Morning vs Evening Dosing of Glaucoma Medication
Morning vs Evening Dosing of Glaucoma Medication
Purpose: To determine if adherence and convenience of once-daily glaucoma medication is greater in the morning or the evening.
Design: Prospective, randomized crossover treatment trial.
Patients and Methods: Thirty patients newly diagnosed with glaucoma or ocular hypertension requiring intraocular pressure (IOP) reduction were started on travoprost eye drops and randomized to either morning or evening administration for 1 month. They were then crossed over to the opposite dosing schedule for the following month. Adherence was monitored using an automated dosing aid.
Main Outcome Measures: Adherence was compared between morning versus evening dosing and first versus second month dosing. Demographic characteristics were obtained, treatment effect was measured, and patients completed a post-study questionnaire regarding the convenience of the 2 dosing regimens.
Results: Patient adherence overall was good (89.3%). There was no statistically significant difference (P=0.07) in adherence between morning dosing (90.9%) and evening dosing (87.3%). Adherence in the first month (91.7%) was superior to the second month (86.5%). There was no significant difference in IOP response between morning and evening dosing. Patients found morning dosing more convenient than evening dosing.
Conclusions: Early adherence to treatment with a prostaglandin analogue is good, but patients prefer morning administration to evening administration. This may lead to greater adherence with morning administration, particularly among men. Adherence decreases from the first to second month after initiation of treatment. IOP response to this treatment is not significantly affected by morning versus evening administration.
It has been demonstrated that lowering of intraocular pressure (IOP) can decrease the risk of visual field loss from glaucoma. Although both laser trabeculoplasty and incisional surgery are effective at lowering IOP, one of the most common initial interventions in the treatment of glaucoma is the prescription of topical ocular antihypertensive medications in the form of eye drops. Of these medications, prostaglandin analogs (PGAs) such as travoprost are among the most frequently prescribed medications used to lower IOP, and are administered once daily. In order for the medication to have the desired effect of lowering IOP, consistent adherence to daily administration of the medication is essential.
The term compliance has been used in the past as a description of how consistently patients take a medication as prescribed, however, this term has been replaced with the more specific terms adherence and persistence. Adherence describes the number of times a patient properly takes their medication over a defined time period, and persistence represents the length of time that a patient takes their medication before discontinuing it.
Most studies in the literature on the topic of adherence show that once-daily medications such as PGAs may have higher adherence rates than medications dosed twice or more daily, but adherence with once-daily medications is still less than ideal. Many reasons for poor adherence to glaucoma medications have been suggested, including environmental, regimen, patient, and provider-related factors. Compounding these barriers to adherence is the asymptomatic nature of the disease, and the perception that eye drops are not "real" medications because they are not dosed orally. Thus, any modification to a treatment regimen, which improves adherence would be beneficial in the management of patients with glaucoma.
Initial studies on the diurnal effect of latanoprost, the first PGA medication, showed a beneficial effect to taking the medication in the evening rather than in the morning. However, this same effect was not shown with travoprost. Since there is no strong evidence that evening dosing of travoprost is superior to morning dosing, any consistent difference in adherence between the 2 dosing schedules becomes a significant factor in planning the treatment of patients with glaucoma. A retrospective, nonrandomized study comparing morning versus evening adherence found patients on morning dosing to be less likely to miss an entire day of dosing. Nonetheless, this study did not find a significant difference between the 2 groups in overall adherence.
Adherence to glaucoma medication can be determined by self-report, pharmacy claims data, or electronic monitoring. Electronic monitoring of glaucoma medication adherence was first described by Kass et al for use with pilocarpine in the 1980s. Recently, a dosing aid for use with travoprost (Alcon, Fort Worth, TX) has been developed that allows precise recording of the date and time at which the bottle of medication is squeezed to dispense a drop. This allows measurement of adherence when the medication is prescribed for different dosing schedules within the day.
The purpose of this study is to determine whether adherence is better with morning or evening administration of a once-daily medication in the treatment of patients with glaucoma or ocular hypertension.
