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Skov AG, Rives AS, Freiberg J, Virgili G, Azuara‐Blanco A, Kolko M. Comparative efficacy and safety of preserved versus preservative-free beta-blockers in patients with glaucoma or ocular hypertension: a systematic review. Acta Ophthalmol 2022; 100:253-261. [PMID: 34128326 DOI: 10.1111/aos.14926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 12/28/2022]
Abstract
Preservative-free topical medications have been introduced for glaucoma care to reduce ocular adverse events associated with preservatives. This is a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing the efficacy and safety of beta-blockers, or combination using beta-blockers, with and without preservatives. PubMed, EMBASE and Web of Science were examined. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews. The primary outcome was change in intraocular pressure (IOP) from baseline to final follow-up. Secondary outcomes included ocular and systemic side effects, and other clinical and quality of life outcomes. Of 242 records identified, seven RCTs (1125 patients) were included. The follow-up period ranged from one to 12 months. Timolol was used in five studies, and two studies used a combination (timolol with bimatoprost or dorzolamide). The difference in mean change (MD) in IOP between the preservative-free and the preserved drugs was statistically significant but not clinically relevant: (MD 0.29 mmHg, 95% confidence interval 0.07-0.51 mmHg, p = 0.010; moderate-certainty evidence). Regarding adverse events: Level of evidence for all ocular surface outcome was low or very low and reported in few studies. No significant difference was observed on ocular surface symptoms. Tear break-up time (TBUT) was better with preservative-free drops (p < 0.001). Schirmer's test was better in the preservative-free group (p < 0.001). Level of evidence for all ocular surface outcomes was low or very low. There was no difference in other secondary outcomes. We found no clinically relevant difference in mean change in IOP between the preserved and the preservative-free treatments. Data on adverse events used different methods and were incompletely reported. Although some measures of ocular surface health favoured preservative-free medications, more evidence is needed. The increasing use of preservative-free drops may be associated with better ocular surface and tolerability, but strong evidence from RCTs would be welcome.
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Affiliation(s)
- Anne Guldhammer Skov
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Glostrup Denmark
| | | | - Josefine Freiberg
- Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA) University of Firenze and AOU Careggi Florence Italy
- Centre for Public Health Queen’s University Belfast Belfast UK
| | | | - Miriam Kolko
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Glostrup Denmark
- Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark
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Katsanos A, Riva I, Bozkurt B, Holló G, Quaranta L, Oddone F, Irkec M, Dutton GN, Konstas AG. A new look at the safety and tolerability of prostaglandin analogue eyedrops in glaucoma and ocular hypertension. Expert Opin Drug Saf 2021; 21:525-539. [PMID: 34666576 DOI: 10.1080/14740338.2022.1996560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION In the last 25 years, topical prostaglandin analogues (PGAs) have emerged to become first line and first choice therapeutic options in the management of glaucoma and ocular hypertension (OHT). Although the short-term efficacy and safety of PGAs has been extensively investigated, less is known about their long term safety and tolerability. This gap in current knowledge is clinically relevant, because treatment-related adverse events and long-term tolerability issues are key determinants of the overall success of long-term therapy and the final outcome of a lifelong, symptomless disease like glaucoma. AREAS COVERED We include selected evidence pertaining to the safety and tolerability of available and emerging PGA formulations. We also outline PGA formulations with different concentrations of the active ingredient, different preservatives, and preservative-free (PF) options. EXPERT OPINION Undoubtedly PGAs will continue to play a major role in the medical therapy of glaucoma and OHT. Despite extensive literature and prolonged clinical experience with these agents worldwide, a number of areas that warrant further research have been identified in the present review. Recently launched novel PGAs, or those still in development offer new opportunities and future challenges.
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Affiliation(s)
- Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | - Ivano Riva
- Istituto Clinico Sant'Anna, Brescia, Italy
| | - Banu Bozkurt
- Department of Ophthalmology, Selcuk University School of Medicine, Konya, Turkey
| | - Gábor Holló
- Tutkimusz Ltd, Solymar, Hungary.,Eye Center, Prima Medica Health Centers, Budapest, Hungary
| | - Luciano Quaranta
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, Irccs Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Murat Irkec
- Faculty of Medicine, Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Gordon N Dutton
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Anastasios G Konstas
- 1st and 3rd University Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Arfaee F, Armin A. A comparison between the effect of topical tafluprost and latanoprost on intraocular pressure in healthy male guinea pigs. J Exot Pet Med 2021. [DOI: 10.1053/j.jepm.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shokoohimand A, Arfaee F, Asghari A, Khaksar E. Effects of topical administration of tafluprost and combination of tafluprost and timolol or tafluprost and betaxolol on Schirmer tear test, intraocular pressure, and pupil size in clinically healthy dogs. Int Ophthalmol 2020; 40:2585-2592. [PMID: 32504308 DOI: 10.1007/s10792-020-01439-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of 0.0015% preservative-free (PF) tafluprost alone and in combination with 0.5% timolol maleate or 0.5% betaxolol HCl on Schirmer tear test (STT), intraocular pressure (IOP), and pupil diameter (PD) in clinically normal dogs. METHODS Twenty-one healthy adult castrated male cross-bred dogs were used in this study. Dogs were randomly divided into three groups. The first group received one drop of (PF) tafluprost (Taf), in a randomly selected eye. The second group received one drop of (PF) tafluprost plus one drop of timolol maleate (Taf-Tim), and the last group received one drop of (PF) tafluprost plus one drop of betaxolol HCl, (Taf-Bet). In all groups, the fellow eyes were served as control and received one drop of saline as a placebo. IOP, STT, and PD measurements were performed at the baseline and every 30 min for the first 2 h, every 2 h for the next 10 h, and at 24 h and 36 h post-instillation (PI). RESULTS In all groups, significant differences in IOP values were observed between treated and untreated eyes (Taf: p < 0.001, Taf-Tim: p = 0.014, Taf-Bet: p = 0.008). The maximum reduction in mean IOP after unilateral administration of Taf, Taf-Tim, and Taf-Bet was 8.3 mmHg, 10.7 mmHg, and 13 mmHg, respectively. No significant differences in STT values were observed between treated and untreated eyes at any time points. In all groups, significant differences in PD values were observed between treated and untreated eyes in all time points except the baseline and 36 h post-drug instillation (p < 0.001). CONCLUSIONS Tafluprost alone or in combination with timolol and betaxolol was able to reduce intraocular pressure. The greatest effect of the drugs occurred 6 and 8 h PI. The present study revealed that the combination of tafluprost/betaxolol is more potent in decreasing IOP than tafluprost alone or a combination of tafluprost/timolol in healthy dogs.
