3 Things You Should Know About Innovations in Glaucoma Therapy

The information provided in this activity is for accredited continuing education purposes only and is not meant to substitute for the independent clinical judgment of a health care professional relative to diagriostic, treatment, or management options for a specific patient's medical condition....

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Published inOphthalmology Times Vol. 49; no. 6; pp. 50 - 52
Main Authors Aboobakar, Inas, Davison, Janelle, Miller-Ellis, Eydie G
Format Magazine Article Trade Publication Article
LanguageEnglish
Published Monmouth Junction Intellisphere, LLC 01.06.2024
MultiMedia Healthcare Inc
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Summary:The information provided in this activity is for accredited continuing education purposes only and is not meant to substitute for the independent clinical judgment of a health care professional relative to diagriostic, treatment, or management options for a specific patient's medical condition. If use of a single drug does not suffi ciently reduce IOP, options include switching to an alternative monotherapy or adding another medication.3 Combining agents from diff erent classes (eg, a β-blocker plus a prostaglandin or carbonic anhydrase inhibitor) may achieve adequate reductions in IOP, whereas fi xed-dose combinations and preservative-free formulations may help to improve medication tolerance and adherence and reduce preservative load.3 Use of topical medications is associated with nonadherence, adverse events (AEs), reduced precorneal residence time and absorption, and other factors that may lead to undertreatment of glaucoma.5 Adherence to topical treatment is generally poor due to challenges such as diffi culty in instilling the eye drops or using them on schedule, forgetfulness, poor knowledge about glaucoma, and cost.6-8 To overcome these obstacles, sustained drug delivery devices can provide medication directly and consistently to target tissues.5 Two such implants have been approved by the FDA-the bimatoprost sustained-release intracameral implant and the travoprost extended-release intraocular implant.9,10 2 Newer topical therapies for glaucoma have unique mechanisms of action. Th e quest to develop new IOP-lowering therapies with superior therapeutic eff ects, comparable AEs, and dosing convenience has yielded 3 novel agents with unique pharmacological characteristics and mechanisms of action.11 Netarsudil, which inhibits both Rho kinase and the norepinephrine transporter, is a fi rst-in-class agent that uses multiple mechanisms to increase trabecular outfl ow, reduce aqueous production, and lower episcleral venous pressure.12 In a pooled analysis, netarsudil 0.02% given once daily resulted in IOP lowering that was noninferior to timolol 0.5% given twice daily.13 In phase 3 trials, the fi xed-dose combination of netarsudil and the prostaglandin analogue latanoprost demonstrated superiority to either active component given as monotherapy.14 Omidenepag isopropyl (OMDI) is a selective prostanoid EP2 receptor agonist that uniquely increases aqueous drainage through the trabecular and uveoscleral outfl ow pathways.15 In a phase 3 study, use of OMDI 0.002% resulted in a 25% reduction in IOP and was noninferior to administration of latanoprost 0.005% in reducing IOP at 4 weeks.15 OMDI also demonstrated an additive eff ect when used in combination with timolol.16 Latanoprostene bunod (LBN) is a nitric oxide (NO)–donating prostaglandin F2α analog that donates NO to relax the trabecular meshwork and facilitate aqueous outfl ow.17 In a phase 2 study, LBN 0.024% given once daily had signifi cantly greater IOP lowering and comparable AEs relative to use of latanoprost 0.005%.18 A pooled analysis of phase 3 trials found that use of once-daily LBN resulted in greater IOP lowering than did administration of timolol 0.5% twice daily and produced a safety profi le comparable to that of prostaglandin analogues.19 Mean IOP was signifi cantly lower with LBN versus timolol at all evaluation time points during the 3-month effi cacy phase of the studies. 3 Minimally invasive glaucoma surgery overcomes some challenges associated with topical therapy and traditional glaucoma surgery. Use of these devices results in a reduction in IOP and reduced need for medications.28,29 Gonioscopy-assisted transluminal trabeculotomy (GATT): A systematic review of 9 studies showed a GATT success rate of 85%.30 The combined IOP decrease after GATT was 9.81 mm Hg.
ISSN:0193-032X
2150-7333