Prostaglandin Analogue Therapy Research Articles

The influence of central corneal thickness on response to topical prostaglandin analogue therapy

ObjectiveCentral corneal thickness (CCT) affects intraocular pressure (IOP) readings; however, CCT influence on topical medication efficacy is unknown. We evaluated the IOP-lowering effect of topical prostaglandin analogues (PGAs) in relation to CCT. DesignPost hoc analysis of a randomized prospective trial. MethodSubjects randomized to a PGA were followed for 24 weeks and were analyzed for relationship between CCT and IOP lowering. ParticipantsPatients with either newly diagnosed ocular hypertension or open-angle glaucoma. Results75 subjects were enrolled. The mean age was 62.7 ± 10.5 years; 48 were Caucasian. The mean CCT was 562.4 ± 41.4 μ. At repeated measures, ANCOVA analysis showed a significant effect of both baseline IOP (p < 0.0001) and CCT (p = 0.003) on IOP. At week 12, a regression analysis of the effect of CCT on baseline IOP showed that for every 10 μ increase in CCT there was 0.3 mm Hg less IOP decrease from baseline. ConclusionsWe found a statistically significantly association between a lower mean IOP and a thinner cornea when baseline IOP is controlled for. The magnitude of the relationship is small but may be clinically significant in patients with either very thin or very thick corneas.

Baseline Factors Predictive of SLT Response: A Prospective Study.

Purpose. To study the response to Selective Laser Trabeculoplasty (SLT) according to baseline medical treatment, angle pigmentation, age, diagnosis (open-angle glaucoma or ocular hypertension), and baseline intraocular pressure (IOP). Methods. 74 eyes of 74 patients were enrolled in this study. Baseline characteristics were recorded for each patient. IOP in the treated and fellow eyes was measured at baseline, and 1 month, 6 months, and 12 months following SLT. IOP changes in the different groups were compared using two-way ANOVA and Pearson's correlation. Results. The mean age of our cohort was 71 ± 10 years. The mean baseline IOP was 21.5 ± 5 mmHg, and the mean change in IOP from baseline in the treated eye at one year was −4.67 ± 3.40 mmHg. Higher baseline IOP was highly correlated with greater absolute IOP decrease. Prostaglandin analogue use at baseline was shown to be associated with a statistically decreased IOP-lowering response following SLT when corrected for baseline IOP. No significant differences in IOP response were found when comparing groups stratified for age, angle pigmentation, phakic status, gender, or diagnosis. Discussion. The results of this study confirm the finding that higher baseline IOP is a predictor of greater IOP response following SLT, and that pretreatment with prostaglandin analogue therapy is associated with a decreased IOP-lowering response following SLT. The study is limited by the small number of eyes with data available for complete case analysis.

The relationship between corneal hysteresis and the magnitude of intraocular pressure reduction with topical prostaglandin therapy

AimsTo evaluate corneal hysteresis (CH) and intraocular pressure (IOP) before and after IOP lowering with prostaglandin analogue (PGA) therapy in medication-naïve eyes.MethodsIn this retrospective study, we included records from 57...

Fixed-Combination Brimonidine/Timolol as Adjunctive Therapy to a Prostaglandin Analog: A 3-Month, Open-Label, Replacement Study in Glaucoma Patients

To evaluate intraocular pressure (IOP) and ocular allergy after replacement of 1 of 2 adjunctive therapy regimens (fixed-combination dorzolamide/timolol or dorzolamide/timolol plus brimonidine) with fixed-combination brimonidine/timolol in glaucoma patients treated with ongoing prostaglandin analog (PGA) therapy. This prospective, nonrandomized, open-label study involved patients on dorzolamide 2%/timolol 0.5% and a PGA who needed lower IOP and patients on brimonidine, dorzolamide 2%/timolol 0.5%, and a PGA who wanted to simplify their treatment regimens. After the baseline evaluation, patients were continued on the PGA and their other IOP-lowering medications were replaced with brimonidine 0.2%/timolol 0.5%. IOP was measured at baseline and months 1 and 3. In patients who replaced dorzolamide/timolol with brimonidine/timolol (n = 45), the mean (SD) IOP was 15.9 (1.4) mm Hg at baseline, 13.3 (0.9) mm Hg after 1 month (P < 0.001 vs. baseline), and 13.3 (1.0) mm Hg after 3 months (P < 0.001 vs. baseline). In patients who replaced both brimonidine and dorzolamide/timolol with brimonidine/timolol (n = 15), the mean (SD) IOP was 15.9 (5.2) mm Hg at baseline, 13.8 (1.8) mm Hg after 1 month (P = 0.053 vs. baseline), and 13.8 (1.4) mm Hg after 3 months (P = 0.079 vs. baseline). Allergy was reported in 5 patients previously treated with dorzolamide/timolol and 1 patient previously treated with brimonidine plus dorzolamide/timolol. For patients on multiple-drug therapy including a PGA, replacement of dorzolamide/timolol with brimonidine/timolol may help achieve a lower IOP, while replacement of brimonidine plus dorzolamide/timolol with brimonidine/timolol may help achieve as low an IOP with fewer medications.

