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Switching prosta drugs in IOP nonresponders suggested

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KOLOA, Hawaii — If a glaucoma patient is unresponsive to one prostaglandin-like drug, the physician might consider switching the patient to a different prosta drug rather than adding another drug to the patient’s treatment regimen, a speaker here at Hawaii 2004: the Royal Hawaiian Eye Meeting suggested.

David Tingey, MD, FRCSC, discussed the characteristics of the four available prostaglandin-like glaucoma drugs, or hypotensive lipids, currently on the market: Xalatan (latanoprost, Pfizer), Lumigan (bimatoprost, Allergan), Travatan (travoprost, Alcon) and Rescula (unoprostone, Santen).

Dr. Tingey noted that the first three of these drugs are all PGF2-a analogues, and as such share similar chemical structures and characteristics. Their mechanism of action is thought to be the increase of uveoscleral outflow. They have roughly similar efficacies, with the ability to lower IOP by 25% to 35%, Dr. Tingey said. Unoprostone, a docosanoid, is somewhat distinct from the other three in structure, in that it lowers IOP by only about 15%, he said.

Dr. Tingey noted that in studies comparing the efficacies of latanoprost, bimatoprost and travoprost, the results are “variable and contentious.” A 6-month study by Noecker and colleagues found bimatoprost to be superior to latanoprost. A 12-week study by Parrish and colleagues of all three drugs found no statistically significant differences.

“All three drugs are very effective,” he said. “If there is a difference in efficacy, it may be hard to show.”

Dr. Tingey said he tends to choose latanoprost for “treatment-naïve” patients and to use any of the three PGF2-a medications in patients who are on multiple medications.

Dr. Tingey suggested that if patients do not respond to one prosta drug, physicians might try switching the patient to another prosta drug before adding another drug to the regimen.

“If one prosta drug does not achieve your target, consider trying another,” he said. He cited a study by Gandolfi and colleagues, in which patients who were uncontrolled on latanoprost achieved lower IOPs when switched to bimatoprost.