|Articles|June 10, 2015

Fixed combination therapy in glaucoma patients

In this comparison study, IOP reductions were greater with BTFC than with TTFC and patients on this combination were more likely to achieve and maintain low target pressures. Combined BrTFC and DTFC may also be a more appropriate therapeutic choice for IOP lowering than TTFC and BrTFC, respectively.

Take-home message: In this comparison study, IOP reductions were greater with BTFC than with TTFC and patients on this combination were more likely to achieve and maintain low target pressures. Combined BrTFC and DTFC may also be a more appropriate therapeutic choice for IOP lowering than TTFC and BrTFC, respectively.

 

By Dr Tamer A. Macky, FRCSEd

Fixed combination drops have a number of potential advantages over separate drops, including no risk of drug washout, reduced exposure to preservatives with reduced side effects, reduced cost of treatment, and ultimately better patient compliance and quality of life.

Around 50-75% of patients will need 2 or more drugs to reach their target pressure at any stage of the disease.1,2 Since these drugs have different structures, a potential different synergy and thus efficacy could exist when these drugs are combined in a single drop. In another words, adding these drugs in fixed combinations does not mean absolute algebraic addition of each of the drug’s strengths. Hence, proper assessment of the strength of fixed combination eye drops is a critical issue as every millimeter reduction of intraocular pressure (IOP) corresponds to approximately 10% reduction in the risk of glaucoma progression.3 Direct head-to-head comparative randomised trials are essential in identifying the actual optimal strength of glaucoma medications in general, as well as in fixed combination therapy.

Bimatoprost/timolol versus travoprost/timolol fixed combination

We compared the ocular hypotensive effect of bimatoprost 0.03% plus timolol 0.5% fixed combination (BTFC) and travoprost 0.004% plus timolol 0.5% fixed combination (TTFC) in primary open-angle glaucoma (POAG) in a prospective randomised clinical study.4 Patients’ IOPs were evaluated for a 6 month period. Patients were also asked about adverse events and compliance. A patient was considered to be clinically successful if the investigator, after considering IOP-lowering efficacy, tolerability and any adverse events, continued the patient on his or her study drug at 6 months.

 

Study results

Eighty patients (80 eyes) were included with 40 patients (40 eyes) in each group. Both study medications provided statistically significant reductions of baseline IOP at all study points (P < 0.001) with no further significant reduction for each drug after the 2-week visit.

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