1
|
Shahid S, Rizvi SWA, Khan AA, Ashraf H, Akhter A. Comparison of safety and efficacy of Netarsudil 0.02% and Bimatoprost 0.01% monotherapy and combination therapy in primary open-angle glaucoma and ocular hypertension. Indian J Ophthalmol 2024; 72:427-431. [PMID: 38146971 PMCID: PMC11001237 DOI: 10.4103/ijo.ijo_1340_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE To study and compare the efficacy and safety profile of Rho-kinase inhibitor (netarsudil 0.02%) and prostaglandin analog (bimatoprost 0.01%) both as monotherapy and in combination. DESIGN Prospective, randomized, monocentric, open-label clinical trial. METHODS Patients ≥20 years of age with primary open-angle glaucoma or ocular hypertension (IOP >21 mmHg) were recruited and randomized to receive either netarsudil 0.02%, netarsudil 0.02% + bimatoprost 0.01%, or bimatoprost 0.01% once daily for a period of 12 weeks. IOP and side effects were documented at 4, 8, and 12 weeks. RESULTS The mean treated IOP ranged 17.51-18.57 mmHg for netarsudil, 15.80-16.46 mmHg for bimatoprost, and 14.00-14.87 mmHg for the combination therapy group. The mean IOP reduction from baseline at 4, 8, and 12 weeks was found to be statistically significant ( P < 0.001) in all three groups. The safety profile of netarsudil/bimatoprost combination was consistent with each constituent individually. The only frequently observed ocular adverse event was conjunctival hyperemia, which was seen mostly in netarsudil and netarsudil + bimatoprost groups ( P < 0.001). CONCLUSION The IOP-lowering effect of netarsudil 0.02% once daily is non-inferior to bimatoprost 0.01% in patients with POAG and ocular hypertension with acceptable ocular safety, and the combination therapy achieved a higher IOP-lowering effect. This group of medications can be a useful adjunct in patients on maximal therapy.
Collapse
Affiliation(s)
- Saima Shahid
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Syed Wajahat A Rizvi
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Adeeb A Khan
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Humayoun Ashraf
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Afeefa Akhter
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| |
Collapse
|
2
|
Stalmans I, Lim KS, Oddone F, Fichtl M, Belda JI, Hommer A, Laganovska G, Schweitzer C, Voykov B, Zarnowski T, Holló G. MERCURY-3: a randomized comparison of netarsudil/latanoprost and bimatoprost/timolol in open-angle glaucoma and ocular hypertension. Graefes Arch Clin Exp Ophthalmol 2024; 262:179-190. [PMID: 37615697 PMCID: PMC10806046 DOI: 10.1007/s00417-023-06192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE : To compare the efficacy and safety of the fixed-dose combination (FDC) of netarsudil 0.02%/latanoprost 0.005% ophthalmic solution (NET/LAT; Roclanda®) with bimatoprost 0.03%/timolol maleate 0.5% (BIM/TIM; Ganfort®) ophthalmic solution in the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS MERCURY-3 was a 6-month prospective, double-masked, randomized, multicenter, active-controlled, parallel-group, non-inferiority study. Patients (≥ 18 years) with a diagnosis of OAG or OHT in both eyes that was insufficiently controlled with topical medication (IOP ≥ 17 mmHg in ≥ 1 eye and < 28 mmHg in both eyes) were included. Following washout, patients were randomized to once-daily NET/LAT or BIM/TIM for up to 6 months; efficacy was assessed at Week 2, Week 4, and Month 3; safety was evaluated for 6 months. Comparison of NET/LAT relative to BIM/TIM for mean IOP at 08:00, 10:00, and 16:00 h was assessed at Week 2, Week 6, and Month 3. Non-inferiority of NET/LAT to BIM/TIM was defined as a difference of ≤ 1.5 mmHg at all nine time points through Month 3 and ≤ 1.0 mmHg at five or more of nine time points through Month 3. RESULTS Overall, 430 patients were randomized (NET/LAT, n = 218; BIM/TIM, n = 212), and all received at least one dose of study medication. Efficacy analyses were performed at Month 3 on 388 patients (NET/LAT, n = 184; BIM/TIM, n = 204). NET/LAT demonstrated non-inferiority to BIM/TIM, with a between-treatment difference in IOP of ≤ 1.5 mmHg achieved at all time points and ≤ 1.0 mmHg at the majority of time points (six of nine) through Month 3. Mean diurnal IOP during the study ranged from 15.4 to 15.6 mmHg and 15.2 to 15.6 mmHg in the NET/LAT and BIM/TIM groups respectively, with no between-group statistically significant difference. No significant differences were observed in key secondary endpoints. No serious, treatment-related adverse events (AEs) were observed, and AEs were typically mild/moderate in severity. The most common treatment-related AEs were conjunctival hyperemia (NET/LAT, 30.7%; BIM/TIM, 9.0%) and cornea verticillata (NET/LAT, 11.0%; BIM/TIM, 0%). CONCLUSIONS Once-daily NET/LAT was non-inferior to BIM/TIM in IOP reduction in OAG and OHT, with AEs consistent with previous findings. NET/LAT offers a compelling alternative FDC treatment option for OAG and OHT.
