Glaucoma patients who have had Schlemm’s canal surgery without adequate pressure reduction might be good candidates, he surmised.
Netarsudil ophthalmic solution (Rhopressa, Aerie Pharmaceuticals) also took a step forward when an FDA committee recommended its approval.
“As I read the report, it was one of the most positive reports issued, so hopefully early next year we will get a new option,” Dr. Iwach said.
Netarsudil works by different mechanisms from drugs currently on the market. According to Aerie, the drug inhibits both Rho-kinase (ROCK) and noreprinephrine transporters (NET). Inhibiting ROCK relaxes the trabecular meshwork cells, while inhibiting NET reduces production of aqueous fluid.
“From the perspective of absolute IOP reduction, it seems to work just as well in people with IOP of 20 mm Hg or lower as those with high IOP,” Dr. Schuman said. “We’re excited about having this new class of drug.”
An evolution in the healthcare system also brought changes to glaucoma drugs in 2017.
“It’s a curious time in the world of generics,” Dr. Iwach said. “The prices of generics have increased, and something I have seen for the first time is that one of my patients asked me to prescribe a branded drug instead of a generic.”
The patient’s employer had recommended that the patient purchase the drug through a Canadian pharmacy because it was less expensive than buying a generic in the United States. Dr. Iwach has seen reports of similar arrangements between businesses and pharmaceutical companies to encourage purchasing branded drugs.
“We need to understand the implications of this as it further evolves,” Dr. Iwach said.