Efficacy and safety of prostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocular hypertension: a meta-analysis

First-line therapy for primary open-angle glaucoma and ocular hypertension generally involves prostaglandin analogue therapy. The relative efficacy of differing prostaglandin therapy is disputed. A meta-analysis was conducted of head-to-head randomized trials of prostaglandin therapies. We included randomized trials assessing head-to-head evaluations of prostaglandin analogues travoprost, latanoprost and bimatoprost in patients with predominantly primary open-angle glaucoma or ocular hypertension. Findings were interpreted in light of equivalence margins. Our search identified 16 eligible trials, of which 15 were included in the meta-analysis. Trials were, in general, poorly reported. We pooled 9 trials assessing IOP-lowering effects of travoprost vs latanoprost (total n = 1098, weighted mean difference [WMD], -0.24 mmHg, 95% CI, -0.87 to 0.38, P = 0.45, I2 = 56%, 95% CI, 0 to 0.77, heterogeneity P = 0.01). Eight trials assessed travoprost vs bimatoprost (total n = 714, WMD, 0.88 mmHg, 95% CI, 0.13 to 1.63, P = 0.02, I2 = 56%, 95% CI, 0% to 78%, heterogeneity P = 0.02). And 8 trials assessed latanoprost vs bimatoprost (total n = 943, WMD, 0.73 mmHg, 95% CI, 0.10 to 1.37, P = 0.02, I2 = 47%, 95% CI, 0% to 74%, heterogeneity P = 0.06). Travoprost was associated with greater incidence of conjunctival hyperemia than latanoprost (RR 5.71, 95% CI, 1.81 to 18.02, P </= 0.001, I2 = 97%, 95% CI, 95 to 98, P </= 0.001). Five trials assessing latanoprost and bimatoprost revealed an elevated risk of conjunctival hyperemia with bimatoprost (RR 1.59, 95% CI, 1.02 to 2.48, P = 0.04, I2 = 76%, 95% CI, 16 to 88, P = 0.002). Randomized head-to-head evaluations of prostaglandin therapy demonstrate similar efficacy effects, but differing hyperemia effects.

Side Effects Associated with Prostaglandin Analog Therapy

Topical prostaglandin analogs, which have become first-line therapy in the medical management of glaucoma, have an excellent safety profile with regard to systemic side effects, but are associated with several ocular side effects. Some of these are common, with no apparent serious consequences other than cosmetic, whereas others are much less common but represent potentially sight-threatening side effects. The former group includes conjunctival hyperemia, elongation and darkening of eyelashes, induced iris darkening, and periocular skin pigmentation. The latter group of side effects, which are relatively rare and lack definitive causal relationship to prostaglandin analog therapy, includes iris cysts, cystoid macular edema, anterior uveitis, and reactivation of herpes simplex keratitis. Most of the literature regarding side effects associated with prostaglandin analogs involves the use of latanoprost, probably because it was the first to be studied. There is no evidence, however, aside from less conjunctival hyperemia with latanoprost, that the commercially available prostaglandin analogs differ significantly with regard to side effects.