Collapse
Affiliation(s)
- Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Louvain, Belgium.
- Research Group of Ophthalmology, Department of Neurosciences, Catholic University KU Leuven, Louvain, Belgium.
| | - Kin Sheng Lim
- KCL Frost Eye Research Department, St Thomas' Hospital, London, UK
| | | | - Marek Fichtl
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and University Hospital Motol in Prague, Prague, Czech Republic
| | - Jose I Belda
- Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain
- Visionker Eye Clinic, Torrevieja, Spain
| | - Anton Hommer
- Private Office for Ophthalmology and Optometry, Albertgasse 39/10, 1080, Vienna, Austria
| | - Guna Laganovska
- Riga Stradins University, P.Stradins Clinical University Hospital, Riga, Latvia
| | - Cédric Schweitzer
- CHU Bordeaux, Department of Ophthalmology, 33000, Bordeaux, France
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, 33000, Bordeaux, France
| | - Bogomil Voykov
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
| | - Tomasz Zarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University, Lublin, Poland
| | - Gábor Holló
- Tutkimusz Ltd, Solymár, Hungary
- Eye Center, Prima Medica Health Centers, Budapest, Hungary
| |
Collapse
|
3
|
Mathur MC, Ratnam PV, Saikumar S, John M, Ravishankar S, Dinesh M, Chandil P, Pahuja K, Cherlikar V, Wadhwani S, Bendale P, Hazari A, Mishra R, Deshmukh S, Achlerkar RR, Shah DT, Hingorani C, Shah K, Topiwala P, Jani S, Rana VG, Majumdar NK, Chakrabarti D, Dey R, Halder D, Choudhury S, Kumar A, Das S, Nanda AK, Kumar VB, Dubey R, Kamdar GA, Pandey A, Kishanpuria S, Srivastava RM, Singh P, Verma SK, Sharma N, Gupta R. Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety. Indian J Ophthalmol 2023; 71:2500-2503. [PMID: 37322670 PMCID: PMC10418014 DOI: 10.4103/ijo.ijo_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40-80. The best way to manage primary open-angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods An open-label, real-world, multicentric, observation-based 3-month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first-line therapy. Diurnal IOP measurements, best-corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day-1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results Four hundred and sixty-nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once-daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion We found that netarsudil 0.02% w/v solution monotherapy when used as the first-line treatment in primary open-angle glaucoma and ocular hypertension was both safe and effective.
