Using Healthcare Databases to Refine Understanding of Exploratory Associations Between Drugs and Progression of Open-Angle Glaucoma

Clin Pharmacol Ther. 2019 Oct;106(4):874-883. doi: 10.1002/cpt.1490. Epub 2019 Jun 14.

Abstract

We sought to refine understanding about associations identified in prior studies between angiotensin-II receptor blockers, metformin, selective serotonin reuptake inhibitors, fibric-acid derivatives, or calcium channel blockers and progression to glaucoma filtration surgery for open-angle glaucoma (OAG). We used new-initiator, active-comparator cohort designs to investigate these drugs in two data sources. We adjusted for confounders using stabilized inverse-probability-of-treatment weights and evaluated results using "intention-to-treat" and "as-treated" follow-up approaches. In both data sources, Kaplan-Meier curves showed trends for more rapid progression to glaucoma filtration surgery in patients taking calcium channel blockers compared with thiazides with as-treated (MarketScan P = 0.15; Medicare P = 0.03) and intention-to-treat follow-up (MarketScan P < 0.01; Medicare P = 0.10). There was suggestion of delayed progression for selective serotonin reuptake inhibitor compared with tricyclic antidepressants in Medicare, which was not observed in MarketScan. Our study provided support for a relationship between calcium channel blockers and OAG progression but not for other investigated drugs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use
  • Calcium Channel Blockers* / adverse effects
  • Calcium Channel Blockers* / therapeutic use
  • Confounding Factors, Epidemiologic
  • Disease Progression*
  • Drug-Related Side Effects and Adverse Reactions / prevention & control
  • Female
  • Glaucoma, Open-Angle / epidemiology
  • Glaucoma, Open-Angle / physiopathology*
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use
  • Kaplan-Meier Estimate
  • Male
  • Medicare / statistics & numerical data
  • Risk Assessment / methods
  • United States

Substances

  • Antidepressive Agents
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Hypoglycemic Agents