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Ripasudil with maximum medical therapy may significantly lower IOP
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Researchers determined that adding ripasudil to patients’ already-maximum therapeutic regimens may lower IOP significantly and also prevent the need for glaucoma surgery.
The study included 35 Japanese men and women with primary open-angle glaucoma in whom the glaucoma was poorly controlled with maximum medical therapy before starting the twice daily treatment with ripasudil. Ripasudil was used as an adjunctive therapy to the ongoing glaucoma treatment, according to the study.
Mean IOP values at baseline and after 1, 2 and 3 months of treatment were 18.2 mm Hg, 16.2 mm Hg, 15.5 mm Hg and 15.4 mm Hg, respectively. IOP reductions from baseline after 1, 2 and 3 months of treatment were -2.0 mm Hg, -2.7 mm Hg and -2.8 mm Hg, respectively. Researchers deemed all reductions statistically significant.
“We think that the addition of ripasudil to existing maximum therapy exerted an IOP-lowering effect, because the mechanism by which ripasudil lowers the IOP differs from that of other antiglaucoma medications,” the researchers wrote.
“In 48.5% of the patients in whom the predefined target IOP was achieved, this adjunctive therapy helped avoid glaucoma surgery at least in the short term,” they said. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Blair Lonsberry, OD, FAAO
Most aqueous outflow occurs via the trabecular meshwork, with the remainder via the uveal-scleral network. Current IOP lowering medications focus on increasing uveal-scleral outflow or decreasing production, or combination of both. The only medication that influences trabecular outflow is pilocarpine, but due to negative side effects pilocarpine is not commonly prescribed.
A new group of medications called rho-kinase inhibitors have a direct influence on the trabecular meshwork by reducing actin-myosin contractility, relaxing the cells of the meshwork and inner walls of Schlemm’s canal, increasing outflow.
In this study, the authors determined that the addition of the rho-kinase inhibitor ripasudil was effective in lowering the IOP in 35 patients with glaucoma poorly controlled on maximal medical therapy. The addition of ripasudil lowered IOP 2.8 mm Hg over the 3 months, achieving the target IOP in 48.5% of patients and postponing the need for surgical intervention. However, it should be noted that every patient in this study suffered conjunctival hyperemia.
Rho-kinase inhibitors are the first group of modern medications to have direct action on the trabecular meshwork and are, thus, an exciting new avenue for glaucoma treatment. Let’s hope patient side effects don’t have rho-kinase inhibitors going the way of pilocarpine.
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