Abstract and Introduction
Abstract
Purpose: To determine if adherence and convenience of once-daily glaucoma medication is greater in the morning or the evening.
Design: Prospective, randomized crossover treatment trial.
Patients and Methods: Thirty patients newly diagnosed with glaucoma or ocular hypertension requiring intraocular pressure (IOP) reduction were started on travoprost eye drops and randomized to either morning or evening administration for 1 month. They were then crossed over to the opposite dosing schedule for the following month. Adherence was monitored using an automated dosing aid.
Main Outcome Measures: Adherence was compared between morning versus evening dosing and first versus second month dosing. Demographic characteristics were obtained, treatment effect was measured, and patients completed a post-study questionnaire regarding the convenience of the 2 dosing regimens.
Results: Patient adherence overall was good (89.3%). There was no statistically significant difference (P=0.07) in adherence between morning dosing (90.9%) and evening dosing (87.3%). Adherence in the first month (91.7%) was superior to the second month (86.5%). There was no significant difference in IOP response between morning and evening dosing. Patients found morning dosing more convenient than evening dosing.
Conclusions: Early adherence to treatment with a prostaglandin analogue is good, but patients prefer morning administration to evening administration. This may lead to greater adherence with morning administration, particularly among men. Adherence decreases from the first to second month after initiation of treatment. IOP response to this treatment is not significantly affected by morning versus evening administration.
Introduction
It has been demonstrated that lowering of intraocular pressure (IOP) can decrease the risk of visual field loss from glaucoma. Although both laser trabeculoplasty and incisional surgery are effective at lowering IOP, one of the most common initial interventions in the treatment of glaucoma is the prescription of topical ocular antihypertensive medications in the form of eye drops. Of these medications, prostaglandin analogs (PGAs) such as travoprost are among the most frequently prescribed medications used to lower IOP, and are administered once daily. In order for the medication to have the desired effect of lowering IOP, consistent adherence to daily administration of the medication is essential.
The term compliance has been used in the past as a description of how consistently patients take a medication as prescribed, however, this term has been replaced with the more specific terms adherence and persistence. Adherence describes the number of times a patient properly takes their medication over a defined time period, and persistence represents the length of time that a patient takes their medication before discontinuing it.
Most studies in the literature on the topic of adherence show that once-daily medications such as PGAs may have higher adherence rates than medications dosed twice or more daily, but adherence with once-daily medications is still less than ideal. Many reasons for poor adherence to glaucoma medications have been suggested, including environmental, regimen, patient, and provider-related factors. Compounding these barriers to adherence is the asymptomatic nature of the disease, and the perception that eye drops are not "real" medications because they are not dosed orally. Thus, any modification to a treatment regimen, which improves adherence would be beneficial in the management of patients with glaucoma.
Initial studies on the diurnal effect of latanoprost, the first PGA medication, showed a beneficial effect to taking the medication in the evening rather than in the morning. However, this same effect was not shown with travoprost. Since there is no strong evidence that evening dosing of travoprost is superior to morning dosing, any consistent difference in adherence between the 2 dosing schedules becomes a significant factor in planning the treatment of patients with glaucoma. A retrospective, nonrandomized study comparing morning versus evening adherence found patients on morning dosing to be less likely to miss an entire day of dosing. Nonetheless, this study did not find a significant difference between the 2 groups in overall adherence.
Adherence to glaucoma medication can be determined by self-report, pharmacy claims data, or electronic monitoring. Electronic monitoring of glaucoma medication adherence was first described by Kass et al for use with pilocarpine in the 1980s. Recently, a dosing aid for use with travoprost (Alcon, Fort Worth, TX) has been developed that allows precise recording of the date and time at which the bottle of medication is squeezed to dispense a drop. This allows measurement of adherence when the medication is prescribed for different dosing schedules within the day.
The purpose of this study is to determine whether adherence is better with morning or evening administration of a once-daily medication in the treatment of patients with glaucoma or ocular hypertension.
Source...