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Affiliation(s)
- Armin Shokoohimand
- Department of Clinical Science, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University, Hesarak, Tehran, 1477893855, Islamic Republic of Iran
| | - Farnoosh Arfaee
- Department of Clinical Science, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University, Hesarak, Tehran, 1477893855, Islamic Republic of Iran.
| | - Ahmad Asghari
- Department of Clinical Science, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University, Hesarak, Tehran, 1477893855, Islamic Republic of Iran
| | - Ehsan Khaksar
- Department of Clinical Science, Faculty of Veterinary Sciences, Garmsar Branch, Islamic Azad University, Garmsar, 3581631167, Islamic Republic of Iran
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Gote V, Ansong M, Pal D. Prodrugs and nanomicelles to overcome ocular barriers for drug penetration. Expert Opin Drug Metab Toxicol 2020; 16:885-906. [PMID: 32729364 DOI: 10.1080/17425255.2020.1803278] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Ocular barriers hinder drug delivery and reduce drug bioavailability. This article focuses on enhancing drug absorption across the corneal and conjunctival epithelium. Both, transporter targeted prodrug formulations and nanomicellar strategy is proven to enhance the drug permeation of therapeutic agents across various ocular barriers. These strategies can increase aqueous drug solubility and stability of many hydrophobic drugs for topical ophthalmic formulations. AREAS COVERED The article discusses various ocular barriers, ocular influx, and efflux transporters. It elaborates various prodrug strategies used for enhancing drug absorption. Along with this, the article also describes nanomicellar formulation, its characteristic and advantages, and applications in for anterior and posterior segment drug delivery. EXPERT OPINION Prodrugs and nanomicellar formulations provide an effective strategy for improving drug absorption and drug bioavailability across various ocular barriers. It will be exciting to see the efficacy of nanomicelles for treating back of the eye disorders after their topical application. This is considered as a holy grail of ocular drug delivery due to the dynamic and static ocular barriers, restricting posterior entry of topically applied drug formulations.
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Affiliation(s)
- Vrinda Gote
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City , Kansas City, MO, USA
| | - Michael Ansong
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City , Kansas City, MO, USA
| | - Dhananjay Pal
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City , Kansas City, MO, USA
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Holló G, Katsanos A, Boboridis KG, Irkec M, Konstas AGP. Preservative-Free Prostaglandin Analogs and Prostaglandin/Timolol Fixed Combinations in the Treatment of Glaucoma: Efficacy, Safety and Potential Advantages. Drugs 2018; 78:39-64. [PMID: 29196953 DOI: 10.1007/s40265-017-0843-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Glaucoma therapy-related ocular surface disease (OSD) is a serious pathology with a broad spectrum of insidious clinical presentations and complex pathogenesis that undermines long-term glaucoma care. Preservatives, especially benzalkonium chloride (BAK), contained in topical intraocular pressure-lowering medications frequently cause or aggravate OSD in glaucoma. Management of these patients is challenging, and to date often empirical due to the scarcity of controlled long-term clinical trials. Most of the available data are extracted from case series and retrospective analysis. Preservative-free prostaglandins and prostaglandin/timolol fixed combinations are novel options developed to remove the harmful impact of preservatives, especially BAK, upon ocular tissues. Based on what is currently known on the value of preservative-free antiglaucoma therapies it is tempting to speculate how these new therapies may affect the future medical management of all glaucoma patients. This article provides a comprehensive and critical review of the current literature on preservative-free prostaglandins and preservative-free prostaglandin/timolol fixed combinations.
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Affiliation(s)
- Gábor Holló
- Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, 1085, Hungary.
| | - Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | - Kostas G Boboridis
- Third Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Murat Irkec
- Department of Ophthalmology, Faculty of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Anastasios G P Konstas
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Comparison of Efficacy and Ocular Surface Disease Index Score between Bimatoprost, Latanoprost, Travoprost, and Tafluprost in Glaucoma Patients. J Ophthalmol 2018; 2018:1319628. [PMID: 29707390 PMCID: PMC5863284 DOI: 10.1155/2018/1319628] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/07/2017] [Accepted: 12/03/2017] [Indexed: 11/18/2022] Open
Abstract
Aim The purpose of this study is to evaluate and compare the efficacy of 4 prostaglandin analogues (PGAs) and to determine the incidence of ocular surface disease in newly diagnosed, primary open-angle glaucoma (POAG) patients started on one of those 4 PGAs: bimatoprost (benzalkonium chloride, BAK, 0.3 mg/mL), latanoprost (BAK 0.2 mg/mL), travoprost (polyquad), and tafluprost (BAK-free). Patients and Methods In this single-center, open-label trial, 32 patients newly diagnosed with POAG were randomly started on one of the four PGAs. All patients underwent a complete ophthalmological exam at presentation and at 1, 3, and 6 months of follow-up. Dry eye disease (DED) was assessed using the original Ocular Surface Disease Index (OSDI) questionnaire, in order to evaluate the impact of the drops on the quality of life of patients. Results The mean age was 60.06 years ± 11.76. All four drugs equally and significantly reduced the intraocular pressure (IOP) with respect to the baseline IOP. There was a trend for a slightly greater reduction of IOP with bimatoprost, but the difference was not found to be statistically significant when compared to other PGAs. OSDI scores were significantly superior for travoprost (10.68 ± 5.73) compared to the other three drugs (p < 0.05). Latanoprost caused the most significant eyelash growth and iris discoloration. Conjunctival hyperemia and superficial keratitis occurrence were similar in the four groups. Conclusion All prostaglandin analogues equally and significantly reduce the IOP in patients with POAG. According to the results of the OSDI score, latanoprost seems to be the least tolerated among the four drugs.
