Balancing efficacy and tolerability of prostaglandin analogues and prostaglandin–timolol fixed combinations in primary open-angle glaucoma

Abstract

Background:

Lowering intraocular pressure (IOP) is currently the only therapeutic approach that preserves visual function in primary open-angle glaucoma. In making treatment decisions for first- and second-line therapy, the clinician needs to provide an appropriate balance of efficacy and tolerability. Prostaglandin analogues (PGAs) are frequently used as first-line monotherapy, because of their efficacy and low risk of systemic side effects. Similarly, PGA-based fixed combinations are frequently used in patients who progress or fail to achieve the target IOP.

Scope:

We have reviewed the literature on the management of primary open-angle glaucoma with PGAs, both as monotherapies and in fixed combinations.

Findings:

In the clinical trial and meta-analysis data identified, bimatoprost 0.03% seems to be associated with a greater overall ability to lower IOP compared with latanoprost, travoprost or tafluprost, at the cost of a slightly higher incidence of conjunctival hyperaemia. Studies indicate that patients’ adherence to treatment is generally better with PGAs than with many other monotherapies. In patients requiring more than one IOP-lowering agent, fixed combination treatments may provide improved adherence and tolerability benefits compared with concomitant use of individual treatments. Bimatoprost/timolol fixed combination appears to be slightly more efficacious than latanoprost/timolol or travoprost/timolol, and tolerability differences between the fixed combinations appear to be slight, probably because the addition of timolol to the PGA component lessens the associated hyperaemia. Surveys on EU physician attitudes appear largely in line with these clinical data.

Conclusion:

An appropriate balance between efficacy and tolerability ensures optimum IOP lowering and reduces the risk of non-adherence. PGAs largely fulfil this need as monotherapies and as components of combinations.

Key words::

• Bimatoprost
• Glaucoma
• Intraocular pressure
• Latanoprost
• Prostaglandins
• Travoprost

Transparency

Declaration of funding

This study was funded by Allergan.

Declaration of financial/other relationships

F.A. has disclosed that he has received lecture fees and travel expenses from Alcon and Allergan, and travel expenses from Pfizer. P.D. has disclosed that he has received consultancy fees, lecture fees and travel expenses from Alcon and Allergan, and Pfizer; lecture fees and travel expenses from MSD; lecture fees from Thea; and consultancy fees from EyeTechCare.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.