Medicine treatment of glaucoma in Australia 2012–2019: prevalence, incidence and persistence

ObjectiveMedical therapy can halt or significantly slow the progression of glaucoma if medicines are used in accordance with the guidelines. We used dispensing claims for a 10% sample of all Australians dispensed publicly subsidised glaucoma medicines to determine the prevalence and incidence of glaucoma medicine treatment and to examine treatment persistence between July 2012 and June 2019.MethodsWe estimated incidence and prevalence per 10 000 population for Australian financial years (1 July to 30 June). We defined prevalence as at least one dispensing of any glaucoma medicine and incidence as a dispensing of any glaucoma medicine with no previous dispensing during the preceding 12 months. We estimated duration of treatment for a cohort initiating glaucoma medicines and used Kaplan-Meier methods to estimate the proportion of people persisting on treatment at 6, 12, 18 and 36 months after initiation. We stratified analyses by the number of repeats prescribed at initiation, age, sex and medicine class.ResultsPrevalence remained stable over the study period at around 180/10 000 people/year; incidence was also stable around 36/10 000/year. Among 34 900 people initiating glaucoma medicines, 37.0% remained on treatment at 6 months from initiation, 29.8% at 12 months and 19.2% at 36 months. Median duration of treatment was 13.2 months (IQR: 2.5—not reached) for people initiating prostaglandin analogues and less than 3 months for those initiating other medicine classes.ConclusionPrevalence and incidence of glaucoma treatment have not changed in Australia over the past decade. Persistence to treatment increased with age but remained poor throughout the study period.

Real-World Persistence with and Adherence to Emicizumab Prophylaxis in Persons with Hemophilia a: A Secondary Claims Database Analysis

Introduction: Emicizumab is a subcutaneously administered, humanized bispecific monoclonal antibody, approved for routine prophylaxis in persons with hemophilia A (PwHA) with or without factor VIII inhibitors. Little is known about patterns of emicizumab use in clinical practice. We aimed to evaluate real-world persistence with and adherence to emicizumab treatment for PwHA on prophylaxis. Methods: This retrospective study used de-duplicated commercial insurance claims data from IBM® MarketScan® Commercial Research and IQVIA PharMetrics® Plus databases from 16 November 2017 to 31 December 2019. Individuals included met the following criteria: 1) evidence of emicizumab use (at least two prescription fills) and 2) continuous enrollment for at least three months pre-emicizumab initiation. Individuals were followed until the end of study period or continuous enrollment. Persistence was defined as the proportion of individuals continuing treatment with emicizumab during the study period. Time to discontinuation and proportion of individuals who restarted emicizumab prophylaxis were reported for patients who discontinued emicizumab. Discontinuation was defined as 60 days without a prescription fill. Adherence was measured over the post-index persistence period using the proportion of days covered (PDC), and the proportion of individuals adherent at ≥80% PDC threshold was reported. Results: We identified 328 unique individuals who met the inclusion criteria. All patients were male (100%); the average age was 23 years (standard deviation [SD] ±16; range=1-64); and the average follow-up post-index was eight months (245±147 days). The vast majority of individuals (92%) were persistent with emicizumab prophylaxis during the study period. Among those who discontinued emicizumab (n=25), the average time to discontinuation was approximately three months (84±124 days); 40% restarted emicizumab prophylaxis after discontinuation, with an average time to restart of approximately four months (126±56 days). During the period for which individuals were persistent to treatment, adherence to emicizumab was high (81%); with 70% individuals meeting the ≥80% PDC threshold. Among those with at least one-year post-index enrollment (n=48), adherence during the first year was also high (85%), with 77% individuals adherent at the ≥80% PDC threshold. Conclusions: In this study, the vast majority of individuals treated with emicizumab had high rates of adherence and persistence to treatment. This is one of the first studies to report real-world persistence with and adherence to emicizumab prophylaxis in PwHA. Future evaluations should examine the association of persistence and adherence with health outcomes in this population. Disclosures Mahajerin: Spark Therapeutics, Alexion, Genentech, Inc.: Speakers Bureau. Khairnar:Genentech, Inc.: Current Employment, Current equity holder in publicly-traded company; F Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company. Meyer:F. Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company; Genentech, Inc.: Current Employment, Current equity holder in publicly-traded company. Abbass:Genentech, Inc.: Current Employment, Current equity holder in publicly-traded company; F Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company. Wang:Genentech, Inc.: Current Employment, Current equity holder in publicly-traded company; F Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company; Acumen, LLC: Ended employment in the past 24 months. Lee:Genentech, Inc.: Current Employment; F. Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company. Tzeng:Genentech, Inc.: Current Employment, Current equity holder in publicly-traded company; F Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company. Raimundo:Genentech, Inc.: Current Employment, Current equity holder in publicly-traded company; F Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company.

