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Fixed combination may improve compliance over unfixed therapy
Fixed combination travoprost 0.004%-timolol 0.5% may promote improved adherence compared with separate containers of travoprost 0.004% and timolol 0.5% in patients with glaucoma or ocular hypertension who require multi-agent therapy, according to researchers in the American Journal of Ophthalmology.
The randomized, controlled, observer-masked clinical trial included 81 eligible adults with open-angle glaucoma or ocular hypertension who were randomized 1:1 to receive fixed combination travoprost 0.004%/timolol 0.5% (TTFC) or separate containers of travoprost 0.004% and timolol 0.5% (TRAV+TIM) for 12 months.
Mean patient age was 60 years, and most patients were male and white.
The 41 patients receiving TTFC were consistently adherent on a greater percentage of days through month 12, at 60%, vs. 43% for the 40 patients in the TRAV+TIM group, according to the study.
Significantly more patients were adherent on at least 80% of days with TTFC compared with TRAV+TIM.
Both treatments reduced IOP from baseline, and no safety issues were identified in either group, researchers wrote.
While adherence declined over time in both treatment groups, the decrease was more rapid with TRAV+TIM than with fixed-combination, according to researchers.
Researchers concluded that, “there appears to be a clear role for fixed-combination medications when adherence is a significant issue.” –by Abigail Sutton
Disclosure: Barnebey is a consultant to Aerie, Alcon, Allergan and Biolight. For all remaining authors’ financial disclosures, please see the full study.
Perspective
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Medications only work when they’re used. Thanks, Dr. Obvious …
While this observation is indeed obvious, poor adherence with glaucoma treatment is the rule rather than the exception – and a primary reason for disease progression.
While many factors influence adherence, treatment complexity is one of the few that is modifiable: with as many as eight in 10 patients eventually requiring more than one medication, fixed combinations are one way to keep things as simple as possible. Unfortunately, this study confirms that even adherence to once-daily dosing can be abysmal: After 12 months, only 32% of patients used their medication at least 80% of the time.
Notwithstanding this limitation, Canadian optometrists are fortunate to have access to two prostaglandin analog/beta-blocker fixed combinations. In my practice, DuoTrav (travoprost 0.004%/timolol 0.5%, Alcon) has proven to be efficacious and tolerable should a stand-alone prostaglandin analog be inadequate.
However, efficacy must be judged on more than in-office IOP alone. Despite significant differences in adherence, patients in this study had similar pressures, suggesting that adherence increases immediately prior to appointments and emphasizing the importance of carefully monitoring structural and functional parameters even in the face of an IOP that appears to be at target.