Adv Ther
JT  - Advances in therapy
JID - 8611864
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Prostaglandins, Synthetic)
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antihypertensive Agents/*therapeutic use
MH  - Drug Prescriptions/*statistics & numerical data
MH  - Female
MH  - Glaucoma/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/*trends
MH  - Prostaglandins, Synthetic/therapeutic use
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Adherence
OT  - Alpha 2 agonists
OT  - Beta blockers
OT  - Carbonic anhydrase inhibitors
OT  - EGS guidelines
OT  - Glaucoma
OT  - Ocular hypertension
OT  - Ophthalmology
OT  - Prostaglandins
EDAT- 2017/07/21 06:00
MHDA- 2018/02/02 06:00
CRDT- 2017/07/21 06:00
PHST- 2017/05/28 00:00 [received]
PHST- 2017/07/21 06:00 [pubmed]
PHST- 2018/02/02 06:00 [medline]
PHST- 2017/07/21 06:00 [entrez]
AID - 10.1007/s12325-017-0593-9 [pii]
AID - 10.1007/s12325-017-0593-9 [doi]
PST - ppublish
SO  - Adv Ther. 2017 Aug;34(8):2033-2042. doi: 10.1007/s12325-017-0593-9. Epub 2017 Jul 
      19.