EyeWorld Asia-Pacific March 2021 Issue

CORNEA EWAP MAR C H 2021 45 by Liz Hillman Editorial Co-Director Real-world treatment patterns of two dry eye drugs Contact information White: darrellwhite@mac.com This article originally appeared in the December 2020 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. A retrospective study based on insurance claims data is giving real-world insights into prescribing/treatment patterns for two dry eye medications— cyclosporine ophthalmic emulsion (Restasis, Allergan) and lifitegrast ophthalmic solution (Xiidra, Novartis). 1 In doing so, researchers can make inferences on adherence, discontinuation, and more. Using information from IBM MarketScan databases from July 2016–February 2019, 6,537 patients were identified as receiving a new prescription for cyclosporine and 3,235 for lifitegrast. Adherence, measured by proportion of days covered by the drug, was 5.9% for cyclosporine and 9.7% for lifitegrast. Non-persistence, measured by refill data, was 7.1% for cyclosporine and 6.8% for lifitegrast. Discontinuation was 70.8% for cyclosporine and 64.4% for lifitegrast within 12 months of starting (median for discontinuation was 89 days for cyclosporine and 29 days for lifitegrast). In the post- index period, the study authors reported 5% switching from cyclosporine to lifitegrast and 9.6% switching from lifitegrast to cyclosporine. Darrell White, MD, lead author of the study, gave EyeWorld further insights and interpretations from the findings. “What I find interesting in this study is this is a somewhat rare example of a non-clinical data mining study in which practicing doctors were consulted on the precise types of analysis of data that would be most consistent with a real-world practice pattern,” Dr. White said. Dr. White explained that patients are directed by pharmacists and the package insert to use one dropperette per dose then throw it away. Looking at that, Dr. White said, you would think patients would need to refill at 30 days for a 1-month supply or 90-days for a 3-month supply. “In reality, the vast majority of patients, at their doctor’s encouragement, will use a Restasis dropperette a minimum of three times. That means a 3-month supply is going to last for 9 months. With Xiidra, there are precisely five drops in the dropperette, which means if you get good at it, you can get two doses out of it, so a single 3-month prescription could last for 6 months.” In light of this perspective, Dr. White said it’s helpful to look at the 9-month data from the study. At this point, Dr. White said about 70% of patients were off their medications. Why aren’t patients staying on these drugs long term? The reasons are likely varied and multifold. “We live in a Tylenol society. You have a headache, you take a Tylenol, and 30 minutes later you feel better,” Dr. White said, adding later, “Dry eye doesn’t work like that.” Dry eye takes a while to become symptomatic for