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Latanoprostene bunod shows efficacy greater than timolol
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Latanoprostene bunod 0.024% once daily showed greater efficacy in lowering diurnal IOP compared with timolol maleate 0.5% twice daily in a large cohort of patients with open-angle glaucoma or ocular hypertension.
The safety profile of latanoprostene bunod (LBN) was comparable to that of prostaglandin analogues.
The pooled analysis included the results of the APOLLO and LUNAR phase 3, randomized, multicenter trials and their open-label safety extension phases.
LBN 0.024% instilled once a day in the evening was superior to timolol 0.5% instilled twice a day over the 3 months of the controlled comparison, and this effect lasted through the 12 months of the open-label phases. A greater proportion of subjects achieved IOP less than 18 mm Hg or had a IOP reduction greater than 25% from baseline. The mean reduction of IOP with LBN was 32% as compared with the 27.6% of timolol. Patients initially randomized for timolol and switched to LBN in the open-label phases had an additional diurnal IOP decrease of 1.2 mm Hg.
The safety profile of LBN was comparable to that of prostaglandin analogues (PGAs), with no systemic serious adverse events and primarily mild to moderate ocular side effects, including conjunctival hyperemia, eye irritation and eye pain. Changes in iris pigmentation, eyelid pigmentation and eyelash growth were uncommon but, as with PGAs, may come as a consequence of more prolonged use.
“This pooled analysis showed that LBN 0.024% demonstrated a high degree of safety through 12 months of treatment and exhibited a safety profile typical of topical PGA therapy,” the authors wrote.
LBN is a nitric oxide (NO)-donating prostaglandin F2 analog, which adds to the well-known effect of latanoprost the pharmacological effect of NO-donating moiety, enhancing aqueous humor outflow through relaxation of the trabecular meshwork and Schlemm’s canal. According to the authors, LBN may be a valid alternative to PGAs, with a greater and more prolonged effect. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
It is with open arms that we welcome a new topical medication into our glaucoma treatment arsenal. Receiving FDA approval this past November, Vyzulta (latanoprostene bunod 0.024%, Bausch + Lomb) has been shown to lower IOP in open-angle glaucoma and ocular hypertension. This novel medication, a dual-acting nitric oxide donating prostaglandin analog, has been shown to increase aqueous outflow through both the uveoscleral and trabecular meshwork pathways.
Theoretically, this medication should be an easy addition to our line-up, with similar characteristics to our prostaglandin analogues: same dosing, same side effects, but with purportedly better outcomes.
As with any new medication, it will take time for practitioners to implement this new option. Being able to effectively lower IOP with daily dosing and a favorable safety profile is a win for practitioners and patients alike. There are always downsides to implementing a new medication, such as limited insurance coverage and the resulting out-of-pocket expenses that patients may incur. Still, these are minor worries that will be addressed over time. Where can I get some samples?
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