Eyeworld

128 | EYEWORLD | APRIL 2019 G UCOMA by Maxine Lipner EyeWorld Senior Contributing Writer PHARMACEUTICAL FOCUS Contact information Brubaker: jbrubaker@gmailsaceye.com Serle: janet.serle@mssm.edu C urrently there are several glaucoma treat- ment options that slow down the rate of progression and preserve vision. As of this writing, the new agent Roclatan (netarsudil/latanoprost, Aerie Pharma- ceuticals) is on the cusp of approval, according to Janet Serle, MD. This combination agent, consisting of a rho kinase inhibitor and a prostaglandin agonist, is one of many tools practitioners will have to enable them to tailor treatment for patients. EyeWorld spoke with two specialists on how different agents can benefit unique glaucoma patients. For those who need additional IOP reduc- tion, the fixed combination Roclatan is promising since it is more efficacious than its individual components, Dr. Serle said, adding that IOP reductions in the Phase 3 clinical trials were 2 to 3 mm Hg greater than with either latanoprost or netarsudil alone. "More of the Roclatan-treated patients met or exceeded typical IOP target pres- sures of low to mid-teens and target percentage IOP reductions of greater than 30% than the patients treated with either of the components," she said. The once-daily dosing also makes it an attractive treatment for those taking drops that require dosing two or three times daily, Dr. Serle said. Jacob Brubaker, MD, agreed. "Not only is it a robust medication but it's also convenient for patients," he said. "They take it just once a day, at night." Other fixed combination therapies such as Combigan (brimonidine/timolol, Allergan) or Cosopt (dorzolamide/timolol, Akorn) must be taken at least twice a day. "I think this will be good for patients on prostaglandins who need a little boost," Dr. Brubaker said. He views this once-a-day agent as invaluable for those who may have difficulty remembering to take more than one eye drop. However, the agent brings with it a nearly 58% chance of conjunctiva redness, so there will be those who can't tolerate it. Fortunately, most of the time this is mild and not always constant. For those with low tension glaucoma, Rocla- tan will also be a good option since it does such a good job of lowering IOP, Dr. Brubaker said. He cited the combined Mercury trials, which indicat- ed that 31% of people had pressure lower than 14 mm Hg on Roclatan. Other adjunctive medications may include the carbonic anhydrase inhibitors, beta blockers, and Alphagan (brimonidine, Allergan), Dr. Brubak- er said. "The Low-Pressure Glaucoma Treat- ment Study showed a benefit to using Alphagan with low tension glaucoma 1 . When compared to timolol 0.5% there was a reduced likelihood of visual field progression even with the same IOP. Because of this there is a suggestion that Alphagan is neuroprotective. There are flaws to the study, however, as there was a high dropout in the Alphagan group. Additionally, some think that timolol, due to its potential systemic hypo- tensive effects at night, is actually to blame for the difference." He views dorzolamide and Azopt (brinzolamide, Novartis) as other great adjunctive options. However, Dr. Brubaker tries to avoid timolol because of the aforementioned systemic hypotensive effects. Tailoring glaucoma medications for patients Drawing on new agents, practitioners can better target therapy for patients with glaucoma. Source: Janet Serle, MD continued on page 130 About the doctors Jacob Brubaker, MD Sacramento Eye Consultants Sacramento, California Janet Serle, MD Professor emeritus of ophthalmology Icahn School of Medicine at Mount Sinai New York References 1. Krupin T, et al. A randomized trial of brimonidine versus timolol in preserving visual function: results from the Low-Pressure Glaucoma Treatment Study. Am J Ophthalmol. 2011;151:671–81. 2. Li G, et al. Visualization of conventional outflow tissue responses to netarsudil in living mouse eyes. Eur J Pharmacol. 2016;787:20–31. Financial interests Brubaker: Aerie Pharmaceuti- cals, Alcon, Allergan Serle: Aerie Pharmaceuticals, Allergan, Bausch + Lomb, Ocular Therapeutix

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