The Experts below are selected from a list of 27 Experts worldwide ranked by ideXlab platform

P. Nucci - One of the best experts on this subject based on the ideXlab platform.

  • Efficacy of Bimatoprost Plus Timolol Fixed Combination in Open Angle Glaucoma Patients Previously Treated with Dorzolamide Plus Timolol Fixed Combination
    Current eye research, 2016
    Co-Authors: M. Sacchi, C. Specchia, E. Villani, Susan Williams, P. Nucci
    Abstract:

    To evaluate the efficacy and safety of bimatoprost Plus Timolol fixed combination (BTFC) in patients with primary open angle glaucoma (POAG) previously treated with Dorzolamide Plus Timolol fixed combination (DTFC). Retrospective, medical records review study. Medical records of patients with POAG previously treated with DTFC and then switched to BTFC for poor intraocular pressure (IOP) control or ocular discomfort were included in the analysis. One baseline IOP diurnal curve, and one diurnal curve under each treatment were required to be eligible for this study. The primary outcome was to compare the mean diurnal IOP between DTFC and BTFC. Secondary outcomes were to compare the IOP diurnal fluctuation, and the percentage of patients achieving a target IOP <14, <16, and <18 mmHg between the two treatments. Medical records of 96 patients were analyzed (mean age 65.8 years ± 7.2, range 39-89 years). The mean diurnal IOP was 23.7 ± 3.8 mmHg at baseline, 16.9 ± 3.4 mmHg with DTFC and 15.1 ± 2.9 mmHg after therapy was switched to BTFC (p < 0.0001 each treatment vs baseline; p < 0.0001 DTFC vs BTFC). The proportion of patients achieving a mean diurnal IOP <18, <16, and <14 mmHg was 76%, 35.4%, and 12.5% with DTFC and 81.2%, 68.8%, and 37.5% with BTFC (p = 0.20, p < 0.01, and p < 0.0001 between the two treatments, respectively). IOP fluctuation did not differ significantly between the treatments. BTFC can provide additional lowering in the mean diurnal IOP in patients previously treated with DTFC with no significant differences in the safety and tolerability profile.

  • efficacy of bimatoprost Plus Timolol fixed combination in open angle glaucoma patients previously treated with Dorzolamide Plus Timolol fixed combination
    Current Eye Research, 2016
    Co-Authors: M. Sacchi, C. Specchia, E. Villani, Susan Williams, P. Nucci
    Abstract:

    ABSTRACTPurpose: To evaluate the efficacy and safety of bimatoprost Plus Timolol fixed combination (BTFC) in patients with primary open angle glaucoma (POAG) previously treated with Dorzolamide Plus Timolol fixed combination (DTFC).Materials and methods: Retrospective, medical records review study. Medical records of patients with POAG previously treated with DTFC and then switched to BTFC for poor intraocular pressure (IOP) control or ocular discomfort were included in the analysis. One baseline IOP diurnal curve, and one diurnal curve under each treatment were required to be eligible for this study. The primary outcome was to compare the mean diurnal IOP between DTFC and BTFC. Secondary outcomes were to compare the IOP diurnal fluctuation, and the percentage of patients achieving a target IOP <14, <16, and <18 mmHg between the two treatments.Results: Medical records of 96 patients were analyzed (mean age 65.8 years ± 7.2, range 39–89 years). The mean diurnal IOP was 23.7 ± 3.8 mmHg at baseline, 16.9 ± 3...

  • Efficacy of Bimatoprost Plus Timolol Fixed Combination in Open Angle Glaucoma Patients Previously Treated with Dorzolamide Plus Timolol Fixed Combination
    'Informa UK Limited', 2016
    Co-Authors: M. Sacchi, C. Specchia, S.e. Williams, E. Villani, P. Nucci
    Abstract:

    Purpose: To evaluate the efficacy and safety of bimatoprost Plus Timolol fixed combination (BTFC) in patients with primary open angle glaucoma (POAG) previously treated with Dorzolamide Plus Timolol fixed combination (DTFC).Materials and methods: Retrospective, medical records review study. Medical records of patients with POAG previously treated with DTFC and then switched to BTFC for poor intraocular pressure (IOP) control or ocular discomfort were included in the analysis. One baseline IOP diurnal curve, and one diurnal curve under each treatment were required to be eligible for this study. The primary outcome was to compare the mean diurnal IOP between DTFC and BTFC. Secondary outcomes were to compare the IOP diurnal fluctuation, and the percentage of patients achieving a target IOP

Caroline M. Perry - One of the best experts on this subject based on the ideXlab platform.

