Eyeworld

I REVOLUTION IN GUCOMA MEDICATIONS N FOCUS 58 | EYEWORLD | MAY 2020 "Newer agents are very safe systemically with no cardiac or pulmonary side effects," he added. At Wills Eye, Dr. Lee said that a "small percentage of those receiving Rhopressa and Rocklatan experience unique side effects not seen in prior classes—subconjunctival hemor- rhages and corneal verticillata"—also seen by Drs. Khouri and Serle. Fortunately, Dr. Lee said, none of the corneal verticillata seen in 5–9% of their patients were visually significant. The sub- conjunctival hemorrhages were generally mild, self-limited, and "mostly described as small and petechial hemorrhages," he said. Interactions between any of the three drugs and other medications have not been reported. Challenges to prescribing "From a strictly clinical standpoint, these medi- cations check off all boxes for characteristics we look for in first-line treatments," Dr. Lee said. However, all three doctors noted challenges to prescribing new medications. Meanwhile, a retrospective review of 95 eyes of 52 patients in which latanopros- tene bunod was substituted for prostaglandin demonstrated that latanoprostene bunod was more efficacious than a prostaglandin that does not contain nitric oxide and found that latanoprostene bunod is additive in patients on multiple ocular hypotensive medications. 7 Side effects The doctors all agreed that latanoprostene bunod has a similar side effect profile to lata- noprost and other prostaglandin analogues, in- cluding periocular side effects, occasional ocular irritation, pain on instillation, and hyperemia, Dr. Serle said. Hyperemia was also the most commonly reported side effect with netarsudil-based prod- ucts. Dr. Khouri said that it was mostly mild and not always present. He thinks this is partly due to how netarsudil works—the dilation of episcleral veins leading to reduction of episcler- al venous pressure. continued from page 57 References 1. Weinreb RN, et al. Latanopro- stene bunod 0.024% in subjects with open-angle glaucoma or oc- ular hypertension: pooled Phase 3 study findings. J Glaucoma. 2018;27:7–15. 2. Weinreb RN, et al. A random- ized, controlled comparison of latanoprostene bunod and latanoprost 0.005% in the treatment of ocular hypertension and open angle glaucoma: the VOYAGER study. Br J Ophthalmol. 2015;99:738–745. 3. Fechtner RD, et al. Pooled efficacy analysis of once-daily netarsudil ophthalmic solution 0.02% in patients with ocular hypertension or open-angle glaucoma. 2018 ASCRS ASOA Annual Meeting. 4. Khouri AS, et al. Once-daily netarsudil versus twice-daily timolol in patients with elevated intraocular pressure: The random- ized Phase 3 ROCKET-4 study. Am J Ophthalmol. 2019;204:97–104. 5. Asrani SG, et al. A 3-month interim report of a prospective, double-masked, randomized, multi-center, active-controlled, parallel-group 12-month study assessing the safety and ocular hypotensive efficacy of PG324 ophthalmic solution. 2017 Amer- ican Glaucoma Society Annual Meeting. 6. Ustaoglu M, et al. The efficacy and safety profile of netarsudil 0.02% in glaucoma treatment: Real-world outcomes. 2019 Asso- ciation for Research in Vision and Ophthalmology Annual Meeting. 7. Radell JE, et al. Incorporation of the first nitric oxide donating prostaglandin, latanoprostene bunod, into clinical practice. 2020 American Glaucoma Society Annual Meeting. Source: Bausch + Lomb Source: Aerie Pharmaceuticals

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