Comparison of brimonidine with latanoprost in the adjunctive treatment of glaucoma

• Published in: Clinical therapeutics Vol. 22; no. 4; pp. 388 - 399
• Main Authors: Simmons, Steven T., Samuelson, Thomas W.
• Format: Journal Article
• Language: English
• Published: Belle Mead, NJ EM Inc USA 01.04.2000; Excerpta Medica
• Subjects: adjunctive therapy; Biological and medical sciences; brimonidine; Eye; latanoprost; Medical sciences; ocular hypertension; open-angle glaucoma; Pharmacology. Drug treatments; open-angle glaucoma; latanoprost; adjunctive therapy; ocular hypertension; brimonidine; Antiglaucomatous agent; α2-Adrenergic receptor; Imidazole derivatives; Quinoxaline derivatives; Agonist; Drug combination; Open angle glaucoma; Dorzolamide; Ocular hypertension; Brimonidine; Pilocarpine; Latanoprost; Parasympathomimetic; β-Adrenergic receptor; Eye disease; Antagonist; Comparative study; Beta blocking agent; Prostaglandin derivatives
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/S0149-2918(00)89008-6

This study compared brimonidine with latanoprost as adjunctive therapy for the treatment of open-angle glaucoma and ocular hypertension. Patients with open-angle glaucoma or ocular hypertension often require > 1 medication to achieve control of intraocular pressure (IOP). Both brimonidine and latanoprost effectively lower IOP, but no previously reported clinical trials have directly compared these agents as adjunctive therapy. This was a prospective, randomized, investigator-masked, multicenter, paralleldesign clinical trial. Forty patients (69 study eyes) with uncontrolled IOP of ≤34 mm Hg while using a topical beta-blocker plus dorzolamide or pilocarpine were randomly assigned to receive either brimonidine 0.2% BID or latanoprost 0.005% QD over 6 months as adjunctive therapy. Tolerability was assessed by reports of adverse events, and efficacy was determined by reduction in IOP from baseline. Clinical success was defined as the achievement of a ≥15% reduction in IOP from baseline. There were no significant between-group differences in any demographic variable. Most patients in each group were white, had open-angle glaucoma, and were being treated with a nonselective beta-blocker and dorzolamide. When brimonidine or latanoprost was used as an adjunctive agent with a beta-blocker and dorzolamide or pilocarpine, the rates of clinical success at month 1 were 85% (17/20 patients) with brimonidine versus 65% (13/20 patients) with latanoprost ( P = 0.144). Overall mean IOP reduction at month 1 was 4.60 ± 0.62 mm Hg (22.8%; P < 0.001) with brimonidine and 3.43 ± 0.62 mm Hg (17.2%; P < 0.001) with latanoprost, with no significant differences between groups ( P = 0.219). Among the patients with an inadequate IOP-lowering response (< 15% reduction from baseline), the mean IOP reduction was 0.36 ± 0.66 mm Hg with latanoprost (n = 7) and 0.50 ±2.18 mm Hg with brimonidine (n = 3). Brimonidine and latanoprost had comparable IOP-lowering efficacy in patients receiving concomitant pilocarpine therapy (mean change in IOP of −4.23 mm Hg vs −3.75 mm Hg, P = 0.173). In patients concurrently treated with dorzolamide, brimonidine produced a mean change in IOP of −5.29 mm Hg, compared with a mean change of −3.21 mm Hg in the latanoprost group ( P = 0.159). Both brimonidine and latanoprost were well tolerated. Few adverse events leading to discontinuation were observed with either drug regimen (n = 2 with brimonidine; n = 0 with latanoprost). Both brimonidine 0.2% BID and latanoprost 0.005% QD were well-tolerated and reduced IOP in most patients when used as third-line adjunctive therapy. However, clinical success was achieved by 17 of 20 patients (85%) who received brimonidine, compared with 13 of 20 patients (65%) who received latanoprost ( P = 0.144). These results suggest that brimonidine 0.2% BID may be more reliable than latanoprost 0.005% QD as adjunctive therapy for glaucoma and ocular hypertension.