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Latanoprost shows long-term safety in pediatric patients
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Latanoprost showed an acceptable safety profile in a cohort of children with glaucoma and elevated IOP.
It was generally better tolerated and had fewer side effects as compared with the average adult population.
A total of 175 children 5 to 18 years old were enrolled and divided in two groups: 102 were treated with latanoprost or with combined latanoprost and timolol, and 73 received other, nonprostaglandin treatments. Both groups included children with primary and secondary glaucoma. The prospective study had a follow up of 3 years and was conducted in 14 countries in Europe and South America. The primary endpoint was the change in best corrected visual acuity. Secondary endpoints included IOP changes and several variables related to the most common side effects of prostaglandins, such as iris color changes; iris, conjunctival and choroidal pigmentation; conjunctival hyperemia; and eyelash thickening and/or darkening.
No statistically or clinically significant change in BCVA was reported in either group. IOP remained the same in the latanoprost group and significantly increased in the nonprostaglandin group. Conjunctival hyperemia and iris hyperpigmentation, which commonly occur in the adult population treated with prostaglandins, occurred only in a small percentage of children and were comparable in the two groups. Eyelash thickening was also comparable in the two groups, while the latanoprost group had a greater incidence of eyelash hyperpigmentation. No case of enophthalmos or upper lid sulcus deepening was identified.
The authors noted that “limited published data are available evaluating the effectiveness and safety of latanoprost in pediatric patients.” This study seems to prove that latanoprost has an acceptable safety profile and causes fewer complications in children than in the adult population. – by Michela Cimberle
Disclosure: Younus is an employee of Pfizer and owns stock in Pfizer. Please see the study for the other authors’ financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Remember 1996? For some of you, that may bring back memories of middle school graduation. For me, that’s the year Xalatan (latanoprost 0.005%, Pfizer) rocked the glaucoma world.
Initially, it needed to be refrigerated, couldn’t be used in pigmentary glaucoma, would cause uveitis and couldn’t be used after cataract surgery. With experience, these restrictions were relaxed and concerns determined to be largely unfounded. Latanoprost turned out to be more versatile and efficacious than we could have dreamed, but is it good for kids? Well, Younus and colleagues say yes. I say, “no,” unless you’re really up against a wall.
Have you ever met someone at a party and started a conversation with: “So, how long have you been on latanoprost?” Me neither, but it’s easy to spot those doe-eyed prostaglandin analogue (PGA) users a mile away.
Personally, I avoid PGAs in young patients. The physical and largely irreversible changes that often occur (lash growth, darkening of the skin, ptosis and enophthalmos) may have a greater impact on children and young adults than our geriatric patients. Having said that, glaucoma can be sight threatening, and PGA medications are excellent therapeutic agents. It’s good to know they will work well for young glaucoma patients, but they won’t be my first choice.
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