Effectiveness of Intraocular Pressure–Lowering Medication Determined by Washout

Jampel, Henry D.; Chon, Brian; Stamper, Robert L.; Packer, Mark; Han, Ying; Nguyen, Quang H.; Ianchulev, Tsontcho

doi:10.1001/jamaophthalmol.2013.7677

Cited by 27 publications

(21 citation statements)

References 25 publications

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“…In a prospective analysis of 603 patients, Jampel and colleagues showed that the IOP changes caused by removing a medication was significantly less than the historically reported maximal IOP changes observed in monotherapy published trials, following discontinuation of a second or third medication class [ 14 ]. This finding highlights the complexity of understanding the true IOP effects of single-agent washout in clinical settings where patients are subject to multiple drug classes.…”

Section: Resultsmentioning

confidence: 99%

“…As expected, the IOP did not return to baseline, as patients remained on at least one other IOP-lowering medication. This suggests that the effectiveness of PGAs is not as high as expected, especially in the setting of using multiple drug classes [ 14 , 19 ] (Stewart et al 2000). It is also possible that full responders, partial responders, and nonresponders to the PGA drug class were pooled in these studies, which the mean IOP values would not adequately reflect.…”

Section: Discussionmentioning

confidence: 99%

“…As such, a large portion of glaucoma and OHT patients are on multiple drug classes to control IOP. The findings of Jampel et al highlight the complexity of the interactions of the IOP-lowering agents when used in combination [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…This review was limited by the number of available studies with published data. Only five studies had washout IOP as the main outcome measured [ 14 , 19 , 22 , 23 ], with only one study [ 19 ] publishing data that could be analyzed for PGAs. A majority of studies were crossover studies which included a discontinuation period.…”

Section: Discussionmentioning

confidence: 99%

“…This difference was not class dependent. They concluded that the effectiveness of IOP-lowering medications may be significantly lower than that in ideal conditions [ 14 ]. The PGA class is dosed once daily, and during clinical trials, the typical washout period for prostaglandin analogues varies between 2 weeks and 8 weeks, with most trials using a 4-week washout.…”

Section: Introductionmentioning

confidence: 99%

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Washout Duration of Prostaglandin Analogues: A Systematic Review and Meta-analysis

Diaconita

Quinn

Jamal

et al. 2018

Journal of Ophthalmology

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Topic Prostaglandin analogues (PGAs) are first-line medical therapy for primary open angle glaucoma (POAG) and ocular hypertension (OHT). Intraocular pressure (IOP) lowering effects in full responders are known to be 25–33% for this class; however, partial responders and nonresponders do exist. In clinical trials or prospective series, discontinuation and washout of PGAs is necessary to evaluate true change in IOP from novel surgeries and medical therapies. Clinical Relevance To identify all relevant papers with pertinent data on washout of PGAs and quantify the duration and long-term effect of reported PGA washout periods in glaucoma and OHT patients. Methods A systematic review and meta-analysis was conducted to investigate the long-term effects on IOP after discontinuation of topical PGAs POAG and OHT patients. The main search was conducted in MEDLINE/PubMed, EMBASE, Cochrane Library, CINAHL, Web of Science, and BIOSIS Previews and conference proceedings. Results 1055 papers were identified, 548 were independently screened by two physicians., and 56 papers were analyzed for washout durations. The mean washout was found to be 4.56 weeks (±1.25), with the mode and median being 5 weeks. Five studies were analyzed as randomized control trials in which latanoprost was discontinued for 4 weeks prior to restarting another intraocular pressure-lowering drug. Meta-analysis revealed a 4-week discontinuation of latanoprost, on average, subjects returned to their baseline IOP. Conclusion A significant IOP-lowering effect of latanoprost was not observed beyond 4 weeks, suggesting this may be an appropriate washout period for latanoprost. We could not identify appropriate washout periods for either travoprost or bimatoprost, although a majority of articles had 4-week washout durations for the two drugs. Despite the widespread use of this class of medication, there is a paucity of literature on the effects of PGA washout in patients that are treatment naïve to other topical medications.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Washout Duration of Prostaglandin Analogues: A Systematic Review and Meta-analysis

Diaconita

Quinn

Jamal

et al. 2018

Journal of Ophthalmology

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Twelve-month results of ab interno trabeculectomy with Kahook Dual Blade: an interventional, randomized, controlled clinical study

Ventura-Abreu

García‐Feijoó

Pazos

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate the efficacy and safety profile of Kahook Dual Blade ab interno trabeculectomy combined with phacoemulsification compared to stand-alone conventional cataract surgery. Methods A single-center longitudinal, randomized controlled trial was conducted. Patients older than 18 years with coexisting cataract and open-angle glaucoma or ocular hypertension were invited to participate. Preoperative and postoperative clinical data were collected and analyzed preoperatively and at months 1, 3, 6, and 12 after the procedure. Main outcome measures included best corrected visual acuity, intraocular pressure, number of glaucoma medications, endothelial cell count, and standard automated perimetry. Results Forty-two eyes from 33 patients were randomly allocated to the combined cataract and KDB (treatment, n = 21) or cataract alone (control, n = 21) groups. Intraocular pressure decreased from 17.9 ± 3.5 to 16.0 ± 2.2 mmHg and from 17.3 ± 2.5 to 15 ± 3.2 mmHg at the last visit in the treatment and control groups (p = 0.47). The use of glaucoma medications was reduced from a median (IQR) 1 (1-2) to 0 (0-0) in the treatment group and from 1 (1-2) to 0 (0-1) in the control group, with no significant differences between groups at the 12-month visit (p = 0.47). Best corrected visual acuity, endothelial cell count, and standard automated perimetry remained similar during follow-up in both groups. Conclusions In patients with well-controlled, mild-to-moderate glaucoma, adding ab interno trabeculectomy with KDB to phacoemulsification might not be more effective than phacoemulsification alone to reach mid-teens IOP values. Both procedures showed similar safety profiles. Key messages What was known beforeAb interno trabeculectomy with Kahook Dual Blade combined with cataract surgery can lead to a moderate IOP and antihypertensive medications reduction in mid-term results. What that study addsCompared to phacoemulsification, ab interno trabeculectomy plus cataract surgery may not add further decrease in IOP and glaucoma medications in mild to moderate glaucoma. This MIGS technique is overall safe, but patients with lower endothelial cell counts could developed corneal decompensation.

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Challenging the "Topical Medications-First” Approach to Glaucoma: A Treatment Paradigm in Evolution

Radcliffe,

Shah,

Samuelson

2023

Ophthalmol Ther

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Topical glaucoma medications are effective and safe, but they have numerous well-documented limitations that diminish their long-term utility and sustainability. These limitations can include high rates of nonadherence (with associated glaucoma progression), concerning side effects, inconsistent circadian intraocular pressure (IOP) control, complex dosing regimens, difficulty with self-administration, costs, and decreased quality of life. Despite these limitations, topical medications traditionally have been first-line in the glaucoma treatment algorithm, as no other minimally invasive treatment alternatives existed. In recent years, however, novel interventional therapies—including sustained-release drug-delivery platforms, selective laser trabeculoplasty, and micro-invasive glaucoma surgery procedures—have made it possible to intervene earlier without relying on topical medications. As a result, the topical medication-first treatment approach is being reevaluated in an overall shift toward earlier more proactive interventions.

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Effectiveness of Intraocular Pressure–Lowering Medication Determined by Washout

Cited by 27 publications

References 25 publications

Washout Duration of Prostaglandin Analogues: A Systematic Review and Meta-analysis

Washout Duration of Prostaglandin Analogues: A Systematic Review and Meta-analysis

Twelve-month results of ab interno trabeculectomy with Kahook Dual Blade: an interventional, randomized, controlled clinical study

Challenging the "Topical Medications-First” Approach to Glaucoma: A Treatment Paradigm in Evolution

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