Korean J Ophthalmol.  2020 Feb;34(1):19-26. 10.3341/kjo.2019.0094.

Comparison of Two Combinations of Maximum Medical Therapy for Lowering Intraocular Pressure in Primary Open-angle Glaucoma

• Wy S
• Kim YK
• Jeoung JW
• Park KH
• Ha A

• KMID: 2469283
• DOI: http://doi.org/10.3341/kjo.2019.0094

Abstract

PURPOSE
We sought to compare the efficacy as well as the safety of two maximum medical therapy combinations applied to lower the intraocular pressure (IOP) in different primary open-angle glaucoma (POAG) age groups.
METHODS
This was a retrospective, consecutive case series study that included 60 eyes of 60 subjects with POAG, specifically 20 subjects aged 40 to 54 years, 21 aged 55 to 69 years, and 19 aged 70 years or older. All had been treated for at least 12 months with triple maximum medical therapy (TMT; dorzolamide/timolol, brimonidine, and latanoprost) to lower their IOP, which subsequently was changed to double maximum medical therapy (DMT, fixed drug combinations of tafluprost/timolol and brinzolamide/brimonidine). The rate of IOP change and adverse drug reactions were compared amongst the three age groups.
RESULTS
The mean IOP change at three months after converting from TMT to DMT was −0.65 ± 1.42 mmHg (−3.84% ± 9.31%) among the overall study group, but this finding was not statistically significant (p = 0.108). In the 40 to 54 years and 55 to 69 years groups, the mean IOP change rates were +0.29 ± 0.96 mmHg (+2.40% ± 6.85%, p = 0.087) and −0.50 ± 0.99 mmHg (−3.05% ± 6.40%, p = 0.084) respectively. In the 70 years or older group, the mean IOP change, interestingly, was −1.80 ± 1.46 mmHg (−11.29% ± 9.31%, p < 0.001) and nine (47.4%) of the 19 subjects showed additional IOP reductions of 10% or more after converting from TMT to DMT. In all three age groups, the incidence rate of dry eye was significantly lower for DMT than for TMT (p = 0.031).
CONCLUSIONS
In POAG patients, DMT was proven to be both effective and safe for lowering the IOP, especially in those 70 years or older group, when compared with the TMT protocol.

Keyword

Disease management; Intraocular pressure; Open-angle glaucoma; Treatment adherence and compliance

MeSH Terms

Brimonidine Tartrate
Disease Management
Drug Combinations
Drug-Related Side Effects and Adverse Reactions
Glaucoma, Open-Angle*
Humans
Incidence
Intraocular Pressure*
Retrospective Studies
Brimonidine Tartrate
Drug Combinations

Figure

• 

  Fig. 1 Graph depicting changes in intraocular pressure (IOP) during triple maximum medical therapy (TMT) and double maximum medical therapy (DMT). IOPs were compared between the two regimens at one, three, and six months before the conversion to DMT and one, three, and six months after the conversion in each age group. Note that the X-axis is not to scale but does depict the times at which the IOPs were measured. The Y error bars indicate the standard deviation of the mean.

Reference

1. European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and options Supported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options. Br J Ophthalmol. 2017; 101:130–195.

2. The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol. 2000; 130:429–440.

3. Leske MC, Heijl A, Hussein M, et al. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol. 2003; 121:48–56.

4. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002; 120:701–713.

5. Friedman DS, Nordstrom B, Mozaffari E, Quigley HA. Variations in treatment among adult-onset open-angle glaucoma patients. Ophthalmology. 2005; 112:1494–1499.

6. Webers CA, Beckers HJ, Nuijts RM, Schouten JS. Pharmacological management of primary open-angle glaucoma: second-line options and beyond. Drugs Aging. 2008; 25:729–759.

7. Quigley HA, Enger C, Katz J, et al. Risk factors for the development of glaucomatous visual field loss in ocular hypertension. Arch Ophthalmol. 1994; 112:644–649.

8. Inoue K, Ishida K, Tomita G. Effectiveness and safety of switching from prostaglandin analog monotherapy to prostaglandin/timolol fixed combination therapy or adding ripasudil. Jpn J Ophthalmol. 2018; 62:508–516.

9. Barnebey HS, Orengo-Nania S, Flowers BE, et al. The safety and efficacy of travoprost 0.004%/timolol 0.5% fixed combination ophthalmic solution. Am J Ophthalmol. 2005; 140:1–7.