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Rolle T, Spinetta R, Nuzzi R. Long term safety and tolerability of Tafluprost 0.0015% vs Timolol 0.1% preservative-free in ocular hypertensive and in primary open-angle glaucoma patients: a cross sectional study. BMC Ophthalmol 2017; 17:136. [PMID: 28768500 PMCID: PMC5541512 DOI: 10.1186/s12886-017-0534-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effects of preservatives of antiglaucoma medications on corneal surface and tear function have been widely shown in literature; it's not the same as regards the active compounds themselves. The purpose of our study was to compare Ocular Surface Disease (OSD) signs and symptoms of Tafluprost 0.0015% versus preservative free (PF) Timolol 0.1% eyedrops in ocular hypertensive (OH) and in primary open-angle glaucoma (POAG) patients. METHODS A cross-sectional study included patients in monotherapy for at least 36 months with Tafluprost 0.0015% (27) or PF Timolol 0.1% (24) and 20 healthy age and sex-matched volunteers. All subjects underwent clinical tests (Schirmer I and break-up time), in vivo confocal microscopy (IVCM) and were surveyed using Ocular Surface Disease Index (OSDI) and Glaucoma Symptoms Scale (GSS) questionnaires. The groups were compared with ANOVA, Kruskal-Wallis test, t-test, Mann-Whitney test and Bonferroni's adjustment of p-values. RESULTS No significant differences were found in questionnaires scores, clinical tests, IVCM variables between therapy groups. Tafluprost 0.0015% group showed significantly higher OSDI score, basal epithelial cells density, stromal reflectivity, sub-basal nerves tortuosity (p = 0.0000, 0.037, 0.006, 0.0000) and less GSS score, number of sub-basal nerves (p = 0.0000, 0.037) than controls but similar clinical tests results (p > 0.05). PF Timolol group had significantly higher OSDI score, basal epithelial cells density, stromal reflectivity and sub-basal nerve tortuosity (p = 0.000, 0.014, 0.008, 0.002), less GSS score, BUT and number of sub-basal nerves (p = 0.0000, 0.026, 0.003) than controls. CONCLUSIONS Compared to PF Timolol 0.1%, Tafluprost 0.0015% showed similar safety with regards to tear function and corneal status and a similar tolerability profile. Both therapy groups show some alterations in corneal microstructure but no side effects on tear function except for an increased tear instability in PF Timolol 0.1% group. Ophtalmologists should be aware that even PF formulations may lead to a mild ocular surface impairment.
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Affiliation(s)
- Teresa Rolle
- Eye Clinic, Department of Surgical Sciences, University of Torino, Via Juvarra 19, 10122 Torino, Italy
| | - Roberta Spinetta
- Eye Clinic, Department of Surgical Sciences, University of Torino, Via Juvarra 19, 10122 Torino, Italy
| | - Raffaele Nuzzi
- Eye Clinic, Department of Surgical Sciences, University of Torino, Via Juvarra 19, 10122 Torino, Italy
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Chabi A, Baranak C, Lupinacci R, Herring WJ. Preservative-free tafluprost in the treatment of open-angle glaucoma or ocular hypertension in India: a phase III clinical trial. Int J Clin Pract 2016; 70:577-86. [PMID: 27292765 DOI: 10.1111/ijcp.12815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM The aim of this study was to evaluate the efficacy and safety of preservative-free (PF) tafluprost compared with PF timolol in Indian subjects with open-angle glaucoma (OAG) or ocular hypertension. METHODS This was a randomised, multicentre, double-masked, phase III trial. Subjects aged 18-80 years, following washout of current medication, with intraocular pressure (IOP) ≥ 24 and ≤ 36 mmHg in at least one eye were randomised in a 1:1 ratio to 0.0015% PF tafluprost or 0.5% PF timolol for 4 weeks. IOP was measured at 08:00, 10:00 and 16:00 hours at baseline and at weeks 2 and 4. The primary efficacy end-point was the mean diurnal IOP change from baseline at week 4, and PF tafluprost was considered non-inferior to PF timolol if the upper bound of the 95% confidence interval (CI) for between-treatment differences was ≤ 1.5 mmHg. The secondary end-point was the proportion of subjects with ≥ 25% reduction in IOP from baseline at week 4. RESULTS In total, 190 subjects were randomised, 95 each, to PF tafluprost and PF timolol treatment. PF tafluprost was non-inferior to PF timolol with respect to diurnal IOP changes from baseline over 4 weeks. The mean PF tafluprost-PF timolol difference in the diurnal IOP change was -1.7 (95% CI -2.6 to -0.7), suggestive of superiority for PF tafluprost. The secondary end-point was achieved in a higher proportion of PF tafluprost group subjects. Both PF tafluprost and PF timolol were well-tolerated with similar incidences of adverse events. CONCLUSIONS PF tafluprost was safe and efficacious in reducing IOP in Indian subjects.
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Affiliation(s)
- A Chabi
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - C Baranak
- Merck & Co., Inc., Kenilworth, NJ, USA
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Konstas AGP, Holló G. Preservative-free tafluprost/timolol fixed combination: a new opportunity in the treatment of glaucoma. Expert Opin Pharmacother 2016; 17:1271-83. [DOI: 10.1080/14656566.2016.1182983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
PURPOSE To evaluate the impact of antiglaucoma drugs on the corneal healing process and corneal toxicity. MATERIALS AND METHODS Four eye drops to treat glaucoma--Xalatan (latanoprost 50 μg/mL; Pfizer), Monoprost (latanoprost 50 μg/mL; Théa Pharma), Taflotan Sine (tafluprost 15 μg/mL; Santen Pharmaceutical Co.), Travatan (travoprost 40 μg/mL; Alcon), and 0.02% benzalkonium chloride (BAC) solution and HyloComod (1 mg/mL sodium hyaluronate; Ursapharm) as positive and negative control were tested regarding corneal irritability and effect on corneal healing. Formulas were tested over 3 days and administered 6 times daily on rabbit corneas cultured on an artificial anterior chamber (the Ex Vivo Eye Irritation Test system). Initially, 4 corneal abrasions (2.5 to 5.7 mm2) were applied. All defects were monitored during drug application by fluorescein stains and photographs. Glucose/lactate concentrations were monitored for corneal metabolic activity evaluation. RESULTS For Xalatan and BAC, the corneal erosion size increased from 14.65 to 66.57 mm2 and 14.80 to 87.26 mm2. Travatan and Taflotan Sine did not interfere with corneal healing. Monoprost delayed corneal healing. For Xalatan and BAC, histology showed severe alteration of the superficial cornea. An increase in anterior chamber lactate concentration indicates corneal toxicity for Xalatan, BAC, and Monoprost. CONCLUSIONS Corneal toxicity of Xalatan is most probably caused by BAC. Monoprost delays corneal healing, which is not well understood. The Monoprost effects could be caused by its additive, macrogolglycerolhydroxystearate 40. This excipient is a known skin irritant, and its concentration is relatively elevated in Monoprost, 50 mg/mL, compared with its active ingredient, latanoprost (0.05 mg/mL).