Patients' and physicians' perceptions of the travoprost dosing aid: An open-label, multicenter study of adherence with prostaglandin analogue therapy for open-angle glaucoma or ocular hypertension

Objective: This study describes patients' and physicians' perceptions of issues related to dosing adherence with topical therapies for lowering intraocular pressure before and after use of the travoprost dosing aid (Travatan™ Dosing Aid, Alcon Research Ltd., Fort Worth, Texas). Methods: The study had an open-label, multicenter, single-treatment-arm design that included sequential patients with open-angle glaucoma (with or without pigment dispersion or pseudoexfoliation component) or ocular hypertension who were taking any prostaglandin analogue monotherapy. Ten participating physicians were chosen on the basis of factors such as their experience, qualifications, and previous clinical study participation. The study consisted of 2 visits: screening and week 4. Patients were asked to complete a survey about their medication adherence before study entry at the screening visit and at study exit during the week-4 visit. In addition, each physician was asked to complete an entry and exit survey on each patient as well as a survey to provide feedback on the travoprost dosing aid. Results: Of the 87 enrolled patients, 6 did not complete the exit survey; therefore, 81 patients were included in the intent-to-treat analysis. Mean (SD) age at enrollment was 65.4 (11.6) years; 61.7% (50/81) of the patients were women and 60.5% (49/81) were white. Most patients (96.3% [78/81]) had open-angle glaucoma. Participating physicians perceived that problems involving dosing and adherence were reduced after patients used the dosing aid. Physicians indicated that they would recommend continued use of the travoprost dosing aid for 91.3% (73/80) of patients. All 10 participating physicians said that they would recommend the dosing aid to patients in the future. Of the 81 patients, the majority (68.8% [55/80]) indicated that they would like to continue using the travoprost dosing aid. For 67.5% (54/80) of patients, dosing adherence as recorded by the travoprost dosing aid was >70%. The dosing lever (39.7% [31/78]) and the visual alarm (29.5% [23/78]) were the 2 most favored features of the dosing aid reported by all evaluable patients. The majority of patients (58.8% [47/80]) indicated that they were “relieved” or “very relieved” that the doctor was able to monitor when they dosed their medication; few (7.5% [6/80]) were “concerned” or “very concerned” that the doctor was able to monitor their dosing. Conclusions: The travoprost dosing aid was perceived to be effective in reminding this group of patients to take their medication as prescribed. In this study, the device was well accepted by both patients and physicians.

Adjunctive glaucoma therapy use associated with travoprost, bimatoprost, and latanoprost

ABSTRACTPurpose: This study contrasts the utilization of adjunctive medication associated with travoprost, bimatoprost, or latanoprost, as primary glaucoma therapies.Methods: Patients in the Medco Health database who initiated prostaglandin analog therapy on travoprost, bimatoprost or latanoprost between January 1, 2002 and July 31, 2002 were selected if they had no prostaglandin analog use in the prior 6 months. Patients were also required to have 12 months of prostaglandin therapy subsequent to the initial prescription. Data were available through July 31, 2003. The t-test and chi-square were used where appropriate to calculate p-values and assess significant differences.Results: A total of 13 171 benefit-eligible subjects were identified of which 8381 (64%), 2637 (20%), and 2153 (16%) patients were treated with latanoprost, bimatoprost, and travoprost, respectively. There were no significant differences in mean age or gender between the three study groups with the exception that latanoprost patients were statistically older than travoprost patients (69.0 vs. 68.0). This was not considered a clinically meaningful difference. Overall, patients using travoprost or bimatoprost had a significantly lower rate of adjunctive medication use compared to patients starting on latanoprost monotherapy (22.5%, 23.2%, and 30.2 %, respectively). Therefore, for every 14 patients treated with latanoprost instead of travoprost or bimatoprost, one additional patient would be expected to need adjunctive therapy with another agent. The difference between travoprost and bimatoprost patients was not significant.Conclusions: The use of adjunctive medications to control intraocular pressure was significantly higher for latanoprost patients compared to travoprost and bimatoprost patients. This finding should be interpreted in the context that this study was based only on prescription claims data. It is important to simplify ophthalmic medical regimen as it is more cost effective, better for the patient, and minimizes the washout effect from administering two eye medications within 5 min. Decreasing the complexity of the patients’ drug regimen may lead to increased adherence to prescribed therapy and a decreased risk of the incidence of blindness.

Role of endogenous prostaglandins in pregnancy termination by 15-methyl PGF 2α

Thirty pregnant women with foetal death in utero received 15-methyl PGF 2α to terminate their pregnancies. Two groups (15 cases each) matched for age, gravidity and age of pregnancy were studied. One group received indomethacin suppositories before and during the PG induction while the second group received the prostaglandin analogue therapy only. The group which received the prostaglandin biosynthesis inhibitor showed a longer induction-termination interval, more PG ampoules were used and the number of failed cases was higher. Thus, the Release of Endogenous prostaglandins seems to play a complementary role in the therapeutic termination of pregnancy.