(171) Real-World Prescription Drug Treatment Patterns in Patients with Dry Eye Disease

Background: : Dry eye disease (DED) is a prevalent ocular condition characterized by discomfort, visual disturbance, and ocular surface damage. While the treatment landscape has expanded beyond immunomodulators to include newer therapeutic classes such as anti-evaporatives and neuromodulators, significant unmet needs remain. Real-world data on treatment persistence, adherence, and class-switching behavior remain limited.

Objective: : To describe real-world treatment patterns among patients with DED and evaluate patient demographics, treatment behaviors, and switching patterns across therapeutic classes.

Methods: : A retrospective analysis of dry eye disease (DED) patients used Symphony Health Solutions claims data (2018–2024). Patients were identified by prescriptions for immunomodulators (Restasis, Xiidra, Cequa, Vevye, ophthalmological cyclosporines), anti-evaporatives (Miebo), neuromodulators (Tyrvaya), or ≥2 DED diagnosis claims (ICD10 HO4.12). The index date was defined as the first prescription or diagnosis date, with 24 months of continuous data required (12 months before and after index). Switching patterns were analyzed in mono-therapy patients. Persistence (Kaplan-Meier methods) was assessed in single-line therapy patients, while adherence (medication possession ratio, MPR) was analyzed in single-line patients with ≥2 first-line prescriptions. Adherence was defined as MPR ≥ 80%.

Results: : A total of 3,440,818 patients with dry eye disease (DED) were identified; 73% were female and 27% male, with a mean age of 62.6 years (SD 14.3). As first-line treatment, 98.2% received immunomodulators, 1.4% neuromodulators, and 0.4% anti-evaporatives. At 90 days post-index, 75% of patients or more had discontinued treatment in each of the three treatment classes. Among the 10.8% who switched to second-line therapy, 82.9% switched within the immunomodulator class, 1.8% switched to immunomodulators, 8.3% switched to anti-evaporatives, and 7.0% to neuromodulators. Adherence (MPR ≥80%) was 33.9% (immunomodulators), 49.5% (anti-evaporatives), and 54.9% (neuromodulators).

Conclusions: : High discontinuation rates and limited switching across therapeutic classes underscore the need for more durable and diverse treatment options in DED management. The relatively low adherence across all classes suggests that current therapies may not adequately meet patient needs. Emerging treatments may enhance treatment persistence by addressing underlying factors contributing to discontinuation.

Sponsorship:: Alcon