  • Brinzolamide
    Drugs & Aging, 2003
    Co-Authors: Risto S. Cvetkovic, Caroline M. Perry
    Abstract:

    Brinzolamide is a highly specific carbonic anhydrase (CA) inhibitor which lowers intraocular pressure (IOP) by reducing the rate of aqueous humour formation. Formulated as a 1 % ophthalmic suspension (Azopt®) and administered twice or three times daily, brinzolamide is indicated for the topical management of primary open-angle glaucoma (POAG) and ocular hypertension (OH) as either monotherapy or adjunctive therapy with topical β-blockers. As monotherapy in patients with POAG or OH, brinzolamide 1% demonstrated IOP-lowering efficacy that was significantly greater than placebo, equivalent to three-times-daily Dorzolamide 2% but significantly lower than twice-daily Timolol 0.5%. Brinzolamide 1% was equally effective in twice- and three-times—daily regimens producing diurnal mean IOP reductions from baseline in the range of 13.2–21.8%. When used adjunctively twice daily with Timolol 0.5%, brinzolamide 1% was as effective as Dorzolamide 2% and superior to placebo in lowering IOP in patients with POAG or OH. In clinical trials, brinzolamide 1% was well tolerated causing only nonserious adverse effects that were generally local, transient and mild to moderate in severity. The incidence of the most common adverse events associated with the use of brinzolamide 1 % was either similar to (blurred vision and abnormal taste) or significantly lower than (ocular discomfort) with Dorzolamide 2%. Topical brinzolamide 1% does not appear to produce the acid-base or electrolyte disturbances and severe systemic adverse effects characteristic of oral CA inhibitors. It can be used in patients unresponsive to β-blockers or in whom β-blockers are contraindicated. Brinzolamide 1% administered twice daily is among the least costly alternatives and adjuncts to β-blocker therapy for glaucoma and is generally associated with less direct medical cost than Dorzolamide. Conclusion : Brinzolamide 1% ophthalmic suspension administered twice or three times daily, as monotherapy or adjunctive therapy with topical β-blockers, has good IOP-lowering efficacy in patients with POAG or OH that is equivalent to that of Dorzolamide 2% (three times daily as monotherapy, twice daily as adjunctive therapy). Brinzolamide is generally well tolerated and does not produce the systemic adverse effects associated with oral CA inhibitors. It can be used in patients who are unresponsive to, intolerant of, or unable to receive, ophthalmic β-blockers. Thus, brinzolamide, either as monotherapy or adjunctive therapy with topical β-blockers, should be regarded as a good second-line option in the pharmacological management of POAG and OH, and may be preferred over Dorzolamide because of significantly less ocular discomfort. Overview of Pharmacodynamic Properties Brinzolamide is a nonbacteriostatic sulfonamide derivative with higher lipophilicity and lower aqueous solubility than Dorzolamide or acetazolamide at physiological pH. As a consequence, brinzolamide forms a suspension at pH 7.4 which is more comfortable to the eye than the acidic pH of Dorzolamide solution (pH 5.6). Brinzolamide is a highly specific, noncompetitive and reversible carbonic anhydrase (CA)-II inhibitor with an ≈4-fold greater in vitro binding affinity for CA-II than Dorzolamide. The main local ocular effect of brinzolamide is produced predominantly by inhibition of CA-II in the secretory cells of ciliary processes inside the eye. Inhibition of this isoenzyme reduces the rate of aqueous humour formation, consequently lowering intraocular pressure (IOP). Following topical instillation, brinzolamide enters the blood circulation but systemic adverse effects with its use do not occur mainly because of incomplete saturation and inhibition of CA-II in erythrocytes and kidneys, and the low affinity of brinzolamide for other CA isoforms in the human body. Brinzolamide has been shown to produce significant reduction in IOP compared with placebo in the eyes of healthy volunteers and patients with glaucoma (see also Therapeutic Efficacy summary). Significantly greater reductions in both daytime and night-time rates of aqueous humour flow were obtained with brinzolamide compared with both placebo (p < 0.001) and Dorzolamide (p < 0.05) in healthy volunteers. However, in the same study, the effects on IOP reduction at both trough and peak times were similar with both drugs. CA-II is also present in corneal endothelium, where it plays a role in the mechanism responsible for maintaining corneal stroma in a relatively dehydrated state. Inhibition of this mechanism can potentially lead to corneal decompensation and impaired vision. Brinzolamide 1% appears to have no adverse effect on corneal endothelial cell function in patients with normal corneas; no clinically relevant or statistically significant changes from baseline in corneal thickness and corneal endothelial cell density occurred in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH) during an 18-month clinical trial. Topically applied brinzolamide significantly (p-values not reported) reduced the optic nerve head blood flow to normal levels in the eyes with hypertensive and preperimetric POAG, but caused no change in the eyes with advanced, perimetric glaucoma compared with normal eyes, in a 1-month clinical trial. Overview of Pharmacokinetic Properties Published data relating to the pharmacokinetic properties of brinzolamide in humans are limited. After