Fixed-combination topical anti-hypertensive ophthalmic agents

ABSTRACT

Introduction

Fixed-combination glaucoma medications have altered the paradigm of ocular hypertension and glaucoma treatment and are in widespread use today. A comprehensive review of fixed-combination medications will help educate and inform providers for optimal patient care.

Areas covered

In this review, the authors describe the composition, mechanism of action, efficacy, side effects, and safety profile of fixed-combination agents for the treatment of ocular hypertension and glaucoma as well as comparisons between the most frequently prescribed medications.

Expert opinion

Fixed-combination therapeutics provide an effective and efficient means of lowering intraocular pressure with comparable side effects and outcomes to constituent parts with lower patient exposure to preservatives and improvement in compliance.

KEYWORDS:

• Drug combinations
• fixed-combination agents
• glaucoma therapy
• ocular hypertension

Article highlights

• Fixed-combination pressure-lowering medications show improved adherence and equal efficacy to constituent parts

• Fixed-combination brinzolamide-timolol is more tolerable than fixed-combination dorzolamide timolol though both are equally efficacious in lowering intraocular pressure

• Fixed-combination brimonidine-timolol has equal efficacy to individual administration with less associated allergy

• Fixed-combination brinzolamide-brimonidine is unique in that the combination contains no prostaglandin analogs or beta-blockers

• Fixed-combination dorzolamide-timolol and brinzolamide-brimonidine showed equal efficacy in pressure lowering

• In some studies, unfixed combination of beta-blockers and prostaglandin analogs appear to be more effective than fixed-combination agents, a finding attributed to twice-daily dosing of beta-blockers when administered unfixed

• Latanoprostene bunod breaks down to latanoprost acid and butanediol mononitrate acting via the trabecular meshwork and Schlemm’s canal with effective pressure lowering in a once-daily dosing format

• Parasympathomimetic agents are less commonly utilized but may be combined with beta-blockers and have shown superiority to fixed-combination dorzolamide-timolol in one representative study

• Fixed-combination Rho kinase inhibitors-prostaglandin analogs provide two modalities of pressure lowering with superior efficacy compared to separate administration of netarsudil or latanoprost

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One referee declares that they have received congress expenses and honoraria from Allergan, Théa Group, Santen and Vianex. They also have received research funding from Théa Group. Another referee declares consultancy/advisory fees and lecture fees from Aerie Pharmaceuticals Inc, consultancy/advisory fees and grant support from Allergan Inc, and consultancy/advisory and lecture fees from Bausch + Lomb. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.