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Cheema A, Chang RT, Shrivastava A, Singh K. Update on the Medical Treatment of Primary Open-Angle Glaucoma. Asia Pac J Ophthalmol (Phila) 2016; 5:51-8. [PMID: 26886120 DOI: 10.1097/apo.0000000000000181] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Glaucoma comprises a group of progressive, neurodegenerative disorders characterized by retinal ganglion cell death and nerve fiber layer atrophy. Several randomized controlled trials have consistently demonstrated the efficacy of intraocular pressure lowering to slow or halt the measurable progression of the disease. Medical therapy, in places where it is easily accessible, is often the primary method to lower intraocular pressure. We review the medical options currently available and possible future options currently in development. The 5 contemporary classes of topical agents in use include prostaglandin analogs, beta blockers, carbonic anhydrase inhibitors, alpha agonists, and cholinergics. In addition, several fixed combination agents are commercially available. Agents from each of these classes have unique mechanisms of action, adverse effects, and other characteristics that impact how they are used in clinical practice. Despite the plethora of medical options available, there are limitations to topical ophthalmic therapy such as the high rate of noncompliance and local and systemic adverse effects. Alternate and sustained drug delivery models, such as injectable agents and punctal plug delivery systems, may in the future alleviate some such concerns and lead to increased efficacy of treatment while minimizing adverse effects.
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Affiliation(s)
- Anjum Cheema
- From the *Department of Ophthalmology, Kaiser Permanente, Atlanta, GA; †Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA; and ‡Department of Ophthalmology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Suzuki K, Teranishi S, Sagara T, Yoshino H, Nakayama M, Enoki M, Nuno Y, Hirano S, Wakuta M, Takahashi N, Tokuhisa K, Kondo Y, Shiraishi R, Ishida Y, Sonoda KH. Safety and Efficacy of Benzalkonium Chloride-optimized Tafluprost in Japanese Glaucoma Patients With Existing Superficial Punctate Keratitis. J Glaucoma 2015; 24:e145-50. [PMID: 24240881 DOI: 10.1097/ijg.0000000000000020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of benzalkonium chloride (BAK)-optimized tafluprost (with a BAK concentration reduced from 0.01% to 0.001%) in glaucoma patients with existing superficial punctate keratitis (SPK). PATIENTS AND METHODS A prospective, multicenter, open-label study was designed to compare BAK-optimized tafluprost administered over 12 weeks relative to other preserved prostaglandin analogs previously administered in Japanese glaucoma patients. Thirty patients with SPK graded at <6 points by area density (AD) scoring in 1 eye were recruited. The primary outcome measure was change in AD score at 12 weeks after the switch in treatment compared with that at baseline. Secondary outcome measures included changes in tear film breakup time (TBUT), hyperemia score, and intraocular pressure (IOP). Four patients were excluded from analysis because of treatment discontinuation. RESULTS Mean AD score±SD decreased significantly from 3.4±0.9 to 1.8±1.8 after the switch (P<0.0001). Mean TBUT increased significantly from 6.3±3.3 to 8.0±4.2 seconds (P<0.01). Mean hyperemia score remained unchanged, whereas mean IOP decreased significantly from 15.6±2.6 to 14.4±2.0 mm Hg (P<0.01). For patients previously treated with BAK-preserved latanoprost (n=17) or bimatoprost (n=2), mean AD score decreased significantly from 3.4±0.9 to 1.8±1.8 (P<0.01) and mean TBUT increased significantly from 6.4±3.6 to 8.2±4.3 seconds (P<0.01); no such changes were apparent for patients previously treated with sofZia-preserved travoprost (n=7). CONCLUSIONS BAK-optimized tafluprost is a treatment option to improve the condition of the ocular surface and to maintain IOP control in glaucoma patients with existing SPK who have been previously treated with other BAK-preserved prostaglandin analogs.
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Affiliation(s)
- Katsuyoshi Suzuki
- *Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University **Ube Industires Ltd. Central Hospital, Ube †Sagara Eye Clinic, Hagi ‡Tokuyama Central Hospital, Shunan §Saiseikai Shimonoseki General Hospital ¶Shimonoseki Kousei Hospital ††Toyota Central Hospital, Shimonoseki ∥Ogori Daiichi General Hospital, Yamaguchi #Yamaguchi Grand Medical Center, Hofu, Yamaguchi, Japan
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Cho SY, Kim YY, Yoo C, Lee TE. Twenty-four-hour efficacy of preservative-free tafluprost for open-angle glaucoma patients, assessed by home intraocular pressure (Icare-ONE) and blood-pressure monitoring. Jpn J Ophthalmol 2015; 60:27-34. [PMID: 26411460 DOI: 10.1007/s10384-015-0413-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/29/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the effect of preservative-free (PF) tafluprost on diurnal variation of intraocular pressure (IOP) and ocular perfusion pressure (OPP), measured by use of home IOP and blood-pressure (BP) monitoring devices, for primary open angle glaucoma (POAG) patients. METHODS Twenty-two eyes from 22 patients with POAG were studied. Initially, IOP was measured at the hospital by Goldmann applanation tonometry (GAT) and Icare-ONE rebound tonometry. Each patient was then instructed how to use the Icare-ONE and BP home monitoring devices. IOP and BP were measured at home by the patients, every 4 h, before and 2 weeks after once daily treatment with PF tafluprost (0.0015%) ophthalmic solution. RESULTS Intraclass correlations between different IOP measurements were greater than 0.8. PF tafluprost reduced mean diurnal IOP significantly for patients with POAG, from 15.7 ± 1.2 mmHg at baseline to 12.5 ± 0.6 mmHg 2 weeks after treatment (p < 0.001). It increased mean diurnal OPP from 48.5 ± 7.3 mmHg at baseline to 51.3 ± 7.0 mmHg post-treatment (p < 0.017). CONCLUSIONS Icare-ONE enables glaucoma patients to measure their own diurnal IOP fluctuations. Patient-measured Icare-ONE IOP readings showed that PF tafluprost effectively reduced diurnal IOP in eyes with POAG.