topical ocular instillation in rabbits, brinzolamide 1% was readily absorbed in the conjunctiva, cornea, iris, ciliary body, aqueous humour, lens, choroid and retina, reaching peak concentrations in the anterior eye segment tissues within 0.5–2 hours. Systemic absorption of brinzolamide does occur, but plasma concentrations in healthy human volunteers are generally below quantitation levels because of the drug’s preferential distribution to erythrocytes. Extensive but saturable binding to CA-II in erythrocytes is the cause of nonlinear whole-blood pharmacokinetics of brinzolamide in rats. Concentration-independent plasma protein binding of brinzolamide in the range of 59–63% has been reported in an in vitro study in human plasma. Metabolic inactivation of brinzolamide is carried out predominantly in the liver through oxidative O - and N -dealkylation by cytochrome P450 isoenzymes. N -desethyl-brinzolamide binds predominantly to CA-I in erythrocytes and is the major metabolite found in whole human blood (but not in plasma). N -desmethox-ypropyl- and O -desmethyl-brinzolamide have been detected as minor metabolites in urine but not in the whole blood of humans. In humans, brinzolamide is predominantly excreted in the urine (≈60% unchanged and 20% as the N -desethyl metabolite) and has a long whole-blood half-life (111 days following topical administration of brinzolamide 3% ophthalmic suspension three times daily for 14 days in 15 healthy male volunteers). Therapeutic Efficacy The efficacy of brinzolamide 1% ophthalmic suspension administered twice or three times daily as monotherapy or adjunctive therapy with twice-daily Timolol 0.5% ophthalmic solution has been evaluated in six randomised, double-blind, multicentre, comparative clinical trials of 2 weeks to 18 months duration in a total of 1735 evaluable patients (previously pharmacologically treated) with POAG or OH. The trials compared the IOP-lowering efficacy of brinzolamide 1% with that of Dorzolamide 2% (twice daily in monotherapy, three times daily in adjunctive therapy trials), Timolol 0.5% (twice daily) or placebo. The primary efficacy endpoint in most trials was the diurnally corrected (i.e. for trough and peak times) mean IOP reduction from baseline; the longest duration trial reported only the mean reduction from baseline in trough IOP (measured at 8am). In all trials, IOP measurements were performed using Goldmann applanation tonometry. All trials were also preceded by appropriate washout periods, which, in two trials evaluating adjunctive use of brinzolamide 1%, also served as run-in phases for nonblind Timolol administration. As Monotherapy : Overall, in four monotherapy trials in a total of 1414 patients, brinzolamide 1% demonstrated IOP-lowering efficacy that was significantly greater than that of placebo (all p < 0.005), similar to Dorzolamide 2%, but significantly lower than Timolol 0.5% (p < 0.0002, where reported). In a placebo-controlled, parallel-group trial in 142 patients with POAG or OH, brinzolamide 1–3% produced clinically relevant and statistically significant reductions in mean baseline IOP (p-values not reported). Brinzolamide 1%, 2% and 3% were equally effective in reducing diurnally corrected mean IOP from baseline and more effective than brinzolamide 0.3% (p < 0.036). The study found brinzolamide 1 % to be the optimal concentration for lowering the elevated IOP in patients with glaucoma when administered twice daily. The short-term efficacy of brinzolamide 1% administered twice and three times daily was equivalent to that of three-times-daily Dorzolamide 2%; mean daily IOP reduction from baseline was in the range of 13.2–21.8% for twice-daily and 13.2–21.5% for three-times-daily brinzolamide 1%, and 15.7–22.9% for Dorzolamide 2% in two 3-month clinical trials in a total of 921 patients with POAG or OH (all p < 0.001). Clinically relevant reductions from baseline of the morning trough IOP were maintained long term with brinzolamide 1% throughout an 18-month trial involving 351 patients with POAG or OH (13.2% and 12.6%, respectively, in twice- and three-times-daily regimens; both p < 0.0001 vs baseline), although the effect was significantly lower than with twice-daily Timolol 0.5% ophthalmic solution (20.5%; p < 0.0002). After 3 months of treatment in two monotherapy trials, brinzolamide 1% administered twice or three times daily, respectively, produced IOP response (i.e. an IOP reduction ≥5mm Hg) or control (i.e. IOP of ≤21mm Hg) in up to 75.7% and 80.1% of patients, compared with up to 80.0% of patients who received Dorzolamide 2% three times daily and up to 82.0% of patients who received Timolol 0.5% twice daily. As Adjunctive Therapy : Brinzolamide 1% was as effective as Dorzolamide 2% (14.1–22.0% vs 14.0–21.2%) and superior to placebo (13.2–16.6% vs 4.4–10.4%; all p ≤ 0.03) in lowering IOP in patients with POAG or OH (n = 321) when used adjunctively with Timolol 0.5% ophthalmic solution in twice- and three-times-daily regimens, respectively, at all timepoints during two 3-month trials. Furthermore, in the active-controlled trial (n = 213), a similar proportion of patients achieved IOP reduction or control with brinzolamide Plus Timolol and Dorzolamide Plus Timolol (50.0–89.3% vs 43.9–85.4%, respectively). Tolerability Brinzolamide 1% ophthalmic suspension administered twice or three times daily was well tolerated in randomised, double-blind, multicentre, comparative, mono-therapy clinical trials in a total of 1626 patients with POAG or