Article

Adjunctive brimonidine results in greater IOP lowering

Results of a prospective, randomized, investigator-masked trial comparing brimonidine 0.15% with oxidative preservative (Purite) (Alphagan P, Allergan) and dorzolamide 2% (Trusopt, Merck) as adjuncts to latanoprost 0.005% (Xalatan, Pfizer) show the addition of either agent results in further IOP reduction, but the IOP-lowering effect was greater in the brimonidine/oxidative preservative group.

Key Points

"A prostaglandin analog is considered first-line medical therapy for IOP-lowering, and latanoprost is the most commonly prescribed agent in that class," he said. "However, when considering dual therapy for a patient who[se condition] does not have adequate response to monotherapy, the results of this study support trying brimonidine [with oxidative preservative] first before reaching for dorzolamide. Of course, if sufficient IOP-lowering is still not achieved, then physicians should consider switching to a topical carbonic anhydrase inhibitor before adding a third agent," said Dr. Mundorf, who is a private solo practitioner specializing in glaucoma in Charlotte, NC.

The multicenter study enrolled patients with open-angle glaucoma (n = 49) or ocular hypertension (n = 6) who had a bilateral IOP of 16 mm Hg or greater after a minimum of 6 weeks of latanoprost monotherapy. The patients continued using the latanoprost at 8 p.m. and were randomly assigned to begin twice-daily treatment with brimonidine/oxidative preservative (n = 27) or dorzolamide (n = 28) at 8 a.m. and 8:15 p.m. The investigators were blind as to which adjunctive medicine the patients were randomly assigned. Patients with a history of using either of the adjunctive therapies were excluded from the study.

At both 1 and 3 months, IOP measured at peak effect was lower in the brimonidine/preservative-treated patients compared with the dorzolamide group. The difference between groups was statistically significant at 1 month. Mean IOP at 1 month was 15.1 mm Hg in patients treated with brimonidine/preservative and 16.7 mm Hg in the dorzolamide group. Mean peak IOP values at 3 months in the brimonidine/preservative and dorzolamide groups were 15.6 and 16.5 mm Hg, respectively. The mean IOP reduction from baseline at 1 month also was significantly greater in the brimonidine/preservative group than in patients treated with dorzolamide (–5.7 versus –4.0 mm Hg.)

No significant differences in mean IOP at trough or mean trough IOP reduction existed between groups at either follow-up visit. Mean trough effect IOP at 3 months was 18.7 mm Hg in the dorzolamide group and 18.5 mm Hg in patients treated with brimonidine/oxidative preservative.

"Both dorzolamide and brimonidine [with oxidative preservative] are approved for t.i.d. administration, but they are indicated for b.i.d. dosing outside the United States and often [are] prescribed twice daily in this country. Regardless of what administration schedule they use, physicians who are concerned about a trough effect should check the patient at a trough time," Dr. Mundorf said.

Treatment was considered clinically successful if the investigator determined that the patient should continue the existing regimen. A higher proportion of patients in the brimonidine/preservative group compared with the dorzolamide group were considered to have clinically successful outcomes (84.6% versus 66.7%), although the difference was not statistically significant.

Newsletter

Don’t miss out—get Ophthalmology Times updates on the latest clinical advancements and expert interviews, straight to your inbox.

Related Videos
Shehzad Batliwala, DO, aka Dr. Shehz, discussed humanitarian ophthalmology and performing refractive surgery in low-resource, high-risk areas at the ASCRS Foundation Symposium.
(Image credit: Ophthalmology Times) ASCRS 2025: Advancing vitreous care with Inder Paul Singh, MD
(Image credit: Ophthalmology Times) The Residency Report: Study provides new insights into USH2A target end points
Lisa Nijm, MD, says preoperative osmolarity testing can manage patient expectations and improve surgical results at the 2025 ASCRS annual meeting
At the 2025 ASCRS Annual Meeting, Weijie Violet Lin, MD, ABO, shares highlights from a 5-year review of cross-linking complications
Maanasa Indaram, MD, is the medical director of the pediatric ophthalmology and adult strabismus division at University of California San Francisco, and spoke about corneal crosslinking (CXL) at the 2025 ASCRS annual meeting
(Image credit: Ophthalmology Times) ASCRS 2025: Taylor Strange, DO, assesses early visual outcomes with femto-created arcuate incisions in premium IOL cases
(Image credit: Ophthalmology Times) ASCRS 2025: Neda Shamie, MD, shares her early clinical experience with the Unity VCS system
Patricia Buehler, MD, MPH, founder and CEO of Osheru, talks about the Ziplyft device for noninvasive blepharoplasty at the 2025 American Society of Cataract and Refractive Surgeons (ASCRS) annual meeting
(Image credit: Ophthalmology Times) ASCRS 2025: Bonnie An Henderson, MD, on leveraging artificial intelligence in cataract refractive surgery
© 2025 MJH Life Sciences

All rights reserved.