Experts tout Rhopressa use in early glaucoma

J. James Thimons
Robert J. Noecker

ATLANTA — Last year was an exciting time for new glaucoma drugs, J. James Thimons, OD, FAAO, said at SECO.

A Rho kinase inhibitor, Rhopressa (netarsudil ophthalmic solution 0.02%, Aerie Pharmaceuticals) is a truly new mechanism of action, he said.

“An attractive component to ROCK inhibitors is they target the problem in glaucoma patients, that the trabecular meshwork isn’t working as well as it should,” Robert J. Noecker, MD, said.

Glaucoma patients have cellular loss or stiffening with aging earlier than they should. The idea is that the drug actually targets rather than bypasses the trabecular meshwork, which is what all other glaucoma drugs do, he added.

“Ideally, and if you catch the patient early enough in the disease process, you want to alter and hopefully reverse some of the pathology that’s happening on the trabecular meshwork,” Noecker added.

The once-daily eye drop alters the cytoskeleton, he said.

“In early patients, you are tipping their facility of outflow over just enough so that it works well; you may be able to give patients back some of the reserve they have lost,” Noecker said.

This class of drug may be used earlier in the disease process, as the treatment can reverse some of those changes that have occurred to the trabecular meshwork, he said.

As for episcleral venus pressure, Rhopressa did well in decreasing those patients with lower pressures, Thimons, a Primary Care Optometry News Editorial Board member, said.

“I would likely consider using this drug first if I have a shot at reversing the disease process early in the course,” Thimons said. “I’m fascinated by the idea that the cytoskeleton can be rehabilitated over time.”

Noecker added that the cytoskeleton rehabilitation will likely have a natural plateau or cutting-off point.

In every disease state, whether dry eye or glaucoma, early treatment yields a much better chance of reversing pathology, he said.

All drugs that work well for glaucoma can cause hyperemia, according to Thimons. Of the studies available, the dropout rate for Rhopressa was high, at 21%, and primarily due to hyperemia. He believes that hyperemia is no more an issue with this drug than it is with prostaglandins.

Thimons noted that Rhopressa is not yet commercially available. by Abigail Sutton and Joan-Marie Stiglich, ELS

Disclosures: Noecker reports he is a consultant for Alcon, Aerie, Alimera, Beaver-Visitec, Diopsys, Ethis Communications, Glaukos, InnFocus, Inotek, Iridex, Novartis, Ocular Therapeutix, Omeros, PolyActiva, Santen, Shire, Solx and Sun Pharmaceuticals; is a speaker for Alcon, Allergan, Beaver-Visitec, Diopsys, Imprimis, Iridex, Novartis and Quantel; does research for AqueSys, Glaukos and InnFocus; and has an ownership interest in Ocular Therapeutix, Tula Medical and ISP Surgical. Thimons reported he is on the advisory board for Allergan, Glaukos and Novartis.

J. James Thimons
Robert J. Noecker

ATLANTA — Last year was an exciting time for new glaucoma drugs, J. James Thimons, OD, FAAO, said at SECO.

A Rho kinase inhibitor, Rhopressa (netarsudil ophthalmic solution 0.02%, Aerie Pharmaceuticals) is a truly new mechanism of action, he said.

“An attractive component to ROCK inhibitors is they target the problem in glaucoma patients, that the trabecular meshwork isn’t working as well as it should,” Robert J. Noecker, MD, said.

Glaucoma patients have cellular loss or stiffening with aging earlier than they should. The idea is that the drug actually targets rather than bypasses the trabecular meshwork, which is what all other glaucoma drugs do, he added.

“Ideally, and if you catch the patient early enough in the disease process, you want to alter and hopefully reverse some of the pathology that’s happening on the trabecular meshwork,” Noecker added.

The once-daily eye drop alters the cytoskeleton, he said.

“In early patients, you are tipping their facility of outflow over just enough so that it works well; you may be able to give patients back some of the reserve they have lost,” Noecker said.

This class of drug may be used earlier in the disease process, as the treatment can reverse some of those changes that have occurred to the trabecular meshwork, he said.

As for episcleral venus pressure, Rhopressa did well in decreasing those patients with lower pressures, Thimons, a Primary Care Optometry News Editorial Board member, said.

“I would likely consider using this drug first if I have a shot at reversing the disease process early in the course,” Thimons said. “I’m fascinated by the idea that the cytoskeleton can be rehabilitated over time.”

Noecker added that the cytoskeleton rehabilitation will likely have a natural plateau or cutting-off point.

In every disease state, whether dry eye or glaucoma, early treatment yields a much better chance of reversing pathology, he said.

All drugs that work well for glaucoma can cause hyperemia, according to Thimons. Of the studies available, the dropout rate for Rhopressa was high, at 21%, and primarily due to hyperemia. He believes that hyperemia is no more an issue with this drug than it is with prostaglandins.

Thimons noted that Rhopressa is not yet commercially available. by Abigail Sutton and Joan-Marie Stiglich, ELS

Disclosures: Noecker reports he is a consultant for Alcon, Aerie, Alimera, Beaver-Visitec, Diopsys, Ethis Communications, Glaukos, InnFocus, Inotek, Iridex, Novartis, Ocular Therapeutix, Omeros, PolyActiva, Santen, Shire, Solx and Sun Pharmaceuticals; is a speaker for Alcon, Allergan, Beaver-Visitec, Diopsys, Imprimis, Iridex, Novartis and Quantel; does research for AqueSys, Glaukos and InnFocus; and has an ownership interest in Ocular Therapeutix, Tula Medical and ISP Surgical. Thimons reported he is on the advisory board for Allergan, Glaukos and Novartis.

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