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New glaucoma medications relax trabecular meshwork, lower episcleral venous pressure

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CHICAGO – IOP lowering through three different mechanisms comes together in one agent regardless of IOP baseline, a speaker said here at an Aerie Pharmaceuticals press briefing.

Rhopressa relaxes the trabecular meshwork and increases outflow by inhibiting Rho kinase, lowers episcleral venous pressure, and reduces fluid production through inhibition of the norepinephrine transporter, Casey Kopczynski, PhD, said.

 “What we found to be really interesting, once we got into the clinic, was that unlike every other drug out there on the market, it achieves very effective IOP lowering regardless of the patient’s baseline IOP,“ Kopczynski said. He noted that this is the first time in 20 years that a new mechanism of action for a glaucoma drug is being studied.

Citing IOP less than 26 mm Hg in 80% of patients with glaucoma in the Baltimore Survey, Kopczynski said, “It’s very important to have drugs that can treat this 80% that have pressures below 26, and this is where current medications tend to become less effective.”

To treat both patients with lower baseline pressures as well as higher baseline pressures, Aerie has added a prostaglandin to the Rhopressa formulation in a once-daily combination drop, Roclatan, Kopczynski said.

“One of the untreated areas is low-tension glaucoma,” Richard A. Lewis, MD, said, and before the development of Rhopressa and Roclatan, the treatment would be surgical rather than medical. “It may be the only drug that can be combined with a prostaglandin if this works out.”

For the U.S. Food and Drug Administration to approve such a combination, the effect of the combination has to exceed the effect of the individual components.

“It would be a huge advantage,” Lewis said.

Disclosure: Casey Kopczynski, MD, Chief Scientific Officer, Aerie Pharmaceuticals. Lewis is a consultant for AbbVie, Aerie, Alcon Laboratories, Allergan, AqueSys, AVS, Glaukos, Ivantis and Merck.