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Affiliation(s)
- Soon Young Cho
- Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Yong Yeon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
| | - Chungkwon Yoo
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Tae-Eun Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Holló G, Katsanos A. Safety and tolerability of the tafluprost/timolol fixed combination for the treatment of glaucoma. Expert Opin Drug Saf 2015; 14:609-17. [DOI: 10.1517/14740338.2015.1010507] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Pfeiffer N, Traverso CE, Lorenz K, Saarela V, Liinamaa J, Uusitalo H, Astakhov Y, Boiko E, Ropo A. A 6-month study comparing efficacy, safety, and tolerability of the preservative-free fixed combination of tafluprost 0.0015% and timolol 0.5% versus each of its individual preservative-free components. Adv Ther 2014; 31:1228-46. [PMID: 25447269 PMCID: PMC4271134 DOI: 10.1007/s12325-014-0163-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Indexed: 12/03/2022]
Abstract
Introduction The efficacy, safety and tolerability of the preservative-free (PF) fixed combination (FC) of tafluprost 0.0015% and timolol 0.5% (once daily) were compared to those of the individual components (PF tafluprost 0.0015% once daily and PF timolol 0.5% twice daily) in patients with open-angle glaucoma or ocular hypertension inadequately controlled on prior timolol or prostaglandin monotherapy for 6 months. Methods A stratified, double-masked, randomized, multicenter phase III study was conducted. A total of 189 prior timolol users were randomized within the timolol stratum (TS) to receive either FC (n = 95) or timolol 0.5% (TIM; n = 94). Furthermore, a total of 375 prior prostaglandin analog (PGA) users were randomized within the prostaglandin stratum (PS) to receive either FC (n = 188) or tafluprost 0.0015% (TAF; n = 187). To be eligible for participation in the study, the patients were required to have an intraocular pressure (IOP) of ≥22 mmHg when on timolol (TIM) or of ≥20 mmHg when on PGA in either treated eye at the screening and end-of-run-in visits. In addition to these, the study included visits at baseline, 2 and 6 weeks, 3 and 6 months and at a post-study visit. IOP was measured at 8 a.m., 10 a.m., 4 p.m., and 8 p.m. Results In the TS, a significant reduction from baseline IOP was seen with FC and TIM throughout the study. Average diurnal IOP change from baseline at month 3 was −8.55 mmHg (32%) for FC and −7.35 mmHg (28%) for TIM. The model-based treatment difference (FC–TIM) was −0.885 mmHg [95% confidence interval (CI) −1.745 to −0.024; p = 0.044] demonstrating the superiority of FC over TIM. In the PS, a significant reduction in IOP was seen with both FC and TAF throughout the study. The average diurnal IOP change from baseline at month 3 was −8.61 mmHg (33%) for FC and −7.23 mmHg (28%) for TAF. The model-based treatment difference (FC–TAF) was −1.516 mmHg (95% CI −2.044 to −0.988; p < 0.001) demonstrating the superiority of FC over TAF. In the TS, related ocular adverse events (AEs) were more frequent for patients treated with FC compared to TIM (16.8% versus 6.4%), whereas related non-ocular AEs were more frequent with TIM compared to FC (2.1% versus 0.0%). In the PS, AEs were similarly distributed between FC and TAF. The frequency of conjunctival hyperemia of FC was low (6.4%). Conclusion The preservative-free fixed combination of tafluprost and timolol provided a substantial and significant IOP reduction in both strata. The IOP reduction was superior to both tafluprost 0.0015% and timolol 0.5% when given as monotherapies. Overall, the study treatments were safe and well tolerated. Funding Santen Oy, Tampere, Finland. Electronic supplementary material The online version of this article (doi:10.1007/s12325-014-0163-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Norbert Pfeiffer
- Department of Ophthalmology, Mainz University Medical Center, Langenbeckstr. 1, 55101, Mainz, Germany,
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Lin L, Zhao YJ, Chew PT, Sng CCA, Wong HT, Yip LW, Wu TS, Bautista D, Teng M, Khoo AL, Lim BP. Comparative Efficacy and Tolerability of Topical Prostaglandin Analogues for Primary Open-Angle Glaucoma and Ocular Hypertension. Ann Pharmacother 2014; 48:1585-93. [DOI: 10.1177/1060028014548569] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To systematically review the efficacy and tolerability of 4 prostaglandin analogues (PGAs) as first-line monotherapies for intraocular pressure (IOP) lowering in adult patients with primary open-angle glaucoma or ocular hypertension. Data Sources: A literature search was performed in PubMed (1965-June 2013) and the Cochrane Library (1980-June 2013) using the search terms ocular hypertension, open-angle glaucoma, prostaglandin analogues, bimatoprost, latanoprost, tafluprost, and travoprost. Additional studies were searched from the reference lists of identified publications. Study Selection and Data Extraction: In all, 32 randomized controlled trials comparing between PGAs (bimatoprost 0.03%, latanoprost 0.005%, tafluprost 0.0015%, and travoprost 0.004%) or PGA with timolol were selected. Data Synthesis: A network meta-analysis was conducted. Using timolol as reference, the relative risks (RRs) of achieving treatment success, defined as the proportion of patients achieving at least 30% IOP reduction, with 95% CIs, were as follows: bimatoprost, 1.59 (1.28-1.98); latanoprost, 1.32 (1.00-1.74); travoprost, 1.33 (1.03-1.72); and tafluprost, 1.10 (0.85-1.42). The mean IOP reductions after 1 month were 1.98 (1.50-2.47), 1.01 (0.55-1.46), 1.08 (0.59-1.57), and 0.46 (−0.41 to 1.33) mm Hg, respectively, and the results were sustained at 3 months. Bimatoprost was associated with the highest risk of developing hyperemia, whereas latanoprost had the lowest risk, with RRs (95% CI) of 4.66 (3.49-6.23) and 2.30 (1.76-3.00), respectively. Conclusions: Bimatoprost achieved the highest efficacy in terms of IOP reduction, whereas latanoprost had the most favorable tolerability profile. This review serves to guide selection of the optimal PGA agent for individual patient care in clinical practice.
