Systematic Review of Intraocular Pressure-Lowering Effects of Adjunctive Medications Added to Latanoprost

Abstract

Objective: To evaluate the intraocular pressure (IOP)-lowering effects of adjunctive medications when added to 0.005% latanoprost taken once daily. Methods: Pertinent publications were identified through systematic searches of PubMed, Embase, and the Cochrane Controlled Trials Register. Randomized clinical trials with over 85% of patients presenting with primary open-angle glaucoma or ocular hypertension who were treated with the combination treatment of latanoprost were selected. The pooled additional IOP-lowering effects at 1–3 months after a run-in phase of at least 2 weeks on 0.005% latanoprost once daily were calculated using the random effects model. Results: Nine randomized clinical trials were included. The mean pooled IOP reductions were 3.3 mm Hg (95% CI: 2.1–4.5) at trough and 4.4 mm Hg (95% CI: 3.4–5.4) at peak when adding 0.5% timolol once daily, 2.6 mm Hg (95% CI: 1.9–3.3) at trough and 3.8 mm Hg (95% CI: 2.5–5.2) at peak when adding 0.1/0.15% brimonidine twice daily, 2.6 mm Hg (95% CI: 1.7–3.4) at trough and 3.1 mm Hg (95% CI: 2.6–3.6) at peak when adding 2% dorzolamide twice daily, 2.4 mm Hg (95% CI: 2.0 –2.8) at trough and 2.7 mm Hg (95% CI: 2.2–3.2) at peak when adding 0.5% timolol twice daily, and 2.8 mm Hg (95% CI: 1.5–4.1) at trough and 1.8 mm Hg (95% CI: 1.2–2.3) at peak when adding 1% brinzolamide twice daily. Conclusions: The addition of brimonidine, dorzolamide, timolol, or brinzolamide can further lower IOP in eyes being treated with latanoprost. Timolol 0.5% once daily might be the most effective adjunctive medication.

Addition of a fixed combination of brinzolamide 1%/timolol 0.5% to prostaglandin monotherapy in patients with glaucoma or ocular hypertension

“…In this study, it produced a further mean reduction of 5.4 mmHg (24.4%) when added to PGA monotherapy, demonstrating its usefulness as adjunctive hypotensive therapy. This activity is higher than that reported in previous studies of single-agent adjunctive therapy, in which mean IOP decreased by 5%–21%,11,12 and is within the range of other adjunctive fixed combination therapies (23.5%–29.3%) 13…”

Pharmacological Enhancement of ex vivo Gene Therapy Neuroprotection in a Rodent Model of Retinal Degeneration

“…It may then be that, as illustrated in this study, neuroprotective therapies are best applied in combination with other treatment modalities. In refractile glaucoma [51] and uveitis [52] , combination regimens have been shown to be invaluable for their synergistic effectiveness, particularly when monotherapy has proved inadequate. Combining one neuroprotectant with another [46][47][48] , with a molecule targeting another part of the pathological process [16,38] or with a completely different treatment modality [53] , may emerge as the most useful way in which neuroprotection is used in clinical practice.…”

Effectiveness of Intraocular Pressure–Lowering Medication Determined by Washout

“…In one meta-analysis, the additional IOP reduction from adding a β-blocker to a prostaglandin analogue was between 10% and 21%. 20 In a second meta-analysis, 3 the addition of a second medication (β-blocker, carbonic anhydrase inhibitor, or α-agonist) to a prostaglandin analogue improved IOP lowering by an additional 15% or less. The removal of 3 medications in our study was associated with an increase in IOP of 9.0 mm Hg, compared with 6.9 mm Hg for removal of 2 medications, an incremental benefit of 2.1 mm Hg.…”