Comparative effectiveness of glaucoma drops
Background
The purpose of this program is to determine possible alternatives for a
patient who fails to achieve an
intraocular pressure (IOP)
target and to provide guidance on more potent alternatives while
staying with a single commercial product which includes some combination
products.
Key points
- The goal of topical therapies is to preserve visual function by
lowering intraocular pressure (IOP) below a level that is likely to
produce further damage to the optic nerve.
- The growth in available agents for the medical treatment of glaucoma
has increased dramatically over the years.
- It is important to note that no individual medication can be used in
all patients in all circumstances. The goals of therapy are
preserving function with the lowest risk, fewest adverse or undesirable
effects, and least disruption of the patient's life.
- An initial reduction in the intraocular pressure of 20% from
baseline is suggested.
- Patients with more advanced disease on initial presentation
require lower initial reductions to prevent further progression and
vision loss.
- The reduction of IOP to the target pressure range does not guarantee
that progression will not occur. Therefore, the target pressure range
needs to be constantly reassessed and changed as dictated by IOP
fluctuations, optic nerve changes, and/or visual field progression.
- Generic versions of these topical products do not have to prove
bioequivalence or equal effectiveness. Data is generally not available
for guidance on selection.
- Topically administered glaucoma medications can have significant
systemic absorption. Patients must be instructed on the proper
administration techniques to reduce the risk of systemic adverse
effects.
Select the product the patient is currently receiving that has not achieved the intraocular pressure (IOP) target:
Alphagan® P- Brimonidine tartrate 0.2%
Azopt® -Brinzolamide ophthalmic
suspension 1%
Betagan® - Levobunolol HCI 0.25%, 0.5%
Betoptic® -Betaxolol HCI 0.25%, 0.5%
Combigan® (brimonidine tartrate/timolol maleate) [Combination]
Cosopt® - Dorzolomide HCI & Timolol Maleate [Combination]
Lumigan®- Bimatoprost 0.01%, 0.03%
Rhopressa®- Netarsudil 0.02%
Rocklatan® (netarsudil and
latanoprost) [Combination]
Simbrinza®
(brinzolamide/brimonidine tartrate) [Combination]
Timoptic® -Timolol maleate
0.25%, 0.5%
Travatan® Z - Travoprost
0.004%
Trusopt® - Dorzolamide HCI 2%
Vyzulta™ -Latanoprostene
bunod 0.024%
Xalatan® - Latanoprost 0.005%
Zioptan™ - Tafluprost
ophthalmic solution 0.0015%
Potency - Comparative
effectiveness
Notes
- Estimated potency based primarily on
Li T, Lindsley K, et al.
Additional comments from the various package inserts (clinical trial
data) were also used.
- Medications containing brackets below indicate the mean
reductions (95% credible intervals) in IOP in mmHg at 3 months - from Li
T, Lindsley K, et al.
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References
- Li T, Lindsley K, Rouse B, et al. Comparative Effectiveness of First-Line
Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network
Meta-analysis. Ophthalmology. 2016;123(1):129-140.
doi:10.1016/j.ophtha.2015.09.005
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695285/
Conclusions:
All active first-line drugs are effective compared to placebo in reducing
IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most
efficacious drugs, although the within class differences were small and may
not be clinically meaningful. All factors, including adverse effects,
patient preferences, and cost should be considered in selecting a drug for a
given patient.
- Fingeret M, Gaddie IB, Bloomenstein M. Latanoprostene bunod ophthalmic
solution 0.024%: a new treatment option for open-angle glaucoma and ocular
hypertension. Clin Exp Optom. 2019;102(6):541-550. doi:10.1111/cxo.12853.
https://pubmed.ncbi.nlm.nih.gov/30614563/
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