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Affiliation(s)
- Liang Lin
- Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore
| | - Ying Jiao Zhao
- Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore
| | - Paul T.K. Chew
- Department of Ophthalmology, National University Hospital, Singapore
| | - Chelvin C. A. Sng
- Department of Ophthalmology, National University Hospital, Singapore
| | - Hon-Tym Wong
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Leonard W. Yip
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Tuck Seng Wu
- Department of Pharmacy, National University Hospital, Singapore
| | | | - Monica Teng
- Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore
| | - Ai Leng Khoo
- Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore
| | - Boon Peng Lim
- Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore
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Holló G, Hommer A, Antón López A, Ropo A. Efficacy, Safety, and Tolerability of Preservative-Free Fixed Combination of Tafluprost 0.0015%/Timolol 0.5% Versus Concomitant Use of the Ingredients. J Ocul Pharmacol Ther 2014; 30:468-75. [DOI: 10.1089/jop.2013.0229] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Gábor Holló
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | | | - Auli Ropo
- Santen Oy, Clinical Research and Medical Affairs, Helsinki, Finland
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20
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Incidence of deepening of the upper eyelid sulcus on treatment with a tafluprost ophthalmic solution. Jpn J Ophthalmol 2014; 58:212-7. [PMID: 24390604 DOI: 10.1007/s10384-013-0299-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Deepening of the upper eyelid sulcus (DUES), one symptom of prostaglandin-associated periorbitopathy, was recently found to be an additional side effect of prostaglandin-related ophthalmic solutions. Here, we prospectively investigated the incidence and factors associated with DUES in Japanese open-angle glaucoma patients initially treated with benzalkonium chloride (BAK)-preserved tafluprost (TAF). METHODS In this open-label prospective study instilling TAF in one eye, mean deviation (MD) and intraocular pressure (IOP) were measured, and facial photographs and subjective reports of DUES were obtained at intervals over 6 months. Three ophthalmologists independently assessed the photographs of DUES and reached consensus. Relationships between demographic and ocular/systemic factors (age, sex, MD, refraction and IOP reduction) and DUES occurrence were evaluated. RESULTS Forty-three eyes of 43 glaucoma patients (24 men and 19 women) were evaluated. Mean IOP before treatment was 16.6 ± 2.7 and after treatment, 14.1 ± 2.3 mmHg (P < 0.001). The objective rate of DUES was 9 % (4/43) at 2 months, 14 % (6/43) at 4 months and 14 % (6/43) at 6 months. During this period, only one patient self-reported an occurrence of DUES. No significant association was found between DUES occurrence and any of the demographic, ocular, or systemic factors. CONCLUSIONS Physicians should inform patients about DUES as a minor side effect when prescribing TAF for IOP control.
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21
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Rosin LM, Bell NP. Preservative toxicity in glaucoma medication: clinical evaluation of benzalkonium chloride-free 0.5% timolol eye drops. Clin Ophthalmol 2013; 7:2131-5. [PMID: 24204115 PMCID: PMC3817055 DOI: 10.2147/opth.s41358] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Timolol (generic name) is a frequently used medication for the control of glaucoma. Benzalkonium chloride (BAK) is a commonly used preservative in ophthalmic solutions with a broad range of antimicrobial activity; however, this nonspecificity can result in toxicity. Adverse effects attributed to BAK, including conjunctival inflammation and fibrosis, tear film instability, corneal cytotoxicity, anterior chamber inflammation, trabecular meshwork cell apoptosis, cataract development, macular edema, and even systemic effects, have been well documented. These effects can lead to ocular discomfort, poor intraocular pressure control, glaucoma surgery failure, and decreased patient compliance. BAK use in topical medications has decreased recently as newer and less toxic preservatives have become available. Yet these preservatives still exert some toxic effects, especially in patients with chronic eye disease who use multiple drops over extended periods of time. Thus, attempts to reduce overall preservative loads for patients are important, whether it be decreasing the amount of preservative, decreasing the total number of drops patients use, or eliminating preservatives entirely. A preservative-free formulation of timolol, TIMOPTIC® in OCUDOSE®, is available in unit-dose vials. Preservative-free unit-dose vials minimize toxic adverse effects and are a good option for patients with ocular surface disease, on long-term multidrop therapy, or who simply do not tolerate the effects of preservatives due to discomfort.
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Affiliation(s)
- Lauren M Rosin
- Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, TX, USA
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22
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Inoue K, Tanaka A, Tomita G. Effects of tafluprost treatment for 3 years in patients with normal-tension glaucoma. Clin Ophthalmol 2013; 7:1411-6. [PMID: 23874082 PMCID: PMC3711876 DOI: 10.2147/opth.s46340] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effects of tafluprost treatment for 3 years on intraocular pressure (IOP) and visual field performance. Methods The IOP of 55 patients with normal-tension glaucoma was monitored every 1–3 months for 3 years. The Humphrey visual field test was performed every 6 months after treatment and results compared with before-treatment results. Visual field performance was also evaluated by trend and event analysis. Results After 3 years’ tafluprost single-use vials treatment, the IOP (12.8 ± 2.8 mmHg [mean ± standard deviation]) was significantly lower than before treatment (15.7 ± 2.2 mmHg; P < 0.0001). When comparing before-treatment Humphrey visual field test findings with those after 3 years of treatment, no change was found in the mean deviation and pattern standard deviation. Visual field performance had worsened in four patients and three patients according to trend analysis and event analysis, respectively. Adverse reactions appeared in ten cases and one patient (1.8%) discontinued treatment due to an adverse reaction. Conclusion Tafluprost single-use vials treatment was effective in reducing IOP over the 3 years of this study, but visual field performance worsened by 10.3%–13.8% in patients with normal-tension glaucoma. Safety was satisfactory.