Collapse
Affiliation(s)
| | | | | | - Manuel John
- Holy Ghost Mission Hospital, Kottayam, Kerala, India
| | | | - M.B Dinesh
- Uma Eye Clinic, Chennai, Tamil Nadu, India
| | | | - Kishore Pahuja
- Natasha Eye Care and Research Centre, Pune, Maharashtra, India
| | | | | | - Pankaj Bendale
- Dr. Bendale’s Eye Care, Pimpri-Chinchwad, Maharashtra, India
| | - Ajit Hazari
- Hazari Nursing Home, Aurangabad, Maharashtra, India
| | - Rajesh Mishra
- Advanced Eye Hospital, A Unit of Dr Agarwals Eye Hospital, Vashi, Navi Mumbai, Maharashtra, India
| | - Susheel Deshmukh
- Sudrishti Eye Care and Goregaon Glaucoma Centre, Mumbai, Maharashtra, India
| | | | | | | | - Kaivan Shah
- Bhavna Super Speciality Eye Care, Surat, Gujarat, India
| | | | - Sheetal Jani
- Netralaya Superspecialty Eye Hospital, Ahmedabad, Gujarat, India
| | - Viral G. Rana
- Shree Bidada Survoday Trust- Laxmi Jyot Eye Hospital, Bidada, Gujarat, India
| | | | | | - Rituparna Dey
- Citizen’s Eye and Healthcare, Hooghly, West Bengal, India
| | | | | | - Ajeet Kumar
- Sharda Eye and Dental Hospital, Patna, Bihar, India
| | - Sasmita Das
- Kar Vision Eye Hospital, Bhubaneshwar, Odisha, India
| | | | | | - Rama Dubey
- Rama Eye Hospital, Jaipur, Rajasthan, India
| | | | | | | | | | - Parul Singh
- GSVM Medical College, Kanpur,Uttar Pradesh, India
| | | | - Neha Sharma
- P.C. Sharma Eye Hospital, Ambala, Haryana, India
| | | |
Collapse
|
4
|
Xie N, Xiao C, Shu Q, Cheng B, Wang Z, Xue R, Wen Z, Wang J, Shi H, Fan D, Liu N, Xu F. Cell response to mechanical microenvironment cues via Rho signaling: From mechanobiology to mechanomedicine. Acta Biomater 2023; 159:1-20. [PMID: 36717048 DOI: 10.1016/j.actbio.2023.01.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/30/2023]
Abstract
Mechanical cues in the cell microenvironment such as those from extracellular matrix properties, stretching, compression and shear stress, play a critical role in maintaining homeostasis. Upon sensing mechanical stimuli, cells can translate these external forces into intracellular biochemical signals to regulate their cellular behaviors, but the specific mechanisms of mechanotransduction at the molecular level remain elusive. As a subfamily of the Ras superfamily, Rho GTPases have been recognized as key intracellular mechanotransduction mediators that can regulate multiple cell activities such as proliferation, migration and differentiation as well as biological processes such as cytoskeletal dynamics, metabolism, and organ development. However, the upstream mechanosensors for Rho proteins and downstream effectors that respond to Rho signal activation have not been well illustrated. Moreover, Rho-mediated mechanical signals in previous studies are highly context-dependent. In this review, we systematically summarize the types of mechanical cues in the cell microenvironment and provide recent advances on the roles of the Rho-based mechanotransduction in various cell activities, physiological processes and diseases. Comprehensive insights into the mechanical roles of Rho GTPase partners would open a new paradigm of mechanomedicine for a variety of diseases. STATEMENT OF SIGNIFICANCE: In this review, we highlight the critical role of Rho GTPases as signal mediators to respond to physical cues in microenvironment. This article will add a distinct contribution to this set of knowledge by intensively addressing the relationship between Rho signaling and mechanobiology/mechanotransduction/mechanomedcine. This topic has not been discussed by the journal, nor has it yet been developed by the field. The comprehensive picture that will develop, from molecular mechanisms and engineering methods to disease treatment strategies, represents an important and distinct contribution to the field. We hope that this review would help researchers in various fields, especially clinicians, oncologists and bioengineers, who study Rho signal pathway and mechanobiology/mechanotransduction, understand the critical role of Rho GTPase in mechanotransduction.
Collapse
Affiliation(s)
- Ning Xie
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China; The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Cailan Xiao
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China; The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Qiuai Shu
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Bo Cheng
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China; The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Ziwei Wang
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Runxin Xue
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Zhang Wen
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Jinhai Wang
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Haitao Shi
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an Shaanxi 710049, China.
| | - Na Liu
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China; The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China.
| | - Feng Xu
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China; The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China.
