Safety, efficacy, and patient selection of ripasudil in patients with uncontrolled glaucoma with maximum conventional medical therapy

Jethva, Jignesh; Bhagat, Purvi; Prajapati, Kamini; Tank, Gunjan

doi:10.4103/ijo.ijo_3145_21

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…The most common ocular adverse effects seen in patients receiving netarsudil/latanoprost in a fixed-dose combination were cornea verticillata (13.1%), conjunctival hyperemia (54.5%), and conjunctival hemorrhage (8.6%). 6 The most commonly seen ocular adverse effects of ripasudil were conjunctival hyperemia, allergic conjunctivitis, and blepharitis. 7 The difference in IOP found in all three groups after 7 days and after 15 days of treatment was clinically significant but not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of 0.4% ripasudil, 0.02% netarsudil, and 0.5% timolol in combination with 0.005% latanoprost in the medical management of primary open-angle glaucoma or ocular hypertension

Tirupati Nath,

Snigdha Sen,

Himanshu Kumar Yadav

et al. 2024

Asian J Med Sci

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Background: Globally, it is expected that 111 million people will have glaucoma by 2040. Intraocular pressure (IOP) is the most crucial clinical risk factor for glaucoma onset and/or progression. Aims and Objectives: The aim of the study is to compare 0.4% ripasudil, 0.02% netarsudil, and 0.5% timolol in combination with 0.005% latanoprost in the medical management of primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Materials and Methods: The prospective randomized clinical study was conducted on patients with mild-to-moderate POAG or OHT on a single prostaglandin analog (e.g., latanoprost) not achieving target IOP. Patients with narrow-angle glaucoma, any ocular surgery, and advanced glaucoma were excluded from the study. Patients were followed up at 15 days, 1 month, 2 months, and 3 months for a complete ophthalmic examination. Results: The maximum number of patients showed 41–60 years of age group. The male–female ratio was 1.8:1. A mild-to-moderate adverse event in the form of conjunctival hyperemia was seen in all groups. The mean reduction in IOP (mmHg) from baseline to 3 months in Groups A, B, and C is 5.7±0.923, 7.11±0.832, and 6.83±0.707 mmHg, respectively. Conclusion: When given in combination with 0.005% latanoprost and comparing IOP reduction in terms of efficacy, 0.4% ripasudil and 0.02% netarsudil are almost similar, but ripasudil was well tolerated and showed minimal ocular adverse effects; hence, ripasudil is better in comparison to netarsudil.

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Section: Discussionmentioning

confidence: 99%

A comparative study of 0.4% ripasudil, 0.02% netarsudil, and 0.5% timolol in combination with 0.005% latanoprost in the medical management of primary open-angle glaucoma or ocular hypertension

Tirupati Nath,

Snigdha Sen,

Himanshu Kumar Yadav

et al. 2024

Asian J Med Sci

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“…Medical therapy could consist of switching the steroid to loteprednol or fluorometholone (as much as 45% reduction in IOP after substituting and/or adding a Rho kinase inhibitor [rho]), which has been shown to significantly reduce IOP (up to 33% reduction after failing maximum medical therapy). 1,2…”

