Glaucoma drug therapy continues to evolve with Rho kinase inhibitors that specifically target glaucomatous abnormalities such as trabecular meshwork outflow.
Dr. Ou recounted a clinical trial in which various doses of netarsudil (0.01% and 0.02%) were compared with latanoprost 0.005% (Xalatan, Pfizer). The study found that netarsudil was about 1 mm Hg less effective than latanoprost. In a subgroup of patients in whom the IOP was 26 mm Hg or less, netarsudil 0.02% was noninferior to latanoprost. This study was published in the British Journal of Ophthalmology (2016;100:339-344).
The ROCKET phase III clinical studies compared netarsudil 0.02% dosed at nighttime or twice daily with timolol twice daily. In the four studies, the investigators reported in the American Journal of Ophthalmology (2018;186:116-22) that netarsudil was noninferior to timolol in three groups of patients with IOPs less than 25, 27, and 30 mm Hg.
The mean IOP decreases ranged from 3 to 4.5 mm Hg; greater decreases were seen with netarsudil dosed twice daily but there were side effects such as hyperemia (about 50% of patients), petechial hemorrhages (13% to 15%), and corneal verticillata (5.4% to 9%), which resulted in patient discontinuation of netarsudil up to 30% in the twice daily group and 10% to 12% in the once daily group. Most cases of hyperemia were mild; all adverse effects resolve with drug discontinuation and vision was not adversely affected.
Yvonne Ou, MD
E: [email protected]
Dr. Ou is a consultant and advisor to Merck & Co. Inc.