Fixed combination agents hold promise for glaucoma, clinician says

NEW ORLEANS — Available data suggest that three fixed combination drugs currently being investigated for glaucoma treatment hold great promise, one clinician said.

When approved, these drugs “will ultimately benefit patients and will likely prove to be important adjuncts,” said Eve J. Higginbotham, MD, here at the glaucoma subspecialty day at the American Academy of Ophthalmology meeting.

Dr. Higginbotham said one of the combination drugs on the horizon is Xalcom, from Pfizer, a fixed combination of timolol 0.5% and latanoprost 0.005%. This drug has been approved in some markets outside the United States under the name Xalacom.

Dr. Higginbotham said two multicenter trials showed a statistical difference in reduction in IOP between patients who received the combination drug and patients who received another combination. In one study, 32 patients were started on timolol twice a day, and 1 month later they were randomized to either the fixed combination of latanoprost and timolol or an unfixed combination of brimonidine twice a day and timolol twice a day for 6 weeks. Starting from a baseline of 20.9 mm Hg, the mean IOP decreased to 17.9 mm Hg in the fixed combination group, and to a mean of 19 mm Hg in the unfixed brimonidine/timolol group.

Dr. Higginbotham also discussed Extravan, from Alcon, a fixed combination of travoprost 0.004% and timolol 0.5%. She said that in a study, the fixed combination reduced the mean IOP more than either of its components individually. In a study of 263 patients who were followed for 3 months, patients who were randomized to receive the fixed combination experienced IOP reductions from baseline of 32% to 38%.

Another drug in the works is Combigan, from Allergan, a fixed combination of brimonidine and timolol. Dr. Higginbotham said a 1-year study showed that the reduction from baseline IOP was greater in patients receiving the combination than in patients who received either drug individually.