Skip to main content

Persistence of the carteolol hydrochloride/latanoprost fixed-combination ophthalmic solution, compared with the other β-blocker/prostanoid FP receptor agonist fixed-combination ophthalmic solutions



To investigate the treatment persistence of carteolol hydrochloride/latanoprost fixed-combination ophthalmic solution (CAR/LAT) and other β-blocker/prostanoid FP receptor agonist fixed-combination ophthalmic solutions (BB/FP) in the treatment of glaucoma.

Study design

Retrospective observational cohort study.


A retrospective observational cohort study using JMDC Claims Database. Patients aged 20 years or older diagnosed with glaucoma between February 1, 2017, and March 31, 2020, and prescribed CAR/LAT or another BB/FP were included.


A total of 16,612 patients (7423 in the CAR/LAT group and 9189 in the other BB/FP group) were included. The cumulative treatment persistence rate at the end of follow-up was 42.0% (64.9% at 1 year, 53.4% at 2 years, 45.0% at 3 years, and 42.0% at 4 years) in the CAR/LAT group and 34.7% (54.8% at 1 year, 43.6% at 2 years, 37.1% at 3 years, and 34.7% at 4 years) in the other BB/FP group. Treatment persistence was significantly longer in the CAR/LAT group compared to that in the other BB/FP group (hazard ratio 0.747, p < 0.0001). Over the treatment period, the number of patients who discontinued treatment was 3281 (44.2%) in the CAR/LAT group and 4926 (53.6%) in the other BB/FP group; the median duration of treatment was 135 days and 97 days, respectively.


The study results suggest that persistence rates vary depending on the BB/FP and CAR/LAT appears to be more persistent than other BB/FP.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. Morizane Y, Morimoto N, Fujiwara A, Kawasaki R, Yamashita H, Ogura Y, et al. Incidence and causes of visual impairment in Japan: the first nation-wide complete enumeration survey of newly certified visually impaired individuals. Jpn J Ophthalmol. 2019;63:26–33.

    Article  PubMed  Google Scholar 

  2. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311:1901–11.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Heijl A, Bengtsson B, Chauhan BC, Lieberman MF, Cunliffe I, Hyman L, et al. A comparison of visual field progression criteria of 3 major glaucoma trials in early manifest glaucoma trial patients. Ophthalmology. 2008;115:1557–65.

    Article  PubMed  Google Scholar 

  4. Kiuchi Y, Inoue T, Shoji N, Nakamura M, Tanito M, Glaucoma Guideline Preparation Committee, Japan Glaucoma Society. The Japan Glaucoma Society guidelines for glaucoma 5th edition. Jpn J Ophthalmol. 2023;67:189–254.

  5. Kashiwagi K, Furuya T. Persistence with topical glaucoma therapy among newly diagnosed Japanese patients. Jpn J Ophthalmol. 2014;58:68–74.

    Article  PubMed  Google Scholar 

  6. Quigley HA, Friedman DS, Hahn SR. Evaluation of practice patterns for the care of open-angle glaucoma compared with claims data: the glaucoma adherence and persistency study. Ophthalmology. 2007;114:1599–606.

    Article  PubMed  Google Scholar 

  7. Robin AL, Covert D. Does adjunctive glaucoma therapy affect adherence to the initial primary therapy? Ophthalmology. 2005;112:863–8.

    Article  PubMed  Google Scholar 

  8. Robin AL, Novack GD, Covert DW, Crockett RS, Marcic TS. Adherence in glaucoma: objective measurements of once-daily and adjunctive medication use. Am J Ophthalmol. 2007;144:533–40.

    Article  PubMed  Google Scholar 

  9. Schwartz GF, Burk C, Bennett T, Patel VD. Adherence and persistence with glaucoma therapy: brimonidine/timolol versus dorzolamide/timolol and various two-bottle combinations. J Clin Exp Ophthalmol. 2012;3:1000248.

    Article  Google Scholar 

  10. Hasebe Y, Kashiwagi K, Tsumura T, Suzuki Y, Yoshikawa K, Suzumura H, et al. Changes in adherence and associated factors among patients on newly introduced prostaglandin analog and timolol fixed-combination therapy. Patient Prefer Adherence. 2018;12:1567–77.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tsumura T, Kashiwagi K, Suzuki Y, Yoshikawa K, Suzumura H, Maeda T, et al. A nationwide survey of factors influencing adherence to ocular hypotensive eyedrops in Japan. Int Ophthalmol. 2019;39:375–83.

    Article  PubMed  Google Scholar 

  12. Newman-Casey PA, Niziol LM, Gillespie BW, Janz NK, Lichter PR, Musch DC. The association between medication adherence and visual field progression in the collaborative initial glaucoma treatment study. Ophthalmology. 2020;127:477–83.

    Article  PubMed  Google Scholar 

  13. Takahashi M, Naitou T, Mizoue S, Kanno M, Suzumura H, Yoshikawa K. Questionnaire survey on use of glaucoma eyedrops: second report. J Eye. 2012;29:555–61 (in Japanese).

  14. Kikuchi S, Ouchi K. Mikeluna® combination ophthalmic solution, carteolol hydrochloride 2% /latanoprost 0.005% fixed combination for glaucoma and ocular hypertension. Jpn J Ocul Pharmacol. 2017;31:28–33 (in Japanese).

  15. Shirai C, Matsuoka N, Nakazawa T. Comparison of adherence between fixed and unfixed topical combination glaucoma therapies using Japanese healthcare/pharmacy claims database: a retrospective non-interventional cohort study. BMC Ophthalmol. 2021;21:52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Zimmerman TJ. Topical ophthalmic beta blockers: a comparative review. J Cli Exp Ophthalmol. 1993;9:373–84.

    CAS  Google Scholar 

  17. Kido A, Miyake M, Akagi T, Ikeda HO, Kameda T, Suda K, et al. Association between topical β-blocker use and asthma attacks in glaucoma patients with asthma: a cohort study using a claims database. Graefes Arch Clin Exp Ophthalmol. 2022;260:271–80.

    Article  CAS  PubMed  Google Scholar 

  18. Ministry of Health, Labour and Welfare. Medical Facility Survey (as of June 2022). Accessed 1 September 2022 (in Japanese).

  19. Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol. 2005;140:598–606.

    Article  PubMed  Google Scholar 

Download references


This study was sponsored by Otsuka Pharmaceutical Co., Ltd. The study protocol was prepared by Miyuki Matsukawa of Otsuka Pharmaceutical Co., Ltd. Statistical analyses were performed by Takumi Tajima and Gen Terashima of JMDC Inc. Medical writing service was provided by Koki Yamashita, PhD. of Maxwell International, Inc., which was funded by Otsuka Pharmaceutical Co., Ltd.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Kenji Kashiwagi.

Ethics declarations

Conflicts of interest

K. Kashiwagi, Consulting fees (Otsuka, Novartis, Santen, Senju, Kowa); K. Ouchi, Employee (Otsuka); Y. Shibasaki, Employee (Otsuka); M. Suginaka, Employee (Otsuka).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Corresponding Author: Kenji Kashiwagi

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 210 kb)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kashiwagi, K., Ouchi, K., Shibasaki, Y. et al. Persistence of the carteolol hydrochloride/latanoprost fixed-combination ophthalmic solution, compared with the other β-blocker/prostanoid FP receptor agonist fixed-combination ophthalmic solutions. Jpn J Ophthalmol 67, 658–667 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: