Intraocular pressure control over 24 hours using travoprost and timolol fixed combination administered in the morning or evening in primary open‐angle and exfoliative glaucoma

Abstract

ABSTRACT.Purpose: To evaluate intraocular pressure (IOP) control over 24 hours using travoprost and timolol fixed combination (TTFC) administered in the morning or evening in primary open-angle and exfoliative glaucoma.Methods: Patients were randomized to TTFC administered in either the morning or evening for 8 weeks. Previously treated patients underwent an untreated washout period of 4)6 weeks, after which baseline IOP was required to be > 25 mm Hg and < 38 mmHg (in two readings taken at 10.00 ± 1 hours). During the treatment period, IOP was measured at 10.00, 14.00, 18.00, 22.00, 02.00 and 06.00 hours. Patients were then treated with the opposite dosing regimen for 8 weeks and IOP measurements were repeated.Results: In 32 subjects who completed the study, the untreated baseline IOP following washout was 27.7 ± 3.5 mmHg. Both dosing regimens reduced IOP from baseline at each time-point and throughout the 24-hour diurnal curve (p < 0.0001). When treatments were compared directly, evening dosing (18.4 ± 3.3 mmHg) provided a statistically significant lower 24-hour curve than morning dosing (19.2 ± 3.5 mmHg; p = 0.001). Evening dosing also resulted in a lower 24-hour IOP fluctuation (3.8 ± 1.6 mmHg) than morning dosing (5.1 ± 1.6 mmHg; p = 0.0002) and lower peak IOP (p = 0.0003).Conclusions: Both morning and evening administration of TTFC provide effective 24-hour IOP reduction, but evening dosing demonstrates better 24-hour pressure control.

24-hour Intraocular Pressure and Ocular Perfusion Pressure in Glaucoma

“…Konstas et al found that although peak IOP in up to 45% of untreated exfoliation glaucoma and 22.5% of untreated primary open-angle glaucoma (POAG) patients are outside office hours, 52 the mean peak IOP in 24-hour curves is generally between 6 AM and 10 AM. 48,49,51 Quaranta et al found similar IOP profiles. 92--94 These discrepancies in the observed circadian IOP patterns may be explained by differences in equipment (pneumotonometer vs Perkins or Goldmann tonometers) or study samples.…”

24-h Intraocular pressure control with evening-dosed travoprost/timolol, compared with latanoprost/timolol, fixed combinations in exfoliative glaucoma

“…Previous studies have shown that when the prostaglandin-based fixed combinations were dosed in the evening a greater separation could be observed from its individual components, or compared with morning dosing. 5,6,24,25 These 24-h studies have suggested that prostaglandin analogues show a peak effect 12 to 24-h after dosing. [24][25][26] Consequently, when dosed in the evening the peak effect of the medicine may occur in the following daytime hours when pressures tend at the highest by most studies.…”

“…Nonetheless, previous data by Konstas et al [5][6][7] evaluating the latanoprost/timolol and TTFCs, have shown that evening dosing provides better 24-h IOP control compared with the respective individual prostaglandin component. Therefore, evening dosing might better separate any potential efficacy differences between the latanoprost and travoprostbased fixed combinations.…”

Safety and Efficacy of Fixed Combination Travoprost-Timolol in the Lowering of Intraocular Pressure

“…Two studies that evaluated the optimal timing for administration of the FCM travoprost 0.004%/timolol 0.5% have been reported by Denis et al and Konstas et al 54,55 The studies suggested that PM dosing of the FCM travoprost/timolol contributes to lower mean IOP and a lower 24-hour IOP curve. The study by Dennis et al was a 6-week, prospective, randomized, double masked, parallel group study of 92 patients either assigned AM or PM dosing of the FCM travoprost/ timolol.…”