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Brinzolamide-brimonidine lowers IOP in POAG
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The fixed combination of brinzolamide-brimonidine significantly lowers intraocular pressure in primary open-angle glaucoma and is especially useful for patients with comorbidities, according to researchers in the European Journal of Ophthalmology.
Researchers divided 44 patients into two groups of 22 subjects. For 12 weeks, group A was treated with dorzolamide-timolol twice a day and group B received brinzolamide-brimonidine. IOP was measured twice a day, at 9 a.m. and 4 p.m.
At the end of the 12 weeks, mean morning IOP reduction was 7.0 ± 2.8 mm Hg in group A and 8.4 ± 1.9 mm Hg in group B, with a significant difference found.
Afternoon IOP reduction was 8.6 ± 2.7 mm Hg in group A and 7.9 ± 1.6 mm Hg in group B, with no significant difference found by the researchers.
“It seems that brimonidine has a powerful additive effect when compared with the brinzolamide, which complements its action and outweighs brimonidine’s lower hypotensive effect when used as a monotherapy,” the researchers wrote.
The researchers also noted that an advantage of the brinzolamide-brimonidine combination is the lack of the side effects caused by beta-blockers. – by Abigail Sutton
Disclosure: The researchers reported no financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Fixed-combination IOP lowering medications have been well received by doctors and patients alike. Simplifying treatment regimens has led to better compliance and better glaucoma control. Additionally, fixed combination drops reduce the possibility of a “wash-out” effect where a subsequent drop dilutes the concentration of the first drop taken just prior.
In the U.S., we have historically been limited to fixed-combination medications containing beta-blockers: Cosopt (dorzolamide HCl-timolol maleate, Merck) and Combigan (brimonidine tartrate-timolol maleate, Allergan). In 2013, Simbrinza (brimonidine tartrate-brinzolamide, Alcon) became our first beta-blocker free fixed-combination drop.
Kozobolis and colleagues found that Simbrinza lowers IOP as well as Cosopt. No significant adverse effects were noted in either group, but the study lasted only 12 weeks. In my practice, I have welcomed Simbrinza with open arms for patients who need multiple drop therapy and have a beta-blocker contraindication. It is also a go-to drop for patients with normotensive glaucoma where I hope to avoid reducing ocular perfusion pressure with a beta-blocker.
However, for patients without said contraindications, I have found patients more receptive to Cosopt. It is available in generic form, which saves money and hassle, and it is better tolerated (I will remind you that many disagree with me on this point). For me, the results read: “Cosopt lowers IOP as well as Simbrinza.”
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