ISSUE 1551
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The FDA has approved two new ophthalmic drugs for reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension: latanoprostene bunod (Vyzulta – Bausch and Lomb), a modified prostaglandin analog, and netarsudil (Rhopressa – Aerie), the first Rho kinase inhibitor to be approved in the US.
STANDARD TREATMENT — A prostaglandin analog such as latanoprost (Xalatan, and generics) is generally the drug of choice for initial treatment of glaucoma. Dosed once daily in the evening, prostaglandin analogs typically lower IOP by 25-30% throughout the night and following day. They are generally well tolerated and have few, if any, systemic effects.
Topical beta blockers such as timolol (Timoptic, and others) are also commonly used; they lower IOP by 20-25% with once- or twice-daily dosing, but their use as
... more- Brinzolamide/brimonidine (Simbrinza) for glaucoma. Med Lett Drugs Ther 2013; 55:57.
- LJ Lu et al. Novel pharmacologic candidates for treatment of primary open-angle glaucoma. Yale J Biol Med 2017; 90:111.
- JW Kiel and CC Kopczynski. Effect of AR-13324 on episcleral venous pressure in Dutch Belted rabbits. J Ocul Pharmacol Ther 2015; 31:146.
- FA Medeiros et al. Comparison of latanoprostene bunod 0.024% and timolol maleate 0.5% in open-angle glaucoma or ocular hypertension: The LUNAR study. Am J Ophthalmol 2016; 168:250.
- RN Weinreb et al. Latanoprostene bunod 0.024% versus timolol maleate 0.5% in subjects with open-angle glaucoma or ocular hypertension: the APOLLO study. Ophthalmology 2016; 123:965.
- Center for Drug Evaluation and Research. Latanoprostene bunod clinical review. Available at: www.accessdata.fda.gov. Accessed July 3, 2018.
- RN Weinreb et al. A randomised, controlled comparison of latanoprostene bunod and latanoprost 0.005% in the treatment of ocular hypertension and open angle glaucoma: the VOYAGER study. Br J Ophthalmol 2015; 99:738.
- JB Serle et al. Two phase 3 clinical trials comparing the safety and efficacy of netarsudil to timolol in patients with elevated intraocular pressure: rho kinase elevated IOP treatment trial 1 and 2 (ROCKET-1 and ROCKET-2). Am J Ophthalmol 2018; 186:116.
- J Bacharach et al. Double-masked, randomized, dose-response study of AR-13324 versus latanoprost in patients with elevated intraocular pressure. Ophthalmology 2015; 122:302.
- K Kawase et al. Long-term safety and efficacy of latanoprostene bunod 0.024% in Japanese subjects with open-angle glaucoma or ocular hypertension: The JUPITER Study. Adv Ther 2016; 33:1612.
- RN Weinreb et al. Latanoprostene bunod 0.024% in subjects with open-angle glaucoma or ocular hypertension: pooled phase 3 study findings. J Glaucoma 2018; 27:7.
- Bimatoprost 0.03% solution (Latisse) for eyelash enhancement. Med Lett Drugs Ther 2009; 51:43.

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