OH; brinzolamide-related adverse events were nonserious and generally mild to moderate in severity, occurring mostly at the time of eyedrop instillation and usually resolving without treatment. In the only long-term (18-month) clinical trial, adverse events and inadequate IOP control were the most common reasons for treatment discontinuation and accounted, respectively, for 39% and 17% of discontinuations in the twice-, and 27% and 21% in the three-times-daily brinzolamide groups, and for 30% and 4% in the Timolol group. In all clinical trials, the most common ocular adverse events related to brinzolamide treatment were transient blurring of vision and ocular discomfort (i.e. stinging and burning ocular sensations). The incidence of blurred vision in 3- and 18-month trials was relatively low (3–8% with twice-daily, and 3.6–5.2% with three-times-daily regimens) and not statistically significantly greater than that reported in patients receiving three-times-daily Dorzolamide 2% (0.6% and 0.8%) or placebo (1.5%), or twice-daily Timolol 0.5% (0% and 5.3%). In clinical trials of up to 18 months duration, ocular discomfort at the time of instillation occurred ≈3–9 times less frequently with brinzolamide 1% than with Dorzolamide 2% (p < 0.05). In addition, burning and/or stinging sensation was significantly less intense with brinzolamide 1% compared with Dorzolamide 2% (p < 0.0001) in two weekly comfort studies in a total of 198 patients with POAG or OH. Results of a prospective, nonblind, noncomparative, crossover, multicentre clinical study in 447 evaluable patients with glaucoma indicate that substituting Dorzolamide 2% with brinzolamide 1% for mono- or adjunctive therapy may provide improved ocular comfort. One to 3 months after the switch, 69%, 26% and 5% of patients, respectively, reported improvement, no change, and worsening in ocular comfort. Consequently, more than twice as many patients preferred brinzolamide over Dorzolamide for their glaucoma therapy (59% vs 26%; p-value not reported). Brinzolamide did not affect visual acuity, visual fields, cup-to-disc ratio and other ocular signs, and corneal endothelial cell function (see Overview of Pharmacodynamic Properties summary) in patients with POAG or OH receiving treatment for up to 18 months during clinical trials. Abnormal (i.e. bitter or sour) taste was the only local, nonocular adverse event associated with brinzolamide 1%, which occurred in ≥3% of patients across monotherapy and adjunctive therapy trials. The incidence of abnormal taste with brinzolamide use was dose- and frequency-related (6.8–12.1% with brinzolamide 1% three times daily), and was not statistically significantly different than that with Dorzolamide 2%. Topical brinzolamide 1% does not appear to produce acid-base or electrolyte disturbances and was not associated with clinically significant systemic adverse effects, generally observed with oral CA inhibitors, in clinical trials of up to 18 months duration. Pharmacoeconomic Analyses Thus far, pharmacoeconomic analyses relating to the use of brinzolamide in the treatment of POAG and OH have been limited to a cost-minimisation study and two cost analyses. The European cost-minimisation study showed that initiating medical glaucoma therapy with brinzolamide 1% in patients with POAG or OH was associated with lower (in Italy, Spain and Portugal) or similar (in France) total direct medical costs per patient over 3 months compared with Dorzolamide 2%. The analysis was conducted from the perspective of healthcare payers from each country and in the context of second-line use of topical CA inhibitors, and was based on similar week 4 responder rates between brinzolamide and Dorzolamide regimens from four randomised, double-blind, comparative brinzolamide clinical trials. The cost benefit of short-term brinzolamide versus Dorzolamide therapy was explained by the lower administration rate of brinzolamide (twice daily) with equal efficacy to Dorzolamide (three times daily) [see Therapeutic Efficacy summary] and lower rate of therapy discontinuation with brinzolamide than with Dorzolamide due to better local tolerability (see Tolerability summary). Two US cost analyses conducted from a payer’s perspective and covering similar periods (1999 and 1998–2000) both showed that twice-daily therapy with brinzolamide 1% incurred less cost than with Dorzolamide 2%. Both studies also found that glaucoma monotherapy was less costly with twice-daily brinzolamide 1% than with brimonidine 2% (twice daily) or latanoprost 0.005% (once daily), but more costly than with generic Timolol maleate 0.5% (twice daily). Dosage and Administration Brinzolamide 1 % ophthalmic suspension is indicated for the treatment of elevated IOP in patients with POAG or OH. The recommended dosage of brinzolamide in Europe is one drop instilled in the conjunctival sac of the affected eye(s) twice daily (for use as either monotherapy or adjunctive therapy with topical ophthalmic β-blockers). In Europe, brinzolamide monotherapy is also indicated in patients unresponsive to β-blockers or in whom β-blockers are contraindicated. In the US, the recommended administration regimen for brinzolamide as monotherapy is three times daily; formal US recommendations for the use of brinzolamide in combination with other topical antiglaucoma drugs have not been made. Brinzolamide is not recommended in the US and is contraindicated in Europe for the treatment of patients with severe renal impairment (creatinine clearance