| |
Collapse
|
5
|
Pham AT, Bradley C, Casey C, Jampel HD, Ramulu PY, Yohannan J. Effectiveness of Netarsudil versus Brimonidine in Eyes already Being Treated with Glaucoma Medications at a Single Academic Tertiary Care Practice: A Comparative Study. CURRENT THERAPEUTIC RESEARCH 2022; 98:100689. [PMID: 36582193 PMCID: PMC9792385 DOI: 10.1016/j.curtheres.2022.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
Background Rho kinase inhibitors, such as netarsudil, are a relatively new class of medications recently introduced into the market for the treatment of glaucoma, the leading cause of irreversible blindness in the world. Previous clinical trials have studied netarsudil's efficacy when used as a first- or second-line agent but limited studies have investigated its effectiveness in the real world where it is more commonly used as a third, fourth, or fifth agent in combination with other topical medications. Equally important, prior studies have not compared its effectiveness to its peer medications in these settings. Objective To compare intraocular pressure (IOP) lowering after initiation of netarsudil or brimonidine therapy in patients with glaucoma using >2 medications for IOP management. Methods A chart review of 369 eyes from 279 patients followed at a single academic tertiary practice was performed with an institutional review board waiver of consent to compare IOP lowering after prescription of netarsudil (n = 176) versus brimonidine (n = 193) as a third, fourth, or fifth IOP-lowering agent. Patients were identified by querying the electronic medical record for those with a glaucoma-related diagnosis who were prescribed either medication. Five sequential IOP measurements were obtained to determine the mean change in IOP before and after treatment (ΔIOP = mean IOP4,5 - mean IOP1,2,3). A multilevel linear mixed-effects model assessed the influence of medication (independent variable) on ΔIOP (dependent variable). Additional independent variables of interest included the number of glaucoma medications at baseline, age, sex, glaucoma type and severity, race, and pretreatment IOP. Bootstrap analysis was performed to remove sampling bias and confirm mixed-effects model findings. Kaplan-Meier survival analysis evaluated the probability of requiring additional intervention within 3 years following the date of medication prescription. Results The unadjusted mean (SD) ΔIOP for netarsudil and brimonidine was -2.20 (4.11) mm Hg and -2.21 (3.25) mm Hg, respectively (P = 0.484). The adjusted linear mixed-effects models and bootstrap analysis demonstrated that there was no statistical difference in IOP-lowering effectiveness between the medications. Netarsudil and brimonidine failed to adequately control IOP at similar rates with 42% and 47% probabilities of survival respectively by the 3-year follow-up (P = 0.520). Conclusions When escalating pharmacologic therapy, the IOP-lowering effect of netarsudil appeared to be similar to that produced by brimonidine. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX).
Collapse
Affiliation(s)
- Alex T. Pham
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chris Bradley
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Corinne Casey
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry D. Jampel
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pradeep Y. Ramulu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jithin Yohannan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland,Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland,Address correspondence to: Jithin Yohannan, MD, MPH, Wilmer Eye Institute, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287.
| |
Collapse
|
6
|
Li G, Akpek EK, Ahmad S. Glaucoma and Ocular Surface Disease: More than Meets the Eye. Clin Ophthalmol 2022; 16:3641-3649. [PMID: 36389640 PMCID: PMC9642795 DOI: 10.2147/opth.s388886] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/26/2022] [Indexed: 04/23/2024] Open
Abstract
Understanding the association between ocular surface disease and glaucoma is important for improving adherence to treatment and introducing practical solutions. While topical antihypertensive medications for glaucoma are well tolerated according to short-term studies, there is little evidence on their long-term effects. Since they are often required for many years, the effects of these drops on the ocular surface become important in regard to quality of life and adherence. In this nonsystematic review performed in April 2022, we summarize what is known about the relationship between glaucoma and ocular surface disease. Specifically, we examine how each class of topical glaucoma drops affects the ocular surface. We then review the treatment of ocular surface disease for patients on topical glaucoma therapy. Finally, we discuss treatments that may reduce or eliminate the burden of topical medications.
Collapse
Affiliation(s)
- Gavin Li
- Department of Ophthalmology at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Esen Karamursel Akpek
- Ocular Surface Disease Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sumayya Ahmad
- Department of Ophthalmology at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
7
|
Partial Stenosis and Complete Punctal Closure Following Topical Netarsudil Use for Glaucoma. J Glaucoma 2022; 31:920-925. [PMID: 36223296 DOI: 10.1097/ijg.0000000000002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To describe patients who developed partial or complete punctal closure after the use of topical netarsudil in the treatment of glaucoma, with documented reversal of symptoms on drug cessation. PATIENTS AND METHODS This is a retrospective, single-center case series including patients treated with topical netarsudil who were documented to have developed punctal disease ipsilateral to the eye(s) being treated. A literature review was also performed to identify other similar reports. RESULTS A total of 10 patients were included in the study. Six patients developed partial punctal stenosis and 4 patients developed complete closure of the puncta in 1 or both eye(s) ipsilateral to the use of the topical medication. None of the patients developed punctal disease on the non-netarsudil side. The time from initiation of netarsudil to the documentation of punctal disease ranged from 5-32.2 months (18.41±9.94). In the patients with complete punctal closure, discontinuation of the topical medication led to clinical reappearance of the punctal opening, ranging from 31-83 days after drug cessation (45.75±21.57). In 8 cases, discontinuation of netarsudil resulted in improved epiphora and degree of punctal stenosis on clinical examination. CONCLUSIONS The use of topical netarsudil for glaucoma may lead to punctal stenosis and complete punctal closure. These side effects of netarsudil are relevant to therapeutic considerations for glaucoma patients.