Section: Rohit Krishna MDmentioning

confidence: 99%

Open-angle glaucoma and Fuchs dystrophy

Samuelson,

Larson,

Arosemena

et al. 2024

J Cataract Refract Surg

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A 62-year-old woman with a history of moderate myopia, long-standing open-angle glaucoma (OAG), and Fuchs dystrophy in both eyes was referred for consultative care. She had prior trabeculectomy in 1984 and 1992 in the left and right eyes, respectively. She is 3 months post–Descemet-stripping endothelial keratoplasty (DSEK) in the left eye, now referred with uncontrolled intraocular pressure (IOP) despite maximum tolerated medical therapy. Current medical therapy for IOP consists of acetazolamide 250 mg by mouth 2 times a day, brimonidine 2 times a day in the left eye, dorzolamide 2 times a day in the left eye, and timolol 2 times a day in the left eye. The patient has a history of presumed steroid response; however, her corneal surgeon has requested that the steroid be continued for the next several months because of the recent DSEK. The IOP in the left eye has ranged from the mid-20s to mid-30s since DSEK. The right eye has consistently had pressure in the low teens and below for many years without topical antihypertensive medications. Examination revealed stable visual acuity at 20/30 and 20/40 in the right and left eyes, respectively, IOP was 12 mm Hg in the right eye and 25 mm Hg in the left eye by Goldman applanation, irregular but reactive pupils without afferent defect, and full confrontational visual fields. Slitlamp examination showed superior low avascular bleb, moderate-to-severe guttae, and posterior chamber IOL in the right eye. The left eye showed superior low diffuse bleb, clear DSEK graft, quiet chamber, superonasal iridectomy, and posterior chamber IOL with an open posterior capsule. The conjunctiva was moderately scarred but a repeat trabeculectomy or Xen Gel stent (Abbvie) appeared possible. The angles were wide open in each eye. Fundus examination was normal aside from myopic, anomalous-appearing nerves with an approximate cup-to-disc ratio of 0.90 in both eyes. Humphrey visual field showed nonspecific changes on the right and moderate nasal defect on the left eye, stable to previous examinations dating back to 2018 (Figure 1 JOURNAL/jcrs/04.03/02158034-202407000-00018/figure1/v/2024-06-18T204902Z/r/image-tiff and Figure 2 JOURNAL/jcrs/04.03/02158034-202407000-00018/figure2/v/2024-06-18T204902Z/r/image-tiff ). Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) revealed moderated thinning in both eyes that was also stable to prior examinations (Figure 3 JOURNAL/jcrs/04.03/02158034-202407000-00018/figure3/v/2024-06-18T204902Z/r/image-tiff ). Her axial length measured 25.23 and 26.34 mm in the right and left eyes, respectively. Central corneal thickness was 553 μm in the right eye and 563 μm in the left eye before her DSEK procedure. What would be your approach to management of this patient's left eye, addressing the following: Rationale for your procedure of choice? Would you over-rule the corneal surgeon and stop the steroid in an attempt to obviate the need for glaucoma surgery? Does the age of onset of glaucoma affect your surgical decision making? Note that patient age at the time of trabeculectomy was 22 years. Are some procedures better suited for patients after DSEK surgery?

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“…The combination treatment resulted in significant IOP lowering at 1 month and 3 months. Jethva et al conducted a small prospective study in patients with inadequately controlled IOP on two or more treatments [29]; ripasudil was added to patients' ongoing glaucoma therapy, and the authors observed a significant reduction in IOP at 3 months. Furthermore, Tanihara et al found that ripasudil-brimonidine fixed-dose combination therapy was more effective than monotherapy of either drug and just as effective as administering ripasudil shortly followed by brimonidine, but with the added benefit of potentially improving patients' compliance [9].…”

Section: Ripasudil In Glaucomamentioning

confidence: 99%

ROCK Inhibitors in Corneal Diseases and Glaucoma—A Comprehensive Review of These Emerging Drugs

Pagano,

Lee,

Posarelli

et al. 2023

JCM

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Rho kinase (ROCK) inhibitors have gained significant attention as emerging novel treatment options in the field of ophthalmology in recent years. The evidence supporting their efficacy in glaucoma and corneal pathology includes both in vitro and clinical studies. Among the available options, ripasudil and netarsudil have emerged as the leading ROCK inhibitors, and some countries have approved these therapeutic options as treatments for glaucoma. Various dosing regimens have been studied, including monotherapy and combination therapy, especially for patients with secondary glaucoma who are already on multiple medications. Another rising application of ROCK inhibitors includes their use as an adjunct in surgical procedures such as Descemetorhexis Without Endothelial Keratoplasty (DWEK), Descemet Stripping Only (DSO) to accelerate visual recovery, glaucoma surgeries to reduce scarring process and allow better intraocular pressure (IOP) control, or after complicated anterior segment surgery to treat corneal oedema. This article provides a comprehensive overview of the existing literature in the field, offering recommendations for prescribing ROCK inhibitors and also discussing patient selection, drug efficacy, and possible adverse effects.

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Safety, efficacy, and patient selection of ripasudil in patients with uncontrolled glaucoma with maximum conventional medical therapy

Cited by 6 publications

References 15 publications

A comparative study of 0.4% ripasudil, 0.02% netarsudil, and 0.5% timolol in combination with 0.005% latanoprost in the medical management of primary open-angle glaucoma or ocular hypertension

A comparative study of 0.4% ripasudil, 0.02% netarsudil, and 0.5% timolol in combination with 0.005% latanoprost in the medical management of primary open-angle glaucoma or ocular hypertension

Open-angle glaucoma and Fuchs dystrophy

ROCK Inhibitors in Corneal Diseases and Glaucoma—A Comprehensive Review of These Emerging Drugs

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