Sustained-release glaucoma medications needed to reduce treatment burden
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Between poor patient adherence and the inherent IOP peaks and troughs associated with eye drop-managed glaucoma, sustained-release medications are greatly needed, a presenter at the virtual OSN New York meeting said.
About half of all patients taking eye drops struggle with adherence, especially with midday doses, and about two-thirds do not administer the drops correctly, Sarah H. Van Tassel, MD, said.
Furthermore, laser and surgical therapies are not appropriate for all patients because of prior glaucoma surgery, angle anatomy not amenable to selective laser trabeculoplasty, patient resistance and medical comorbidities, she said.
“This context demonstrates that there is a great need for sustained-release glaucoma medications,” Van Tassel said.
In March, the FDA approved Durysta (bimatoprost sustained-release intracameral implant, Allergan) for IOP reduction in patients with open-angle glaucoma or ocular hypertension. Efficacy was demonstrated in two phase 3 studies that showed IOP reduction of approximately 5 mm Hg to 8 mm Hg in patients with mean IOP of 24.5 mm Hg at baseline. The most common ocular adverse event was conjunctival hyperemia in about 27% of patients, Van Tassel said.
Van Tassel identifies patients who may be suitable for such sustained delivery of medication as those who have challenges administering their eye drops, such as those with arthritis or forgetfulness, and those who react to benzalkonium chloride.
“In our practice lifetimes, we will surely see additional sustained-release medication options,” Van Tassel said, including punctal plugs, ring-type systems, contact lenses, implants, microspheres, nanospheres and gels.
Determinants of their success include efficacy, duration, safety, cost/reimbursement, patient acceptance and ease of office flow.
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Van Tassel S. Depot drug delivery for glaucoma. Presented at: OSN New York and OSN New York Retina; Oct. 17-18, 2020 (virtual meeting).
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