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Sustained-release glaucoma treatments in the pipeline will increase adherence
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WAILEA, Hawaii — Annette Giangiacomo, MD, focused on three sustained-release glaucoma treatments “that should be available sooner rather than later,” at Hawaiian Eye 2018.
One benefit of sustained-release drug delivery methods is “as the drug comes closer to the eye, there is a higher bioavailability and lower drug waste,” she said.
Another important consideration is increased patient adherence.
Evolute (Mati Therapeutics Inc.) is a silicone punctal plug that is non-biodegradable and non-bioerodable, Giangiacomo said.
“It elutes drugs at constant rate only to the tear film,” she added. “There may be less systemic absorption of the drug, there’s less getting into the drainage system and therefore less side effects.”
Drug delivery is possible for up to three months.
“The benefit of this drug being in a solid state is that there are no preservatives required,” she said.
The phase 2 trial of the plug demonstrated it was effective at lowering pressure 5 mm Hg to 5.5 mm Hg at 12 weeks. The study also demonstrated a retention rate in 92% to 96% of patients.
“Patients found it comfortable and not much in the way of tearing,” she added.
The plug may fall out without the patient being aware, which could be a potential disadvantage, she said.
Next, Giangiacomo discussed a conjunctival polymer ring from Allergan, Bimatoprost SR.
The sustained release, flexible ring sits on the conjunctiva and is easily inserted underneath the upper eyelid, she said.
It delivers 6 g per day for 6 months and is available in multiple sizes and can be customized, she said. Another convenience with this treatment is it can be removed at any time.
The ring has good accommodation, and is comfortable after a few days for most patients.
It is appropriate for those with early glaucoma.
In the phase 2 trial, 4 mm Hg to 6 mm Hg IOP reduction was noted, she said.
“Device retention was quite good and when the device was dislodged the patient always knew about it,” Giangiacomo said. Adverse effects included itching, redness, discharge, and blurred vision.
Lastly, Giangiacomo introduced Novadur, an intracameral implant from Allergan.
The drug is embedded in a biodegradable platform.
Novadur is inserted in the anterior chamber to allow slow release of medication (6 g to 20 g per day). Drug delivery can last for an extended period.
Phase 1 and Phase 2 have been completed in 75 patients with POAG.
At 4 months, IOP was reduced 7.2 mm Hg to 9.5 mm Hg depending on the dose received.
Adverse events were quite transient, she added.
Giangiacomo said contact lenses that deliver drugs to the surface of the eye are another potential therapy.
“There are many exciting approaches on the horizon for the treatment of glaucoma with the potential to increase the efficacy of and adherence to therapy,” she concluded. “However, especially for more invasive options the risks must be weighed against the benefits.” – by Abigail Sutton
Reference:
Giangiacomo A. Sustained-release glaucoma treatment. Presented at: Hawaiian Eye; Jan. 13-19, 2018; Wailea, Hawaii.
Disclosure: Giangiacomo reports no relevant financial disclosures.