Injectable glaucoma drug holds the potential to usher in new treatment paradigm

WAIKOLOA, Hawaii — Novel ways of delivering glaucoma medication to the eye could usher in a new treatment paradigm, according to a speaker here at Hawaiian Eye 2008.

Alan L. Robin

Alan L. Robin, MD, voted "Speaker of the Day" by the audience Wednesday, described obstacles to patient adherence to therapeutic regimens.

He said the glaucoma community should evaluate three issues: the adequacy of present therapies, whether or not patients adhere to those therapies and whether or not they demonstrate strong performance.

Dr. Robin said that an investigational new modality — anterior juxtascleral delivery of anecortave acetate — could offer an effective alternative to drops to combat the adherence problem.

"How many of you actually watch your patients put drops in their eyes and take the time to teach them to do it?" he asked. "It's not like, 'Take two aspirins and get plenty of rest.' There is more to it than that." About half to two-thirds of glaucoma patients need more than one therapy after 1 year, leading to the possibility that they will burn out, he said.

"We need a medication that works better than once a day, with fewer side effects than prostaglandin analogues, which are good drugs. We need a better than 30% decrease in IOP, something that's additive to a prostaglandin and something that people can deliver," he said.

Dr. Robin said he and his colleagues have evaluated 140 patients who are users of various kinds of glaucoma drops. Overall, they found that roughly three-quarters of patients "don't get the drops out of the bottles into their eyes."

"A lot of people have problems administering [drops] themselves and have to be dependent on others," he said.

Anecortave acetate, an injectable drug under development by Alcon, is promising because it does not have anti-inflammatory effects, does not decrease IOP in uveitis patients, does not raise IOP and has not been shown to cause cataracts. It is also insoluble and can last for months.

Injected into the sub-Tenon's space, anecortave acetate diffuses within a few hours and "seems to migrate to the area around the trabecular meshwork." The modality represents a "potential paradigm shift in the way we treat glaucoma," he said.

"It may obviate problems in how people take drops. It may be an exciting new venue for formulations of medications to help prevent blindness" in glaucoma patients, Dr. Robin said.