  • Latanoprost
    Drugs & Aging, 2003
    Co-Authors: Caroline M. Perry, Jane K. Mcgavin, Christine R. Culy, Tim Ibbotson
    Abstract:

    Latanoprost (Xalatan®) is an ester analogue of prostaglandin F_2α that reduces intraocular pressure (IOP) by increasing uveoscleral outflow. The IOP-lowering efficacy of latanoprost 0.005% lasts for up to 24 hours after a single topical dose, which allows for a once-daily dosage regimen. In patients with ocular hypertension or open-angle glaucoma, a single drop of latanoprost 0.005% solution (about 1.5 µg) administered topically once daily reduced diurnal IOP by 22 to 39% over 1 to 12 months’ treatment in well-controlled trials; efficacy was maintained during treatment periods of up to 2 years. At this dosage, latanoprost was significantly more effective than Timolol 0.5% twice daily in 3 of 4 large, double-blind, randomised studies, was generally as effective as bimatoprost or travoprost, and was significantly more effective than Dorzolamide, brimonidine or unoprostone. Furthermore, in patients whose IOP was poorly controlled with Timolol, switching to latanoprost monotherapy was at least as effective at lowering IOP as adding Dorzolamide or pilocarpine to the regimen. Latanoprost has also shown significant additive effects when used in combination with one or more other glaucoma medications. The fixed combination of latanoprost Plus Timolol was significantly more effective than either of its individual components in two double-blind randomised studies and more effective than the fixed combination of Dorzolamide and Timolol in a 3-month, evaluator-masked study. Data in patients with angle-closure glaucoma are limited, but in patients with elevated IOP after undergoing iridotomy, latanoprost 0.005% once daily was significantly more effective than Timolol 0.5% twice daily at reducing IOP over 12 weeks of treatment in a large double-blind, randomised study. Latanoprost is generally well tolerated and, unlike Timolol, induces minimal systemic adverse events. In well-controlled, 6-month trials, the most commonly occurring drug-related ocular events in latanoprost recipients were mild to moderate conjunctival hyperaemia (3 to 15%) and iris colour change (2 to 9%); these seldom required patient withdrawal although the latter may be permanent. Latanoprost 0.005% as a single daily drop has shown good IOP-lowering efficacy in patients with open-angle glaucoma or ocular hypertension and does not produce the cardiopulmonary adverse effects associated with β-blockers. Thus, latanoprost is a valuable addition to the first-line treatment options for patients with open-angle glaucoma or ocular hypertension. In addition, adjunctive treatment with latanoprost in patients who are refractory to β-blocker therapy is a viable, second-line treatment option. Although preliminary findings are promising, wider clinical experience is required to define the place of latanoprost in the treatment of angle-closure glaucoma. Pharmacodynamic Properties Latanoprost is an ester prodrug analogue of prostaglandin F_2α with a high selectivity for the FP subtype of prostanoid receptors. Like other topically applied prostaglandins, latanoprost reduces intraocular pressure (IOP) by increasing uveoscleral outflow facility. IOP reductions were maximal within 8 to 12 hours after a single topical dose of latanoprost (0.005%), and IOP remained below pretreatment levels for at least 24 hours. In addition, latanoprost showed little or no effect on aqueous humour flow, tonographic or fluorophotometric outflow facility, and did not disrupt the blood-aqueous barrier over short-term or long-term treatment. It is thought that the iridial darkening induced by latanoprost is due to enhanced melanin production. Latanoprost 0.005% once daily either increased or had no appreciable effect on ocular circulation in patients with ocular hypertension or open-angle glaucoma. In one investigation, latanoprost increased diurnal ocular perfusion pressure to a significantly greater extent than Timolol in patients with normal-tension glaucoma. Results from one study investigating the effects of latanoprost in in vitro and/or in vivo models of retinal injury suggest that this agent may have neuroprotective effects. Pharmacokinetic Properties In patients undergoing cataract surgery the mean maximum concentration (C_max) of latanoprost in the aqueous humour was 32.6 µg/L, the elimination half life (t½) was 2.5 hours and the concentration 24 hours after administration was ≤0.2 µg/L. Following topical administration of latanoprost (30µL of a 50 µg/mL solution), t½ was 17 minutes, the area under the latanoprost plasma concentration time curve was 34 ng·h/L, and volume of distribution was 0.36 L/kg. Plasma C_max after topical application of latanoprost was 53 ng/L after 5 minutes. In healthy volunteers, 87.9% of a radiolabelled latanoprost dose was recovered in the urine and 15.3% in the faeces after topical administration. Clinical Efficacy The IOP-lowering efficacy of latanoprost ophthalmic solution (0.005%; 50 µg/mL) has been evaluated in patients with ocular hypertension or open-angle glaucoma, angle-closure glaucoma and other types of glaucoma. Latanoprost was administered as a single drop (about 1.5µg) once daily in all studies (unless otherwise indicated). Open-Angle Glaucoma or Ocular Hypertension: In well-controlled clinical trials including patients with open-angle glaucoma or ocular hypertension (IOP ≥21mm Hg), monotherapy with latanoprost reduced IOP levels by 22 to 39% over 1 to 12 months’ treatment. Latanoprost was significantly more effective than Timolol 0.5% twice daily in 3 of 4 large (n = 163 to 267) randomised, double-blind trials. In these studies, mean baseline diurnal IOP was reduced by 6.2 to 8.6mm Hg (27 to 35%) with latanoprost