With new agents approved and more new drugs moving through the pipeline, there is plenty of innovation occurring for the treatment of glaucoma.
The long drought in new glaucoma medications is over. After more than 20 years without a single new glaucoma eye drop, several therapeutic agents have been approved in recent months, with other novel drugs moving through clinical trials.
“There has been a lot of innovation in glaucoma surgery with MIGS, but also a lot of innovation with glaucoma medical therapy,” said Richard L. Lindstrom, MD, founder and attending surgeon, Minnesota Eye Consultants, and adjunct clinical professor emeritus of ophthalmology, University of Minnesota.
The most recent approval in March 2019 is a combination of netarsudil and latanoprost (Rocklatan) from Aerie Pharmaceuticals. Pooled data from the phase III Mercury trials showed the once-daily combination is more effective at lowering IOP than either of its ingredients used as a single agent. The combination is being pitched as a single-product alternative to multiple eye drops, which could improve adherence as well as therapeutic effect.
Aerie Pharmaceuticals had its first FDA approval in 2018 with netarsudil (Rhopressa), a Rho kinase inhibitor, or ROCK inhibiter, that works differently from other currently approved classes of glaucoma agents. Netarsudil reduces aqueous humor production, increases uveoscleral outflow and increases trabecular meshwork outflow.
Another recent introduction is latanoprostene bunod ophthalmic solution (Vyzulta, Bausch + Lomb), a prostaglandin analogue that also releases nitric oxide. The single molecule is metabolized into two active moieties, latanoprost acid and nitric oxide. The combination facilitates aqueous humor outflow through both the uveoscleral and trabecular meshwork pathways.
Richard L. Lindstrom, MD
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This article was adapted from Dr. Lindstrom’s presentation at the 2018 meeting of the American Academy of Ophthalmology. Dr. Lindstrom has no financial interests to report.