In other phase I and II trials, he found:
- ONO 9054 (Santen), an ONO compound that is an agonist of two prostaglandin receptors (EP3 and FP) receptor agonist)
- A growth factor NT-501 (CNTF) being studied at Stanford
- DE-177 (Santen), a selective EP2 receptor agonist
- GL-101 (Glia)
Dr. Novack noted he was not able to find much information about the last two.
None of the drugs on the horizon provides neuroprotection, he said, pointing out the difficult regulatory hurdles for such a drug to clear.
“So, Gary, where are the rest?” he asked, anticipating his audience’s question. “That’s as many as I could find.”
It takes about 10 years from invention of a molecule to its approval, he said. The past 3 to 4 years of that time span are the phase III studies and the approval.
“By definition if something is not in phase III now it’s going to be at least 4 years before it’s available to you and your patients,” he said.
The problem is not a lack of good ideas. Rather, Dr. Novack believes complex financial incentives are in play.
Still, glaucoma physicians should not give up hope of improving patient care, he noted.
As Millennials take over from baby boomers in drug development, they may bring new approaches, he added.
“I think they’d take a drug reservoir, have a computer-controlled release of that drug, measure efficacy however you want—IOP, visual fields—then have a feedback on the release of the drug, probably through a phone app,” he said.
Another rho kinase inhibitor, ripasudil 0.4% (Glanatec, Kowa), received approval in Japan in 2014. Gene therapy is also being researched.