and 4.4 to 8.3mm Hg (19 to 33%) with Timolol over 3 or 6 months of treatment. Latanoprost demonstrated a stable long-term IOP-lowering effect in 1- or 2-year continuations of these trials, with no sign of diminishing effect during prolonged treatment. In other randomised studies, latanoprost was generally as effective as bimatoprost (0.3% once daily) or travoprost (0.0015 or 0.004% once daily), and was significantly more effective than Dorzolamide (2% three times daily), brimonidine (0.2% twice daily), or unoprostone (0.12 or 0.15% twice daily) at reducing IOP over 1 to 12 months’ treatment. In patients who had elevated IOP despite Timolol treatment, switching to latanoprost monotherapy was at least as effective at reducing diurnal IOP as adding Dorzolamide (2% twice daily) or pilocarpine (2% three times daily) to the regimen: mean diurnal IOP was reduced by 19 to 26%, 17 to 21% and 19 to 20%, respectively, over 6 weeks’ to 6 months’ treatment in randomised studies (n = 35 to 197). The fixed combination of latanoprost Plus Timolol was significantly more effective than either of its individual components in two 6-month double-blind randomised studies and was also more effective than the fixed combination of Dorzolamide Plus Timolol in a 3-month, evaluator masked study. When added to existing therapy with a β-blocker (usually Timolol), latanoprost was significantly more effective than pilocarpine (2% three times daily) and Dorzolamide (2% twice daily), and as effective as brimonidine (0.2% twice daily) at reducing IOP in randomised studies. Mean IOP was reduced by 24 to 32% with adjunctive latanoprost, 19 to 21% with adjunctive pilocarpine, 20% with adjunctive Dorzolamide and 22% with adjunctive brimonidine. Latanoprost also demonstrated additive effects when used in combination with a variety of other IOP-lowering medications including dipivefrine, acetazolamide, Dorzolamide and pilocarpine (but not unoprostone) in other studies. In patients who had persistently elevated IOP despite receiving two or more IOP-lowering medications, latanoprost reduced IOP by a further 16 to 18% in noncomparative trials. In the only randomised study, latanoprost showed similar IOP-lowering efficacy to brimonidine 0.2% twice daily when these drugs were added to therapy with a β-blocker combined with pilocarpine or Dorzolamide. Angle-Closure Glaucoma: In patients who had elevated IOP despite iridotomy and/or iridectomy (including patients of Asian decent), latanoprost (0.005% once daily) was significantly more effective than Timolol (0.5% twice daily) in two double-blind, monotherapy trials (8.2 and 8.8mm Hg vs 5.2 and 5.7mm Hg for latanoprost vs Timolol at 12 and 2 weeks, respectively). As adjunctive therapy in a small nonblind trial (patients had undergone iridectomy and were receiving combined treatment with β-blockers and pilocarpine with or without oral carbonic anhydrase inhibitors), latanoprost rapidly decreased mean IOP. Other Types of Glaucoma: In randomised studies in patients with normal-tension glaucoma or steroid-induced glaucoma, latanoprost (0.005% once daily) displayed similar IOP-lowering efficacy to Timolol 0.5% twice daily over 3 weeks or 4 months’ treatment, respectively. In patients with pigmentary glaucoma (n = 36), latanoprost produced significantly greater reductions in IOP than Timolol after 12 months therapy (5.9 vs 4.6%). Tolerability Overall, ocular-related adverse effects observed in patients with glaucoma who received latanoprost were mild to moderate in severity and the majority resolved after discontinuation of treatment. Treatment with latanoprost may cause mild conjunctival hyperaemia, iridial darkening and eyelash changes. Increased iridial pigmentation did not resolve upon cessation of latanoprost in patients followed for 2 years. An increase in the severity and recurrence of herpes simplex virus keratitis has been reported after initiation of latanoprost therapy and caution is advised in patients with a history of herpes. Anecdotal evidence has suggested development of cystoid macular oedema as a potentially serious adverse effect associated with latanoprost treatment in patients with independent risk factors. Anterior uveitis has also been observed in approximately 1% of patients receiving latanoprost and is resolved with corticosteroid therapy. Administration of latanoprost to patients with active uveitis at the time of treatment may or may not aggravate the condition, but does not appear to lower IOP. Latanoprost-related systemic adverse events are infrequent (unlike those induced by Timolol) but include respiratory complications and headache. A similar incidence of adverse effects has been observed in short-term (range 30 days to 8 weeks) randomised studies of latanoprost with the prostaglandins bimatoprost or unoprostone, although in one study unoprostone recipients experienced more frequent adverse events than latanoprost recipients. Significantly more conjunctive hyperaemia and increased eyelash growth was reported in patients who received bimatoprost than latanoprost for 3 months and headache was more frequently seen in latanoprost than bimatoprost patients. Latanoprost has also shown a similar incidence of adverse effects to both Dorzolamide and brimonidine; systemic effects are more pronounced with Dorzolamide. Dosage and Administration In the US, Europe and Japan latanoprost is approved for first-line use in patients with open-angle glaucoma or ocular hypertension. A single drop of latanoprost 0.005% ophthalmic solution (about 1.5µg) once daily is the recommended dosage. The drug should be used cautiously in patients with renal or hepatic impairment and in patients with active intraocular inflammation (e.g. iritis, uveitis). Contact lenses should be removed before administration of latanoprost.

