EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/596925
EW FEATURE 52 Glaucoma medical treatment • November 2015 AT A GLANCE • There is a need in glaucoma to develop additional IOP-lowering treatments. • Two glaucoma agents currently in phase 3 trials are a Rho kinase inhibitor and a Rho kinase inhibitor combined with a prostaglandin analogue. • The lack of additional therapies may be related to return on investment and risk. • The U.S. FDA could have a growing collaborative role for future drug development. by Vanessa Caceres EyeWorld Contributing Writer (ripasudil hydrochloride hydrate, Kowa Company, Japan), was ap- proved in Japan late last year for twice-daily treatment of glaucoma and ocular hypertension. Preclinical research showed that Rhopressa helps to reduce episcleral venous pressure, one of the factors Bacharach, MD, North Bay Eye Associates, Petaluma, Calif. What's closest on the horizon The agent that has made it furthest along the FDA path to approval is the Rho kinase inhibitor Rhopressa 0.02% (Aerie Pharmaceuticals, Ir- vine, Calif.), a triple-action eye drop. If approved, it would be a once-daily agent that targets the trabecular meshwork, Dr. Bacharach said. Rho kinase inhibitors are a new class of treatment within glaucoma. Another Rho kinase inhibitor called Glanatec ophthalmic solution 0.4% Finding new therapies in glaucoma Monthly Pulse Glaucoma medical treatment What's on the horizon in the U.S. for new glaucoma agents T he Ocular Hypertension Treatment Study (OHTS) showed that 40% of glau- coma patients required at least two medications to lower their intraocular pressure (IOP) by 20%. 1 With landmark studies like OHTS showing the need for better IOP-lowering therapies, U.S.-based glaucoma specialists are particularly interested in eye drops that may be approved soon—or relatively soon— by the U.S. Food and Drug Administration (FDA), said Jason Dual-action Rhopressa (AR-13324) Source: Aerie Pharmaceuticals Triple-action ROCK/NET inhibitor 1. Rho kinase inhibition improves TM outflow and lowers episcleral venous pressure (EVP) • Ocular metabolism releases potent ROCK inhibitor • Relaxes TM, clears extracellular material • Lowers EVP 2. Norepinephrine transporter inhibition decreases fluid production • Increases adrenergic signaling ciliary processes