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Day DG, Walters TR, Schwartz GF, Mundorf TK, Liu C, Schiffman RM, Bejanian M. Bimatoprost 0.03% preservative-free ophthalmic solution versus bimatoprost 0.03% ophthalmic solution (Lumigan) for glaucoma or ocular hypertension: a 12-week, randomised, double-masked trial. Br J Ophthalmol 2013; 97:989-93. [PMID: 23743437 PMCID: PMC3717762 DOI: 10.1136/bjophthalmol-2012-303040] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background/Aim To evaluate efficacy and safety of bimatoprost 0.03% preservative-free (PF) ophthalmic solution versus bimatoprost 0.03% (Lumigan) ophthalmic solution for glaucoma or ocular hypertension. Methods In this double-masked, parallel-group study, patients were randomised to bimatoprost PF or bimatoprost for 12 weeks. The primary analysis for non-inferiority was change from baseline in worse eye intraocular pressure (IOP) in the per-protocol population at week 12. For equivalence, it was average eye IOP in the intent-to-treat population at each time point at weeks 2, 6 and 12. Results 597 patients were randomised (bimatoprost PF, n=302 and bimatoprost, n=295). The 95% CI upper limit for worse eye IOP change from baseline was <1.5 mm Hg at each week 12 time point, meeting prespecified non-inferiority criteria. The 95% CI upper limit for the treatment difference for average IOP was 0.69 mm Hg and the lower limit was −0.50 mm Hg at all follow-up time points (hours 0, 2 and 8 at weeks 2, 6 and 12), meeting equivalence criteria. Both treatments showed decreases in mean average eye IOP at all follow-up time points (p<0.001), were safe and well tolerated. Conclusions Bimatoprost PF is non-inferior and equivalent to bimatoprost in its ability to reduce IOP-lowering with a safety profile similar to bimatoprost.
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Affiliation(s)
- Douglas G Day
- Coastal Research Associates, Roswell, Georgia 30076, USA.
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Lanzl I, Hamacher T, Rosbach K, Ramez MO, Rothe R, Růžičková E, Karhanová M, Kimmich F. Preservative-free tafluprost in the treatment of naive patients with glaucoma and ocular hypertension. Clin Ophthalmol 2013; 7:901-10. [PMID: 23717036 PMCID: PMC3663435 DOI: 10.2147/opth.s41640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The study reported here investigated the efficacy, tolerability, and safety of the preservative-free prostaglandin analog tafluprost 0.0015% in treatment-naive patients. PATIENTS AND METHODS Data were collected in two non-interventional, prospective, multicenter, observational, open-label studies of identical design that were conducted in Germany and the Czech Republic. All subjects received preservative-free tafluprost 0.0015% once daily. Intraocular pressure (IOP) levels were recorded for each eye at untreated baseline and 3 months after initiation of medical treatment. The primary outcome was change in mean IOP from baseline to month 3. In the primary open-angle glaucoma (POAG) and ocular hypertension (OH) patient subgroups, analyses were stratified by the level of baseline IOP: ≥20 to 23 mmHg versus ≥24 mmHg. In addition, responder rates and the achievement of pre-specified IOP levels at month 3 were evaluated. Local tolerance of preservative-free tafluprost was evaluated by the patients at final visit. Overall satisfaction with the medical treatment was evaluated by both patients and physicians. All adverse events were recorded. RESULTS A total of 579 treatment-naive patients with POAG (n = 349), OH (n = 105), normal tension glaucoma (n = 71), exfoliative glaucoma (n = 27), or other glaucomas (n = 27) were included in this observational study. Mean IOP level at baseline for all patients was 23.6 ± 4.0 mmHg. Mean IOP at month 3 was 16.8 ± 2.9 mmHg (-28.8% vs baseline). At month 3, significant reductions in mean IOP (P < 0.001) were seen in all patients and all subgroups. Preservative-free tafluprost lowered mean IOP significantly in patients with POAG and OH with IOP levels ≥ 20 to 23 mmHg from 21.9 ± 1.1 mmHg at baseline to 16.5 ± 2.2 mmHg, and in the subgroup with IOP levels ≥ 24 mmHg from 26.2 ± 2.4 mmHg to 17.9 ± 2.4 mmHg. In the subgroups of patients with POAG and OH, an IOP response ≥20%, ≥30%, and ≥40% was achieved by 83.4%, 44.1%, and 12.8%, respectively. Overall, patients with higher baseline IOP values showed a better response than patients with lower baseline IOP levels. Preservative-free tafluprost was well tolerated and safe. After 3 months, 97.9% of all patients remained on therapy. CONCLUSION In this real-world observational study, treatment with once-daily preservative-free tafluprost proved efficacious, well tolerated, and safe in treatment-naive patients.
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Konstas AGP, Quaranta L, Katsanos A, Riva I, Tsai JC, Giannopoulos T, Voudouragkaki IC, Paschalinou E, Floriani I, Haidich AB. Twenty-four hour efficacy with preservative free tafluprost compared with latanoprost in patients with primary open angle glaucoma or ocular hypertension. Br J Ophthalmol 2013; 97:1510-5. [DOI: 10.1136/bjophthalmol-2012-303026] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ong FS, Kuo JZ, Wu WC, Cheng CY, Blackwell WLB, Taylor BL, Grody WW, Rotter JI, Lai CC, Wong TY. Personalized Medicine in Ophthalmology: From Pharmacogenetic Biomarkers to Therapeutic and Dosage Optimization. J Pers Med 2013; 3:40-69. [PMID: 24624293 PMCID: PMC3947950 DOI: 10.3390/jpm3010040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Rapid progress in genomics and nanotechnology continue to advance our approach to patient care, from diagnosis and prognosis, to targeting and personalization of therapeutics. However, the clinical application of molecular diagnostics in ophthalmology has been limited even though there have been demonstrations of disease risk and pharmacogenetic associations. There is a high clinical need for therapeutic personalization and dosage optimization in ophthalmology and may be the focus of individualized medicine in this specialty. In several retinal conditions, such as age-related macular degeneration, diabetic macular edema, retinal vein occlusion and pre-threshold retinopathy of prematurity, anti-vascular endothelial growth factor therapeutics have resulted in enhanced outcomes. In glaucoma, recent advances in cytoskeletal agents and prostaglandin molecules that affect outflow and remodel the trabecular meshwork have demonstrated improved intraocular pressure control. Application of recent developments in nanoemulsion and polymeric micelle for targeted delivery and drug release are models of dosage optimization, increasing efficacy and improving outcomes in these major eye diseases.
