New prostaglandin shows high efficacy for lowering IOP
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Patients treated with Vyzulta for open-angle glaucoma and ocular hypertension had significantly better outcomes compared with most beta-blockers, according to results of a systemic review and network meta-analysis.
“The objective of this study was to assess the relative efficacy of a new IOP-lowering medication, [Vyzulta], compared with other topical medications for the treatment of POAG [primary open-angle glaucoma] and [ocular hypertension (OH)] and to provide a relative ranking of these treatments,” Paul Harasymowycz, MD, from the University of Montreal in Canada, and colleagues wrote.
Harasymowycz and colleagues noted that the safety and efficacy of Vyzulta (latanoprostene bunod or LBN, Bausch + Lomb) was established through both the APOLLO and LUNAR clinical studies.
The manufacturer explains on its website that Vyzulta is metabolized into two moieties, latanoprost acid, a prostaglandin analog, and butanediol mononitrate, which releases nitric oxide.
The network meta-analysis comprised 114 studies that evaluated the efficacy of various prostaglandin analogues for the treatment of POAG and OH. All active drugs demonstrated an improved reduction of IOP at 3 months. Specifically, the mean difference in IOP reduction compared with placebo ranged from 1.97 mm Hg for unoprostone to 5.59 mm Hg for bimatoprost, with LBN having the second greatest reduction (5.42 mm Hg).
The researchers wrote that these results highlight the statistically significant superiority in efficacy of LBN compared with unoprostone along with beta-blockers, including apraclonidine at 2.55 mm Hg, brimonidine at 1.75 mm Hg and timolol at 1.69 mm Hg, among others. Although not significant, LBN also numerically outperformed latanoprost at a difference of 0.7 mm Hg and tafluprost at 0.41 mm Hg.
“This systematic review and [network meta-analysis], which include the most recent PGA, namely LBN, provides new findings relevant to clinicians and decisionmakers, as it allows for the comparison of drugs that had not yet been evaluated in head-to-head trials,” Harasymowycz and colleagues concluded. “LBN could potentially become a promising option for glaucoma patients.”
Perspective
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Our understanding of the pathophysiology of glaucoma has evolved dramatically over the past few decades, from that of an entirely IOP-mediated process to recognizing the importance of perfusion, autoregulation, immunity and more. This has happened in lockstep with incredible advancements in structural and functional evaluation, including OCT angiography and novel automated visual field testing grids.
What hasn’t changed is that lowering IOP is still the only treatment with a strong evidence base. Topical medications remain the most common means to that end, and the last significant advancement was the advent of PGAs nearly 30 years ago – until recently.
LBN is a PGA with a nitric oxide donating side chain, promoting vasodilation and smooth muscle relaxation. Initial studies suggested that it is effective around-the-clock, at relatively low baseline IOPs, and performs slightly better than latanoprost.
In this meta-analysis, Harasymowycz and colleagues demonstrate that, on average, LBN is comparable to other PGAs and superior to other drug classes. Of note is that good old bimatoprost 0.03% remained the most statistically efficacious medication.
While not a panacea, LBN does put another arrow in our quiver, perhaps one that may prove most helpful in patients progressing at already-low IOPs, making it a welcome addition.
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