Meeting News

New glaucoma therapies provide options for patients on multiple agents

Constance O. Okeke

ORLANDO, Fla. – Fixed combination therapies, new single agents with targeted mechanisms of action, laser surgery and future sustained release technologies may reduce the number of drops glaucoma patients need, Constance O. Okeke, MD, MSCE, said here at the Optometric Glaucoma Society meeting, held prior to the American Academy of Optometry meeting.

Established combination agents such as Combigan (0.2% brimonidine tartrate, 0.5% timolol maleate, Allergan), Cosopt (dorzolamide HCl, timolol maleate, Akorn) and Simbrinza (brimonidine tartrate 0.2%, brinzolamide 1%, Alcon) lower pressures between 21% and 35%, Okeke said. Sometimes, however, patients need a fixed combination, plus one or two more agents.

“A recent concept is using compounded pharmacies to take two, three or four generic medications and put them in one bottle,” she said. “It creates simplicity of usage with the impact of multiple medications in one bottle.”

A patient on three or four generics who is having difficulty keeping up with the regimen or has ocular surface disease and needs artificial tears would be a good candidate for this approach, Okeke said.

Vyzulta (latanoprostene bunod ophthalmic solution 0.024%, Bausch + Lomb) is a new agent with once daily dosing in the evening, she said. The JUPITER study (Hoy) showed Vyzulta lowered IOP 26.5% from baseline, and the APOLLO (Weinreb et al.) and LUNAR (Medeiros et al.) studies showed low adverse reactions.

Okeke said Vyzulta can be used as first-line therapy for open angle glaucoma or for patients on another prostaglandin analog who need an additional 1 mm Hg to 4 mm Hg IOP lowering. It is also a good choice for patients with normal or low tension open angle glaucoma or those who have had previous glaucoma procedures with suboptimal outcomes.

“It’s simple and effective and targets the trabecular meshwork,” she said.

Rho kinase, or ROCK, inhibitors are a new drug class that includes Rhopressa (netarsudil 0.02%, Aerie), Okeke said. They have once daily dosing and also target the trabecular meshwork.

The ROCKET trial (Serle et al.) showed that Rhopressa once daily was comparable to timolol twice daily, Okeke said.

“The trial looked at patients with pressures across the board, and it consistently lowered pressures in all groups by 3.9 mm Hg to 4.1 mm Hg,” she said.

A good use for Rhopressa is as a first-line adjunct to a prostaglandin analog, Okeke said, for normal to low tension open angle glaucoma, as a first-line agent when a prostaglandin is not a good option, or after glaucoma surgery or minimally invasive glaucoma surgery. It targets the trabecular meshwork.

Rocklatan (netarsudil and latanoprost ophthalmic solution) 0.02%/0.005% is the “first and only prostaglandin analog combination medication in the U.S.” Okeke said.

“Pooled Mercury trials [Kish] showed that over 60% of Rocklatan patients achieved at least 30% mean IOP reduction at 3 months,” she said. “The majority of ocular adverse events were mild, with low discontinuation rates. Patients tolerate it quite well.

“When we think about hyperemia, our level of what we’d be OK with is not necessarily the same as what patients would be OK with,” she continued. “If they have hyperemia, but the drug prevents them from having to have surgery, they may be OK with it.”

She said clinicians may want to consider switching patients to Rocklatan before having to add another medication to a prostaglandin analog or as first-line therapy for open angle glaucoma.

“Keep prescribing these medications so insurance companies see there’s a demand for them,” she added.

Xelpros (latanoprost ophthalmic emulsion 0.005%), another new agent, is benzalkonium chloride-free.

“It is preserved with potassium sorbate,” Okeke said, “and delivered with Lipixelle, a novel micelle micro-emulsion formulation. The price is fixed.” – by Nancy Hemphill, ELS, FAAO


References:

Hoy SM. Drugs. 2018;doi:10.1007/s40265-018-0914-6.

Kish T. P T. 2018;43(8):489–502.

Medeiros FA, et al. Am J Ophthalmol. 2016;doi:10.1016/j.ajo.2016.05.012.

Okeke CO. What is new in glaucoma medical therapy? Presented at: Optometric Glaucoma Society meeting; Orlando, Fla.; October 22, 2019.

Serle JB, et al. Am J Ophthalmol. 2018;doi:10.1016/j.ajo.2017.11.019.

Weinreb RN, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2016.01.019.


Disclosure: Okeke reported she is a consultant and speaker for Aerie, Alcon and Bausch + Lomb; a consultant for Allergan, Novartis, Reichert, Santen and Sight Sciences; a speaker for Ellex; a researcher, speaker and consultant for Glaukos; and a trainer and speaker for NeoMedix.