FRI0528 INDICATORS OF EFFECTIVENESS AFTER 6 YEARS OF FOLLOW-UP OF PATIENTS IN THE FLS DR. NEGRIN

Background:Data on the effectiveness of FLS in the medium and long term in Spain are neededObjectives:To analyze the indicators of long-term persistence to treatment, refracture and mortality in our Fracture Liaison Service (FLS)Methods:Throughout 2019, the medical records of patients with an indication of treatment to prevent new fractures whose baseline visit took place between 2012 and 2014 were reviewed. The data included those of the baseline visit (age, sex, type of index fracture, FRAX scale and DXA results) and for the follow-up (death and date, refracture including revision of spine x-rays - it was considered only the first refracture and, in the case of several fractures the most serious was chosen-, prescribed treatment, persistence of treatment trough electronic prescription on the date of review or death, and MPR or proportion of days covered by treatment).Results:399 patients were included, 335 of them women (84%), mean age 73.8 years (range 51-93) and average follow-up of 6 years (range 5.5-7 years).Baseline visit.- The average FRAX was 15 and 7 for major fracture and femoral fracture respectively. DXA was normal in 22 patients (5.5%), osteopenia in 143 (35.8%) and osteoporosis in 234 (58.6%). 78 patients (19.5%) had a previous fragility fracture.Type of fracture index: femur 126 (31.5%), forearm 119 (29.8%), humerus 76 (19%), vertebra 24 (6%), others 54 (13.5%). 80 patients (20%) had received prior treatment for osteoporosis.Follow-up.- The persistence of treatment was assessed in 394 patients; 245 patients (62%) were prescribed a treatment on the most recent date, 200 (51%) with MPR≥80%. When analyzing patients with prescribed treatment, in 176 cases (72%) it was a bisphosphonate in a sustained manner, in 23 cases (9%) a bisphosphonate was prescribed and subsequently changed to denosumab, while in 45 cases (18%) it was initiated and maintained denosumab.71 of 397 patients presented a new fracture (17.8%). The type of incident fracture was as follows: femur in 24 patients (34%), vertebra in 20 patients (28%), forearm in 9 patients (12%) and other fractures in 18 patients (25%). Refracture occurred in 9 patients in the first year, 16 in 2nd, 12 in the 3rd, 9 in 4th, 14 in 5th, 6 in 6th and 3 in 7th year. The persistence of treatment with MPR≥80% was similar in patients with and without refracture (52 vs 51%). The average baseline age and FRAX for major fracture in the fractured and non-fractured were 75 vs. 73 years (p = 0.10) and 17 vs. 14 respectively (p <0.01).92 patients (23%) died, 25% of them in the two years that followed the baseline visit and 61% in the following 4 years. The persistence of treatment was 37% in those who died and 69% in those who remained alive (p <0.01).Conclusion:After an average of 6 years after the assessment in an FLS, the persistence of treatment was 62% (MPR≥80% in 51%), the mortality was 23% and the percentage of refractured patients was 17%.Disclosure of Interests:Antonio Naranjo Grant/research support from: amgen, Consultant of: UCB, Speakers bureau: AMGEN, Amparo Molina Speakers bureau: AMGEN, STADA, Cristina Sepúlveda: None declared, Francisco Rubiño: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO

Long-acting injectable vs oral antipsychotics: Adherence, persistence and switching over three years of real-life analysis

Background: Persistence and adherence to treatment are considered efficacy outcomes in psychiatric disorders. One of the best ways to improve these values in patients with psychiatric disorders is to prefer long-acting injectable (LAI) drugs to oral AP. Objective: The objective of this study is to evaluate adherence, persistence and switching of antipsychotics and compare in real life long-acting with oral formulations. Materials and methods: This pharmacological, observational, retrospective, non-interventional study involved all patients of the ASL of Pescara treated in the front-line with AP in the period between January 2011 and February 2019. Adherence was measured using the ratio between received daily dose and prescribed daily dose. Persistence to treatment with antipsychotics was calculated as the daily difference between start and end of treatment. Results: We examined 840 patients treated with Aripiprazole, 130 patients treated with Paliperidone and 925 patients treated with Risperidone. Adherence was significantly better in long-acting formulations with values of 0.89 (Aripiprazole) and 0.82 (Paliperidone and Risperidone) than in oral formulations with values of 0.78, 0.70 and 0.58, respectively. Persistence curves over three years of therapy have not shown a statistically significant difference (p = 0.3314). Persistence curves based on formulation have not shown a statistically significant difference. 7% of patients treated with Aripiprazole, 12% of patients treated with Risperidone and 28% of patients treated with Paliperidone switched therapy. Conclusions: In all drugs of the present study, adherence values were better in LAI than in OA, whereas no statistically significant difference was found in persistence values.