Comparison of Two Combinations of Maximum Medical Therapy for Lowering Intraocular Pressure in Primary Open-angle Glaucoma

Abstract

We sought to compare the efficacy as well as the safety of two maximum medical therapy combinations applied to lower the intraocular pressure (IOP) in different primary open-angle glaucoma (POAG) age groups. Methods: This was a retrospective, consecutive case series study that included 60 eyes of 60 subjects with POAG, specifically 20 subjects aged 40 to 54 years, 21 aged 55 to 69 years, and 19 aged 70 years or older. All had been treated for at least 12 months with triple maximum medical therapy (TMT; dorzolamide/timolol, brimonidine, and latanoprost) to lower their IOP, which subsequently was changed to double maximum medical therapy (DMT, fixed drug combinations of tafluprost/timolol and brinzolamide/brimonidine). The rate of IOP change and adverse drug reactions were compared amongst the three age groups. Results: The mean IOP change at three months after converting from TMT to DMT was-0.65 ± 1.42 mmHg (-3.84% ± 9.31%) among the overall study group, but this finding was not statistically significant (p = 0.108). In the 40 to 54 years and 55 to 69 years groups, the mean IOP change rates were +0.29 ± 0.96 mmHg (+2.40% ± 6.85%, p = 0.087) and-0.50 ± 0.99 mmHg (-3.05% ± 6.40%, p = 0.084) respectively. In the 70 years or older group, the mean IOP change, interestingly, was-1.80 ± 1.46 mmHg (-11.29% ± 9.31%, p < 0.001) and nine (47.4%) of the 19 subjects showed additional IOP reductions of 10% or more after converting from TMT to DMT. In all three age groups, the incidence rate of dry eye was significantly lower for DMT than for TMT (p = 0.031). Conclusions: In POAG patients, DMT was proven to be both effective and safe for lowering the IOP, especially in those 70 years or older group, when compared with the TMT protocol.

Evaluation of the Use of Brinzolamide-Brimonidine Fixed Combination in Maximum Medical Therapy

“…Previous studies in the literature reported adverse drug reactions similar to those in our study after BBFC. 7 , 15 , 16 , 17 , 18 , 19 , 20 Similar to our study, Lerner et al 7 , reported that the rate of ocular adverse effects was 11.9% in patients who received maximum medical therapy in the form of BBFC and a beta-blocker/PG analog. In the same study, ocular adverse effects were observed in 7.5% of the control group given the beta-blocker/PG analog combination alone.…”

“…No statistically significant difference was found between the double and triple maximum medical therapy groups in terms of IOP reduction rate, but the rate of ocular adverse effects such as conjunctival hyperemia and dry eye was significantly lower in the double maximum therapy group. Similarly, Wy et al 19 examined POAG patients who switched from triple maximum medical therapy (dorzolamide/timolol combination + brimonidine + latanoprost) to double maximum medical therapy (tafluprost/timolol combination + BBFC). Although IOP reduction rates were similar between the double and triple maximal medical therapy groups, the dry eye rate was significantly lower in the double maximal therapy group.…”

“…In previous studies in the literature, it is seen that the majority of patients treated with BBFC are diagnosed with POAG. 15 , 16 , 17 , 18 , 19 In contrast, our study included 48 patients with POAG (52.2%) and 35 patients with PEG (38.0%). BBFC provided effective IOP reduction in both POAG and PEG patients.…”

Comparison of Netarsudil/Latanoprost Therapy with Latanoprost Monotherapy for Lowering Intraocular Pressure: A Systematic Review and Meta-analysis

“…However, concomitant use of two different drugs may lower medication adherence and consequently fail to control IOP [8]. Thus, to reduce the number of drugs a person intake and to improve medication adherence, a fixed-dose combination (FDC) therapy (i.e., two or more drugs contained in a single dosage form), which has advantages in patient convenience, has been developed for glaucoma patients who do not respond to monotherapy [9]. Examples of FDC therapies commonly applied to glaucoma patients include a combination of prostaglandin analogs and beta blockers, combinations of alpha-2 agonists and beta blockers, combinations of carbonic anhydrase inhibitors and beta blockers, combinations of cholinergic agents and beta blockers, and combinations of carbonic anhydrase inhibitors and alpha-2 agonists [7].…”