A new look at the safety and tolerability of prostaglandin analogue eyedrops in glaucoma and ocular hypertension

ABSTRACT

Introduction

In the last 25 years, topical prostaglandin analogues (PGAs) have emerged to become first line and first choice therapeutic options in the management of glaucoma and ocular hypertension (OHT). Although the short-term efficacy and safety of PGAs has been extensively investigated, less is known about their long term safety and tolerability. This gap in current knowledge is clinically relevant, because treatment-related adverse events and long-term tolerability issues are key determinants of the overall success of long-term therapy and the final outcome of a lifelong, symptomless disease like glaucoma.

Areas covered

We include selected evidence pertaining to the safety and tolerability of available and emerging PGA formulations. We also outline PGA formulations with different concentrations of the active ingredient, different preservatives, and preservative-free (PF) options.

Expert opinion

Undoubtedly PGAs will continue to play a major role in the medical therapy of glaucoma and OHT. Despite extensive literature and prolonged clinical experience with these agents worldwide, a number of areas that warrant further research have been identified in the present review. Recently launched novel PGAs, or those still in development offer new opportunities and future challenges.

KEYWORDS:

• Glaucoma medical therapy
• oht
• prostaglandins
• safety
• tolerability
• adverse events
• latanoprost
• travoprost
• bimatoprost
• tafluprost

Article highlights

• Topical prostaglandin analogues (PGAs) have become first line and first choice intraocular pressure lowering medications for patients with open-angle glaucoma or ocular hypertension.

• In contrast to the abundance of published evidence on the short-term efficacy and safety of these drugs, the long-term safety and tolerability of PGAs has not been scrutinized extensively.

• Although the systemic safety and tolerability of these medications is very good, all members of this class cause a number of characteristic local adverse effects.

• To improve safety and tolerability, recent developments in this class include formulations with different concentrations of the active ingredient, different preservatives, and preservative-free options.

• Drugs recently approved in different parts of the world such as the nitric oxide-donating latanoprostene bunod and the selective EP2 receptor agonist omidenepag isopropyl offer novel therapeutic options while posing new dilemmas and challenges.

Disclosure statement

Andreas Katsanos: Research funding from Laboratoires Théa, congress expenses/speaker fees from Santen, Vianex, Cooper, Zwitter. Gábor Holló: Consultant for Aerie and Santen, speaker fees from Aerie, Santen, Mundipharma. Anastasios G. Konstas: Research funding from Allergan, Bayer and Santen; travel support from Vianex; honoraria from Allergan, Mundipharma, Santen and Vianex. 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.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The authors have no funding to report.