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Introduction <p>The COVID-19 pandemic disrupted routine healthcare delivery worldwide. For&#xa0;patients with&#xa0;chronic conditions requiring lifelong therapy, such as glaucoma, this disruption threatened continuity of care. We aimed to quantify the pandemic's impact on medication adherence and persistence using a large Italian administrative database.</p> Methods <p>We conducted a retrospective cohort study using healthcare databases from Lombardy, Italy.&#xa0;Established patients with glaucoma&#xa0;(defined as ≥ 6 dispensations of ATC S01E medications with a glaucoma diagnosis) were identified in two time periods:&#xa0;2017 (2018 Cohort, followed from March 2018&#xa0;before the pandemic) and&#xa0;2019 (2020 Cohort, followed from March 2020&#xa0;at pandemic onset).&#xa0;Newly diagnosed patients&#xa0;had no glaucoma therapy in the preceding year.&#xa0;For the primary persistence analysis, follow-up was restricted to 24&#xa0;months to avoid contamination of the 2018 cohort by pandemic exposure.&#xa0;Persistence was defined as continuous prescription refills allowing a 90-day grace period. Adherence was measured using the Medication Possession Ratio (MPR), with ≥ 80% defined as adherent. We used Cox proportional hazards models and chi-square tests for comparisons.</p> Results <p>Among 111,373&#xa0;established patients, the risk of discontinuation was significantly higher during the pandemic (adjusted HR 1.17, 95% CI 1.15–1.18; <i>p</i> &lt; 0.001).&#xa0;Absolute persistence rates at 12&#xa0;months were 89.1% (2018 cohort) vs. 86.7% (2020 cohort); at 24&#xa0;months, 72.4% vs. 68.9%.&#xa0;This finding was consistent in&#xa0;newly diagnosed-only sensitivity analyses (aHR 1.13, 95% CI 1.08–1.18). Among&#xa0;newly diagnosed patients, adherence was lower in the&#xa0;2020 cohort&#xa0;(65.1% vs. 68.6%, <i>p</i> &lt; 0.001). New therapy initiations declined by 37% in 2020 (1.0 per thousand at-risk population) compared to 2018 (1.6 per thousand).</p> Conclusions <p>The pandemic was associated with significant disruptions to glaucoma therapy, including increased discontinuation among&#xa0;established patients&#xa0;and a marked reduction in new treatment initiations. These findings highlight the vulnerability of daily drop-based regimens to healthcare system disruptions.&#xa0;More resilient therapeutic approaches merit further consideration.</p>

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The Impact of the COVID-19 Pandemic on Adherence and Persistence to Glaucoma Therapy: A Retrospective Italian Cohort Study

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Alessia Antonella Galbussera,
  • Mauro Tettamanti,
  • Ida Fortino,
  • Alessandro Nobili,
  • Luciano Quaranta

摘要

Introduction

The COVID-19 pandemic disrupted routine healthcare delivery worldwide. For patients with chronic conditions requiring lifelong therapy, such as glaucoma, this disruption threatened continuity of care. We aimed to quantify the pandemic's impact on medication adherence and persistence using a large Italian administrative database.

Methods

We conducted a retrospective cohort study using healthcare databases from Lombardy, Italy. Established patients with glaucoma (defined as ≥ 6 dispensations of ATC S01E medications with a glaucoma diagnosis) were identified in two time periods: 2017 (2018 Cohort, followed from March 2018 before the pandemic) and 2019 (2020 Cohort, followed from March 2020 at pandemic onset). Newly diagnosed patients had no glaucoma therapy in the preceding year. For the primary persistence analysis, follow-up was restricted to 24 months to avoid contamination of the 2018 cohort by pandemic exposure. Persistence was defined as continuous prescription refills allowing a 90-day grace period. Adherence was measured using the Medication Possession Ratio (MPR), with ≥ 80% defined as adherent. We used Cox proportional hazards models and chi-square tests for comparisons.

Results

Among 111,373 established patients, the risk of discontinuation was significantly higher during the pandemic (adjusted HR 1.17, 95% CI 1.15–1.18; p < 0.001). Absolute persistence rates at 12 months were 89.1% (2018 cohort) vs. 86.7% (2020 cohort); at 24 months, 72.4% vs. 68.9%. This finding was consistent in newly diagnosed-only sensitivity analyses (aHR 1.13, 95% CI 1.08–1.18). Among newly diagnosed patients, adherence was lower in the 2020 cohort (65.1% vs. 68.6%, p < 0.001). New therapy initiations declined by 37% in 2020 (1.0 per thousand at-risk population) compared to 2018 (1.6 per thousand).

Conclusions

The pandemic was associated with significant disruptions to glaucoma therapy, including increased discontinuation among established patients and a marked reduction in new treatment initiations. These findings highlight the vulnerability of daily drop-based regimens to healthcare system disruptions. More resilient therapeutic approaches merit further consideration.