M. Sacchi - One of the best experts on this subject based on the ideXlab platform.

  • Efficacy of Bimatoprost Plus Timolol Fixed Combination in Open Angle Glaucoma Patients Previously Treated with Dorzolamide Plus Timolol Fixed Combination
    Current eye research, 2016
    Co-Authors: M. Sacchi, C. Specchia, E. Villani, Susan Williams, P. Nucci
    Abstract:

    To evaluate the efficacy and safety of bimatoprost Plus Timolol fixed combination (BTFC) in patients with primary open angle glaucoma (POAG) previously treated with Dorzolamide Plus Timolol fixed combination (DTFC). Retrospective, medical records review study. Medical records of patients with POAG previously treated with DTFC and then switched to BTFC for poor intraocular pressure (IOP) control or ocular discomfort were included in the analysis. One baseline IOP diurnal curve, and one diurnal curve under each treatment were required to be eligible for this study. The primary outcome was to compare the mean diurnal IOP between DTFC and BTFC. Secondary outcomes were to compare the IOP diurnal fluctuation, and the percentage of patients achieving a target IOP <14, <16, and <18 mmHg between the two treatments. Medical records of 96 patients were analyzed (mean age 65.8 years ± 7.2, range 39-89 years). The mean diurnal IOP was 23.7 ± 3.8 mmHg at baseline, 16.9 ± 3.4 mmHg with DTFC and 15.1 ± 2.9 mmHg after therapy was switched to BTFC (p < 0.0001 each treatment vs baseline; p < 0.0001 DTFC vs BTFC). The proportion of patients achieving a mean diurnal IOP <18, <16, and <14 mmHg was 76%, 35.4%, and 12.5% with DTFC and 81.2%, 68.8%, and 37.5% with BTFC (p = 0.20, p < 0.01, and p < 0.0001 between the two treatments, respectively). IOP fluctuation did not differ significantly between the treatments. BTFC can provide additional lowering in the mean diurnal IOP in patients previously treated with DTFC with no significant differences in the safety and tolerability profile.

  • efficacy of bimatoprost Plus Timolol fixed combination in open angle glaucoma patients previously treated with Dorzolamide Plus Timolol fixed combination
    Current Eye Research, 2016
    Co-Authors: M. Sacchi, C. Specchia, E. Villani, Susan Williams, P. Nucci
    Abstract:

    ABSTRACTPurpose: To evaluate the efficacy and safety of bimatoprost Plus Timolol fixed combination (BTFC) in patients with primary open angle glaucoma (POAG) previously treated with Dorzolamide Plus Timolol fixed combination (DTFC).Materials and methods: Retrospective, medical records review study. Medical records of patients with POAG previously treated with DTFC and then switched to BTFC for poor intraocular pressure (IOP) control or ocular discomfort were included in the analysis. One baseline IOP diurnal curve, and one diurnal curve under each treatment were required to be eligible for this study. The primary outcome was to compare the mean diurnal IOP between DTFC and BTFC. Secondary outcomes were to compare the IOP diurnal fluctuation, and the percentage of patients achieving a target IOP <14, <16, and <18 mmHg between the two treatments.Results: Medical records of 96 patients were analyzed (mean age 65.8 years ± 7.2, range 39–89 years). The mean diurnal IOP was 23.7 ± 3.8 mmHg at baseline, 16.9 ± 3...

