Despite the availability of prescription medications for dry eye disease (DED), a significant proportion of patients discontinue their prescribed treatment within one year, often before even obtaining a refill, according to a study presented at ASCRS 2024. This suggests that the current medications may only partially address the diverse clinical presentation of DED, indicating a need for additional agents with different mechanisms of action, particularly for cases such as evaporative DED.
The study, conducted using the American Academy of Ophthalmology’s IRIS Registry linked to Komodo Health claims data, aimed to understand prescription medication treatment and switching patterns, along with reasons for switching among patients with DED.
The retrospective cohort study, which included adult patients initiating DED treatment with cyclosporine (0.05% or 0.09%) or lifitegrast, followed them for 1 year from January 2018 to June 2021. Discontinuation was defined as a gap of 60 days or more between the end of the expected days’ supply and the next refill, while switching was defined as a claim for a different DED medication before discontinuing the index medication. Reasons for switching were extracted from notes from 200 randomly selected patients.
Out of 73,356 patients meeting the inclusion criteria, the majority initiated treatment with cyclosporine 0.05% (47,859 patients), followed by lifitegrast (23,706 patients) and cyclosporine 0.09% (1791 patients). Over half of the patients did not obtain a refill, with only 4% switching therapy and 90% discontinuing therapy altogether. The mean time to the first medication switch varied, with cyclosporine 0.05% at 98.4 ± 84.7 days, cyclosporine 0.09% at 66.2 ± 73.5 days, and lifitegrast at 84.2 ± 79.5 days. Among those who switched, a notable portion (12-33%) experienced a rejected claim prior to switching.
Of the patients with documented reasons for switching (91 out of 200), lack of efficacy was the primary reason cited (45.1%), followed by adverse events (26.4%) and cost concerns (24.4%).
Understanding these patterns and challenges is crucial for optimizing treatment strategies and improving patient outcomes in DED management, the authors concluded.
Reference
Mbagwu M, et al. Characterization of Discontinuation and Switching Patterns of Dry Eye Disease Medications Using Linked EHR Registry and Claims Data. Presented at: ASCRS Annual Meeting 2024.
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