10. Lee AJ, McCluskey P. Fixed combination of topical brimonidine 0.2% and timolol 0.5% for glaucoma and uncontrolled intraocular pressure. Clin Ophthalmol. 2008; 2:545–555.

11. Seong GJ, Lee SC, Lee JH, et al. Comparisons of intraocular-pressure- lowering efficacy and side effects of 2% dorzolamide and 1% brinzolamide. Ophthalmologica. 2001; 215:188–191.

12. Uusitalo H, Pillunat LE, Ropo A. Phase III Study Investigators. Efficacy and safety of tafluprost 0.0015% versus latanoprost 0.005% eye drops in open-angle glaucoma and ocular hypertension: 24-month results of a randomized, double-masked phase III study. Acta Ophthalmol. 2010; 88:12–19.

13. Uusitalo H, Egorov E, Kaarniranta K, et al. Benefits of switching from latanoprost to preservative-free tafluprost eye drops: a meta-analysis of two Phase IIIb clinical trials. Clin Ophthalmol. 2016; 10:445–454.

14. Ikeda Y, Mori K, Tada K, et al. Comparison study of intraocular pressure reduction efficacy and safety between latanoprost and taf luprost in Japanese with normal-tension glaucoma. Clin Ophthalmol. 2016; 10:1633–1637.

15. Suzuki K, Otsuka N, Hizaki H, et al. Multicenter, randomized, controlled study comparing tafluprost/timolol fixed combination with latanoprost/timolol fixed combination in primary open-angle glaucoma and ocular hypertension. Adv Ther. 2018; 35:796–808.

16. Mundorf T, Williams R, Whitcup S, et al. A 3-month comparison of efficacy and safety of brimonidine-purite 0.15% and brimonidine 0.2% in patients with glaucoma or ocular hypertension. J Ocul Pharmacol Ther. 2003; 19:37–44.

17. Kim CY, Hong S, Seong GJ. Brimonidine 0.2% versus brimonidine Purite 0.15% in Asian ocular hypertension. J Ocul Pharmacol Ther. 2007; 23:481–486.

18. Katz LJ. Twelve-month evaluation of brimonidine-purite versus brimonidine in patients with glaucoma or ocular hypertension. J Glaucoma. 2002; 11:119–126.

19. Joh HJ, Jin SW. Comparison of different combinations of maximum medical therapy for lowering intraocular pressure in primary open angle glaucoma: 12-month retrospective consecutive case series. Jpn J Ophthalmol. 2019; 63:322–327.

20. Broadway DC, Cate H. Pharmacotherapy and adherence issues in treating elderly patients with glaucoma. Drugs Aging. 2015; 32:569–581.

21. Winfield AJ, Jessiman D, Williams A, Esakowitz L. A study of the causes of non-compliance by patients prescribed eyedrops. Br J Ophthalmol. 1990; 74:477–480.

22. Lacey J, Cate H, Broadway DC. Barriers to adherence with glaucoma medications: a qualitative research study. Eye (Lond). 2009; 23:924–932.

23. Jin H, Kim Y, Rhie SJ. Factors affecting medication adherence in elderly people. Patient Prefer Adherence. 2016; 10:2117–2125.

24. Lockington D, Macdonald EC, Stewart P, et al. Free radicals and the pH of topical glaucoma medications: a lifetime of ocular chemical injury? Eye (Lond). 2012; 26:734–741.

25. Manni G, Denis P, Chew P, et al. The safety and efficacy of brinzolamide 1%/timolol 0.5% fixed combination versus dorzolamide 2%/timolol 0.5% in patients with open-angle glaucoma or ocular hypertension. J Glaucoma. 2009; 18:293–300.

26. Mundorf TK, Rauchman SH, Williams RD, et al. A patient preference comparison of Azarga (brinzolamide/timolol fixed combination) vs Cosopt (dorzolamide/timolol fixed combination) in patients with open-angle glaucoma or ocular hypertension. Clin Ophthalmol. 2008; 2:623–628.

27. Noecker RJ, Herrygers LA, Anwaruddin R. Corneal and conjunctival changes caused by commonly used glaucoma medications. Cornea. 2004; 23:490–496.

28. Mundorf T, Wilcox KA, Ousler GW 3rd, et al. Evaluation of the comfort of Alphagan P compared with Alphagan in irritated eyes. Adv Ther. 2003; 20:329–336.