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Affiliation(s)
- Frank S. Ong
- Illumina Inc., San Diego, CA 92122, USA
- Author to whom correspondence should be addressed; E-Mail:
| | - Jane Z. Kuo
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Ophthalmology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 119074, Singapore
| | | | - Brian L. Taylor
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Wayne W. Grody
- Departments of Pathology and Laboratory Medicine, Pediatrics and Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Jerome I. Rotter
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Pediatrics and Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tien Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 119074, Singapore
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Dams I, Wasyluk J, Prost M, Kutner A. Therapeutic uses of prostaglandin F(2α) analogues in ocular disease and novel synthetic strategies. Prostaglandins Other Lipid Mediat 2013; 104-105:109-21. [PMID: 23353557 DOI: 10.1016/j.prostaglandins.2013.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 12/27/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
The pharmacological management of glaucoma and ocular hypertension has significantly changed over the last 18 years with the introduction of PGF2α analogues, more specifically latanoprost (6), travoprost (8), bimatoprost (10) and tafluprost (12). Prostanoids are currently the first-line medicines among ocular antihypertensive drugs in terms of efficacy, safety, patient compliance and medical economy. Their ability to effectively reduce intraocular pressure with once-per-day dosing, ocular tolerability comparable to timolol and general lack of systemic adverse effects have made them the mainstay of pharmacological therapy for glaucoma and ocular hypertension all over the world. The present review reports a novel, convergent and highly diastereoselective method for the synthesis of PGF2α analogues from the structurally advanced prostaglandin phenylsulfone (5Z)-(+)-15 and new ω-chain synthons. The biochemistry, clinical efficacy and side effects of four commercially available PGF2α analogues, currently used as first-line agents for reducing intraocular pressure in patients with glaucoma or ocular hypertension, are also discussed.
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Affiliation(s)
- Iwona Dams
- R&D Chemistry Department, Pharmaceutical Research Institute, Rydygiera 8, 01-793 Warsaw, Poland.
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Liu Y, Mao W. Tafluprost once daily for treatment of elevated intraocular pressure in patients with open-angle glaucoma. Clin Ophthalmol 2012; 7:7-14. [PMID: 23293509 PMCID: PMC3533683 DOI: 10.2147/opth.s30951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Glaucoma is a leading cause of visual loss worldwide. Current antiglaucoma therapy focuses on lowering intraocular pressure to a safe level. In recent years, prostaglandin analogs have become the first-line agents for treating open angle glaucoma. Tafluprost, which was first reported in 2003, is a novel prostaglandin analog, and has been shown to be a potent ocular hypotensive agent in a number of preclinical and clinical studies. Also, its unique preservative-free formulation helps to decrease preservative-associated ocular disorders and improve patient compliance. In this review, studies from 2003 to 2012 focusing on the structure, metabolism, efficacy, and safety of tafluprost are summarized. These studies suggested that application of tafluprost once daily is a safe and effective treatment for patients with open angle glaucoma.
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Affiliation(s)
- Yang Liu
- Department of Cell Biology and Anatomy, North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX
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Kim C, Radcliffe NM. One Year of Glaucoma Research in Review: 2011 to 2012. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:364-73. [PMID: 26107730 DOI: 10.1097/apo.0b013e3182747e4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To provide the practicing clinical ophthalmologist with an update of pertinent glaucoma literature published over the past 12 months. METHODS The authors conducted a one year (July 1, 2011 to June 30, 2012) English language glaucoma literature search on Pubmed using the following terms: automated perimetry, optic nerve imaging, optical coherence tomography, glaucoma structure and function, intraocular pressure, central corneal thickness, medical therapy and compliance in glaucoma, glaucoma laser treatment, cataract extraction and intraocular pressure, secondary glaucoma, glaucoma surgery, pediatric glaucoma, molecular biology in glaucoma, and miscellaneous topics in glaucoma. DESIGN Literature review. RESULTS This review includes original and review articles that reflect novel aspects and updates in the field of glaucoma, while excluding letters to the editor, unpublished works, and abstracts. CONCLUSIONS This review is not meant to be all-inclusive-rather, it highlights literature that is most applicable to ophthalmologists in practice.
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Affiliation(s)
- Charles Kim
- From the Department of Ophthalmology, Weill Cornell Medical College, New York, NY
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Swymer C, Neville MW. Tafluprost: The First Preservative-Free Prostaglandin to Treat Open-Angle Glaucoma and Ocular Hypertension. Ann Pharmacother 2012; 46:1506-10. [PMID: 23092867 DOI: 10.1345/aph.1r229] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical trial data, efficacy data, and adverse effect incidence of tafluprost. DATA SOURCES: A literature search was completed using PubMed, Web of Science, and Google Scholar. Tafluprost was the primary search term. Articles published between January 2008 and April 2012 were included in this review. Additional limits placed on the searches were “human” and “English.” Citations in which tafluprost appeared in the title were 36, 29, and more than 300 in PubMed, Web of Science, and Google Scholar, respectively. STUDY SELECTION AND DATA EXTRACTION: Three clinical trials were included in this review. One trial enrolled more than 500 subjects in a randomized fashion. Another also enrolled more than 500 subjects, although the study design was not randomized. The third trial evaluated the effects of tafluprost on subjects who had recently discontinued use of latanoprost, another prostaglandin that is approved to treat glaucoma and ocular hypertension. The duration of all 3 trials was 12 weeks. DATA SYNTHESIS: Tafluprost 0.0015% is the first topical prostaglandin approved by the Food and Drug Administration for treatment of open-angle glaucoma and ocular hypertension that does not contain the widely used preservative, benzalkonium chloride (BAK). Although some controversy surrounds the long-term safety of exposure to BAK, clinical trial data are inconclusive. Tafluprost, like other prostaglandin analogues, exerts its effects on prostaglandin F receptors to reduce intraocular pressure (IOP). Results from 1 trial demonstrated significant reductions in IOP when monotherapy was switched to tafluprost monotherapy. Reductions in IOP with tafluprost use were compared with those seen with use of timolol and latanoprost in 2 trials, and noninferiority was observed. Significant reductions in tear osmolarity were noted in subjects who changed from latanoprost, another prostaglandin analogue, to tafluprost therapy. Conjunctival hyperemia is the most common adverse effect seen in patients receiving drugs from this class. Many have also reported stinging, ocular pruritus, increased darkening or growth of eyelashes, and darkening of eyelids, as well as irreversible brown pigmentation of the iris. CONCLUSIONS: Clinical trial data suggest that tafluprost is as efficacious as other agents used in the management of ocular hypertension and glaucoma. Its use may be especially advantageous in people with allergies, sensitivities to preservatives, or dry or sensitive eyes.
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Affiliation(s)
- Cory Swymer
- Cory Swymer PharmD, at time of writing, PharmD student, College of Pharmacy, University of Georgia, Athens; now, Director of Pharmacy, Putnam General Hospital, Eatonton, GA
| | - Michael W Neville
- Michael W Neville PharmD BCPS FASHP, Clinical Associate Professor, College of Pharmacy, University of Georgia
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