Use of beta-blocker with Simbrinza delays onset of ocular allergy in patients with glaucoma
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Key takeaways:
- Patients who used a beta-blocker with Simbrinza had significantly delayed allergy onset, which may boost adherence.
- These patients also had lower allergy prevalence, but the difference was not significant.
Concurrent use of a beta-blocker with Simbrinza delayed the onset of ocular allergy and may extend treatment duration and adherence among patients with glaucoma, according to a retrospective study in BMC Ophthalmology.
“Drug-induced allergy is an important side effect that decreases patient adherence,” the study authors wrote. “Despite the high prevalence of ocular allergy, the widespread application of brimonidine in the treatment of glaucoma is attributable to its ability to effectively decrease the IOP while supporting neuroprotection and only rare cardiovascular side effects in adults.”
To better understand the role of beta-blockers in reducing ocular allergy, the researchers compared the prevalence, onset and characteristics of allergy related to the use of Simbrinza (1% brinzolamide/0.2% brimonidine tartrate ophthalmic suspension, Alcon), with and without concurrent beta-blocker use, among patients with glaucoma.
They reviewed the medical records of 272 patients who used the fixed-dose combination twice daily, 176 of whom concurrently used a beta-blocker.
According to results, allergy prevalence was 10.23% in the concurrent group and 15.63% in the nonconcurrent group, but the difference was not statistically significant.
The concurrent group did, however, have significantly delayed allergy onset, with an average occurrence time of 15.92 months vs. 6.26 months (P = .004). Occurrence time varied with blepharoconjunctivitis (12.52 months), papillary conjunctivitis (9.53 months) and follicular conjunctivitis (13.23 months).
Further, follicular conjunctivitis was the most prevalent allergy type in the concurrent group (61.1%) vs. papillary conjunctivitis in the non-concurrent group (66.7%).
“When a beta-blocker is used concurrently with [1% brinzolamide/0.2% brimonidine fixed combination], allergy prevalence is reduced, possibly owing to the inhibitory effect of antigen influx and vasoconstriction,” the researchers wrote. “Concurrent use of beta-blocker can delay the onset of allergy and thereby extend the duration of usage.”
Perspective
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Although less invasive than surgery, topical therapy is not benign nor is it without treatment burden. Brimonidine is one of the most likely glaucoma medications to result in ocular allergy, with allergy rates ranging from 4% to 25% when used as monotherapy. When brimonidine is put in fixed combination with timolol, the rate of allergy has been reduced by 50%. It has been proposed that timolol inhibits brimonidine-induced allergy by reducing local hypersensitivity.
This study sought to determine whether patients using a beta-blocker concurrently with brimonidine-brinzolamide fixed combination (BBFC) reduced ocular allergies compared with patients using BBFC alone. The researchers found that the addition of a beta-blocker to BBFC lowered both the rate of and length of time for an allergic reaction.
The potential for a beta-blocker to be able to modulate the risk for a brimonidine-associated allergy is an interesting factoid that warrants consideration if the specific management circumstance studied in this article were to arise. The greater implication of this study is that it reinforces that topical medications are not devoid of side effects.
This underscores the need for us to proactively consider medication side-effect profiles prior to initiating treatment, assess for medication-related side effects at each visit and weigh the risks and benefits of adapting therapies if those side effects are present.
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