Collapse
|
8
|
Effectiveness of Topical Rho-kinase Inhibitors in Veterans with Severe Glaucoma on Maximally Tolerated Medical Therapy. Optom Vis Sci 2022; 99:626-631. [PMID: 35848984 DOI: 10.1097/opx.0000000000001925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SIGNIFICANCE The real-world pharmacological use of netarsudil shows that it can produce a clinically significant decrease in intraocular pressure for a small group of patients, even if they are already taking 3 or 4 other hypotensive glaucoma medication classes. PURPOSE To study the effectiveness of netarsudil in reducing intraocular pressure among veterans with advanced glaucoma on maximally tolerated medical therapy. METHODS All patients with glaucoma who received netarsudil between June 2018 and April 2020 from the West Los Angeles Veterans Administration Medical Center were reviewed. Inclusion criteria included a minimum of one intraocular pressure measurement in each of two time-windows (within and after 4 months of netarsudil use). Exclusion criteria included medication non-adherence, change in treatment plan before post-treatment intraocular pressure could be obtained, corneal disease precluding reliable measurement, outside follow-up, and loss to follow-up. Intraocular pressure at baseline and at two time-windows were compared using ANOVA. Relationships between intraocular pressure and number of baseline medications and concurrent statin therapy were evaluated. Netarsudil tolerability was reported. RESULTS Of 200 patients prescribed netarsudil, 42 patients (eyes) met enrollment criteria. Mean age of these patients was 75.7 years (95% CI: 73.0-78.4 years), 64% were of African descent, 79% had open angle glaucoma, and mean number of baseline medications was 3.7 (95% CI: 3.5-3.9). Baseline intraocular pressure of 17.2 mmHg (95% CI: 16.1-18.2 mmHg) decreased to 15.1 mmHg (95% CI: 14.0-16.2 mmHg; P < .001) and a reduction >20% was seen in 30.9% of patient after 4 months of netarsudil therapy. Intraocular pressure reduction was not associated with number of baseline medications or systemic statin use.Conclusions. Netarsudil may produce a clinically significant intraocular pressure reduction in up to a third of the patients with advanced glaucoma already on maximally tolerated medical therapy.
Collapse
|
9
|
Bahr T, Woolf S, Favre H, Waldman C. Comparison of netarsudil and latanoprostene bunod as adjuncts to maximum medical therapy in primary open-angle glaucoma: a single-centre retrospective cohort study. Can J Ophthalmol 2022:S0008-4182(22)00094-1. [PMID: 35421360 DOI: 10.1016/j.jcjo.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/12/2021] [Accepted: 03/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Compare the efficacy of new agents netarsudil 0.02% (NET) and latanoprostene bunod 0.024% (LB) ophthalmic solutions as adjuncts to traditional 4-class maximum medical therapy (MMT) in primary open angle glaucoma (POAG). DESIGN Single-centre retrospective cohort study using records from a university glaucoma clinic from 2017 to 2021 with follow-up at 30-90 days. PARTICIPANTS Patients with POAG already taking 4-class MMT who either added NET (n = 24) or exchanged a currently prescribed prostaglandin analogue (PGA) for LB (n = 11) with no prior surgery except for selective laser trabeculoplasty or cataract extraction >1 year prior. METHODS Either addition of NET or exchange of PGA for LB and otherwise continuing MMT. Outcome measures were absolute intraocular pressure reduction (IOPR) in mm Hg, percent IOPR, and proportion of patients achieving >10% IOPR. RESULTS Data from 35 eyes in 35 patients were analyzed. Intraocular pressure reduction after adding NET was significantly greater than after exchanging a PGA for LB. Percent IOPR by NET also was significantly greater than after exchanging PGA for LB. The proportion of patients reaching therapeutic threshold after the addition of NET was significantly greater than after exchange of PGA for LB. CONCLUSIONS In patients with POAG on MMT, addition of NET was associated with significantly greater magnitude of IOPR and a significantly greater proportion of patients reaching the >10% IOPR threshold compared with exchange of PGA for LB.
Collapse
Affiliation(s)
- Tyler Bahr
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Scott Woolf
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Hayley Favre
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Corey Waldman
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
| |
Collapse
|