Adherence to Fixed-Combination Versus Unfixed Travoprost 0.004%/Timolol 0.5% for Glaucoma or Ocular Hypertension: A Randomized Trial

Abstract

Patients receiving TTFC maintained better treatment adherence compared with patients receiving TRAV+TIM through 12 months of on-therapy evaluation. This suggests that, for patients requiring multiple IOP-lowering medications, a fixed combination may provide improved long-term adherence compared with unfixed therapy.

Fixed-combination Bimatoprost/Brimonidine/Timolol in Glaucoma: A Randomized, Masked, Controlled, Phase III Study Conducted in Brazil☆

“…The clinical relevance of a 3-agent medication such as TFC is further highlighted when considering that up to 80% of patients with glaucoma may struggle with adherence to their medication regimen because of the inconvenience associated with multiple eye drop instillation, 29e33 among other factors. Patients have also been shown to be less adherent with their first medication drop when a second medication drop is added, 18,34,35 suggesting that adding a third drop could reduce adherence even more. The rationale for developing TFC was thus based on a perceived need for a product that effectively lowers IOP in patients with uncontrolled POAG or OHT, while reducing the burden of treatment and potentially improving adherence to treatment.…”

“…3,6e8 Many published studies have shown that therapies combining 2 types of hypotensive agents in a single formulation provide greater IOP lowering than do the individual components, 9e15 while potentially lessening adverse events (AEs) 10,16,17 and improving patient adherence to the medication regimen. 3,4,18 Such examples include fixed combinations of bimatoprost/timolol, 19 brimonidine/timolol, 20 and dorzolamide/timolol, 21 which are all well-known dual-combination options. Considering that many medications used as adjunctive monotherapies or in dual fixed combinations are administered 2 or 3 times daily 6,8,22 for maximal effect, as well as data showing that bimatoprost can be formulated for twice-daily use without compromise of its efficacy, 23 a new ophthalmic solution of bimatoprost 0.01%/ brimonidine 0.15%/timolol 0.5% (triple fixed combination [TFC]) administered twice daily was developed to incorporate the IOP-lowering power of bimatoprost into a known, dual combination, matching the posology of the dual combination.…”

40 years of topical beta-blockers for glaucoma

“…No patients using separate drops were adherent for >95% of days. [16] Due to the effect of complex dosing regimens on adherence and the greater exposure to preservatives with a greater number of drops, it is recommended to use fixed-dose combination medications when available. [17] A disadvantage of beta-blocker containing fixeddose combinations, however, is that they contain timolol at a concentration of 0.5%, which may expose the patient to greater risk of systemic side effects, with no greater IOP-lowering efficacy compared to lower concentrations such as 0.25% and 0.1%.…”

Pharmacotherapy of glaucoma: new opportunities, old challenges

“…It is intuitively sound that the use of fixed combinations in glaucoma therapy should promote patient adherence. Surprisingly, and despite the widespread use of fixed combinations for glaucoma in several parts of the world for many years, it was only very recently that direct evidence for this assumption was convincingly presented in a peer-reviewed publication [13]. Undoubtedly, the addition of drugs that are currently under development into our clinical practice will be a muchawaited step forward.…”