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Brinzolamide-brimonidine fixed combination provides effective IOP control
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Fixed-combination brinzolamide 1% and brimonidine 0.2% was safe and effective at lowering IOP over a 24-hour period in a prospective, multicenter trial.
Sixteen academic and nonacademic sites in the U.S. were involved, and a total of 123 subjects were recruited, 123 of whom completed the study.
Participants had open-angle glaucoma or ocular hypertension, were at least 18 years old and had a mean baseline IOP between 21 mm Hg and 28 mm Hg. They were randomized 1:1 to receive either BBFC (Simbrinza, Alcon) or vehicle three times daily, at 8 a.m., 3 p.m. and 10 p.m., for 4 weeks.
Measurements of 24-hour pressure were taken twice at baseline and week 4. IOP was measured every 2 hours, in the sitting position during the day (8 a.m. to 8 p.m.) and in the supine position at night (10 p.m. to 6 a.m.) in a sleep laboratory.
Pressure reduction was significantly greater in the BBFC-treated eyes, where a mean 24-hour IOP reduction of 2.5 mm Hg was observed. Greater reduction as compared with vehicle was reported at all time points. Mean change from baseline in daytime was -3.9 mm Hg for BBFC-treated eyes and -0.5 mm Hg for vehicle-treated eyes. Overnight, reduction was -1.9 mm Hg versus -0.7 mm Hg. No alteration of ocular perfusion pressure was reported.
Fixed-dose combinations have become increasingly popular for their potential of improving patients’ adherence to the treatment thanks to the simplified dosing schedule, the authors said. BBFC has shown efficacy in landmark trials and other studies. This study, however, was the first to demonstrate efficacy over the entire 24-hour period, particularly at nighttime.
“Other 24-hour IOP control studies have shown that a number of current glaucoma medications typically have no efficacy, or reduced efficacy, at nighttime,” the authors wrote.
“BBFC treatment administered [three times daily] demonstrated superior 24-hour IOP-lowering efficacy compared with vehicle,” they concluded. – by Michela Cimberle
Disclosure: Weinreb has received grant/research support from Genentech, Heidelberg Engineering, Konan, Meditec-Zeiss, National Eye Institute, Optos, Optovue, Quark, Tomey, Topcon; has acted as consultant/advisor to Aires Pharma, Alcon, Allergan, Bausch and Lomb, Eyenovia, Novartis, Sensimed, Unity; and has patents/has received royalties for intellectual property from Toromedes. The study was sponsored by Alcon.
Perspective
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Lisa M. Young, OD, FAAO
Compliance. Adherence. Persistence. Call it what you want, but it’s no doubt one of our biggest hurdles with glaucoma patients. We know that many of our patients don’t take the drops that we prescribe and are even less likely to comply if we increase the number of medications that they have to take.
So how do we counter? We choose the most effective drop that requires the least amount of work, hence the popularity of prostaglandin analogues (PGA) and fixed-dose combinations (FDCs). With three FDC options to choose from in the U.S., these medications play an important role in adjunctive therapy to our first-line PGAs.
Just how effective are these drops in a 24-hour period? Weinreb and colleagues used a prospective, multicenter trial to show that fixed-dose brinzolamide-brimonidine (BBFC) effectively reduces IOP over a 24-hour period. Similar studies, but with slight variations, have also been done on fixed-dose dorzolamide-timolol and brimonidine-timolol.
Will this change how I prescribe? Probably not. Until I see a head-to-head comparison of the 24- hour effect of all three FDC medications, I will probably continue to choose BBFC only when a beta-blocker isn’t effective or can’t be tolerated.
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