Constance O. Okeke

ORLANDO, Fla. – Fixed combination therapies, new single agents with targeted mechanisms of action, laser surgery and future sustained release technologies may reduce the number of drops glaucoma patients need, Constance O. Okeke, MD, MSCE, said here at the Optometric Glaucoma Society meeting, held prior to the American Academy of Optometry meeting.

Established combination agents such as Combigan (0.2% brimonidine tartrate, 0.5% timolol maleate, Allergan), Cosopt (dorzolamide HCl, timolol maleate, Akorn) and Simbrinza (brimonidine tartrate 0.2%, brinzolamide 1%, Alcon) lower pressures between 21% and 35%, Okeke said. Sometimes, however, patients need a fixed combination, plus one or two more agents.

“A recent concept is using compounded pharmacies to take two, three or four generic medications and put them in one bottle,” she said. “It creates simplicity of usage with the impact of multiple medications in one bottle.”

A patient on three or four generics who is having difficulty keeping up with the regimen or has ocular surface disease and needs artificial tears would be a good candidate for this approach, Okeke said.

Vyzulta (latanoprostene bunod ophthalmic solution 0.024%, Bausch + Lomb) is a new agent with once daily dosing in the evening, she said. The JUPITER study (Hoy) showed Vyzulta lowered IOP 26.5% from baseline, and the APOLLO (Weinreb et al.) and LUNAR (Medeiros et al.) studies showed low adverse reactions.

Okeke said Vyzulta can be used as first-line therapy for open angle glaucoma or for patients on another prostaglandin analog who need an additional 1 mm Hg to 4 mm Hg IOP lowering. It is also a good choice for patients with normal or low tension open angle glaucoma or those who have had previous glaucoma procedures with suboptimal outcomes.

“It’s simple and effective and targets the trabecular meshwork,” she said.

Rho kinase, or ROCK, inhibitors are a new drug class that includes Rhopressa (netarsudil 0.02%, Aerie), Okeke said. They have once daily dosing and also target the trabecular meshwork.

The ROCKET trial (Serle et al.) showed that Rhopressa once daily was comparable to timolol twice daily, Okeke said.

“The trial looked at patients with pressures across the board, and it consistently lowered pressures in all groups by 3.9 mm Hg to 4.1 mm Hg,” she said.

A good use for Rhopressa is as a first-line adjunct to a prostaglandin analog, Okeke said, for normal to low tension open angle glaucoma, as a first-line agent when a prostaglandin is not a good option, or after glaucoma surgery or minimally invasive glaucoma surgery. It targets the trabecular meshwork.

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Rocklatan (netarsudil and latanoprost ophthalmic solution) 0.02%/0.005% is the “first and only prostaglandin analog combination medication in the U.S.” Okeke said.

“Pooled Mercury trials [Kish] showed that over 60% of Rocklatan patients achieved at least 30% mean IOP reduction at 3 months,” she said. “The majority of ocular adverse events were mild, with low discontinuation rates. Patients tolerate it quite well.

“When we think about hyperemia, our level of what we’d be OK with is not necessarily the same as what patients would be OK with,” she continued. “If they have hyperemia, but the drug prevents them from having to have surgery, they may be OK with it.”

She said clinicians may want to consider switching patients to Rocklatan before having to add another medication to a prostaglandin analog or as first-line therapy for open angle glaucoma.

“Keep prescribing these medications so insurance companies see there’s a demand for them,” she added.

Xelpros (latanoprost ophthalmic emulsion 0.005%), another new agent, is benzalkonium chloride-free.

“It is preserved with potassium sorbate,” Okeke said, “and delivered with Lipixelle, a novel micelle micro-emulsion formulation. The price is fixed.” – by Nancy Hemphill, ELS, FAAO


References:

Hoy SM. Drugs. 2018;doi:10.1007/s40265-018-0914-6.

Kish T. P T. 2018;43(8):489–502.

Medeiros FA, et al. Am J Ophthalmol. 2016;doi:10.1016/j.ajo.2016.05.012.

Okeke CO. What is new in glaucoma medical therapy? Presented at: Optometric Glaucoma Society meeting; Orlando, Fla.; October 22, 2019.

Serle JB, et al. Am J Ophthalmol. 2018;doi:10.1016/j.ajo.2017.11.019.

Weinreb RN, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2016.01.019.


Disclosure: Okeke reported she is a consultant and speaker for Aerie, Alcon and Bausch + Lomb; a consultant for Allergan, Novartis, Reichert, Santen and Sight Sciences; a speaker for Ellex; a researcher, speaker and consultant for Glaukos; and a trainer and speaker for NeoMedix.

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