  • Efficacy of Bimatoprost Plus Timolol Fixed Combination in Open Angle Glaucoma Patients Previously Treated with Dorzolamide Plus Timolol Fixed Combination
    'Informa UK Limited', 2016
    Co-Authors: M. Sacchi, C. Specchia, S.e. Williams, E. Villani, P. Nucci
    Abstract:

    Purpose: To evaluate the efficacy and safety of bimatoprost Plus Timolol fixed combination (BTFC) in patients with primary open angle glaucoma (POAG) previously treated with Dorzolamide Plus Timolol fixed combination (DTFC).Materials and methods: Retrospective, medical records review study. Medical records of patients with POAG previously treated with DTFC and then switched to BTFC for poor intraocular pressure (IOP) control or ocular discomfort were included in the analysis. One baseline IOP diurnal curve, and one diurnal curve under each treatment were required to be eligible for this study. The primary outcome was to compare the mean diurnal IOP between DTFC and BTFC. Secondary outcomes were to compare the IOP diurnal fluctuation, and the percentage of patients achieving a target IOP

Béatrice Friren - One of the best experts on this subject based on the ideXlab platform.

  • Comparison of topical brinzolamide 1% and Dorzolamide 2% eye drops given twice daily in addition to Timolol 0.5% in patients with primary open-angle glaucoma or ocular hypertension.
    American journal of ophthalmology, 2001
    Co-Authors: Jean-eric Michaud, Béatrice Friren
    Abstract:

    The aim was to compare topical brinzolamide 1% twice daily with Dorzolamide 2% twice daily, each given with Timolol 0.5% twice daily, for safety and effects on intraocular pressure in patients with primary open-angle glaucoma or ocular hypertension. This double-blind, randomized, active controlled, parallel group study was conducted multinationally at 31 sites, in 241 patients as above, with assessments at baseline and monthly during 3 months of treatment. The primary end point was a diurnal reduction of trough/peak intraocular pressure from a Timolol 0.5% twice daily baseline. Both treatment regimens reduced intraocular pressure significantly at all time points (P <.001): brinzolamide Plus Timolol by -3.6 to -5.3 mm Hg (-14.2 to -21.9%), Dorzolamide Plus Timolol by -3.6 mm Hg to -5.1 mm Hg (-14.1 to -21.2%). Clinically relevant intraocular pressure reductions (decreases 5 mm Hg or greater or absolute intraocular pressure values 21 mm Hg or less) were manifested by 50.0% to 89.3% of patients under brinzolamide Plus Timolol and by 43.9% to 85.4% under Dorzolamide Plus Timolol. The treatments were equivalent in mean intraocular pressure-lowering. In general, both regimens were well tolerated. However, more patients (P =.001) experienced at least one adverse event with Dorzolamide Plus Timolol (32.8%) as compared with brinzolamide Plus Timolol (14.7%); also, more patients (P =.001) experienced ocular discomfort (stinging and burning) after Dorzolamide Plus Timolol (13.1%) than after brinzolamide Plus Timolol (1.7%). In terms of intraocular pressure reduction, brinzolamide 1% twice daily was equivalent to Dorzolamide 2% twice daily, each added to Timolol 0.5% twice daily, but brinzolamide produced significantly less ocular burning and stinging.

Nikolaos Dimitrakoulias - One of the best experts on this subject based on the ideXlab platform.

  • Comparison of the additive intraocular pressure-lowering effect of latanoprost and Dorzolamide when added to Timolol in patients with open-angle glaucoma or ocular hypertension: a randomized, open-label, multicenter study in Greece.
    Journal of glaucoma, 2001
    Co-Authors: Andreas Petounis, Nikolaos Mylopoulos, Artemios Kandarakis, Dimitrios Andreanos, Nikolaos Dimitrakoulias
    Abstract:

    PURPOSE To compare the intraocular pressure-lowering effect of latanoprost with that of Dorzolamide when added to Timolol. PATIENTS AND METHODS This randomized, open-label study with two parallel groups was conducted in five centers in Greece. The study enrolled 148 patients with inadequately controlled open-angle or pseudoexfoliation glaucoma (intraocular pressure of at least 22 mm Hg) or ocular hypertension (intraocular pressure of at least 27 mm Hg) who were receiving monotherapy with a beta-blocker or dual therapy in which one of the agents was a beta-blocker. The patients were switched to Timolol 0.5% twice daily for 2 to 4 weeks (run-in period) before the start of the study (baseline). At baseline, the patients were randomized to receive latanoprost 0.005% once daily or Dorzolamide 2% twice daily as add-on therapy to Timolol. The intraocular pressure was recorded at 9:30 AM, 12:30 PM, and 3:30 PM at baseline and at 3 months. Safety was followed throughout the study. RESULTS The diurnal intraocular pressure reduction was significant in both groups (P < 0.001). The mean intraocular pressure reduction from baseline was 32% for the latanoprost Plus Timolol group and 20% for the Dorzolamide Plus Timolol group. The least square estimate of the mean diurnal intraocular pressure reduction after 3 months was -7.06 mm Hg in the latanoprost Plus Timolol group and -4.44 mm Hg in the Dorzolamide Plus Timolol group (P < 0.001). Drugs administered in both treatment groups were well tolerated. CONCLUSION This study clearly showed that the additive diurnal intraocular pressure-lowering effect of latanoprost is superior to that of Dorzolamide in patients treated with Timolol.