Monotherapy with Bimatoprost in Patients with Glaucoma and Ocular Hypertension
Can monotherapy with bimatoprost be sufficiently effective in controlling intraocular pressure in non-responders to previous treatments? This is the question posed by British researchers in the presented study.
Reduction of Intraocular Pressure as a Primary Goal
Glaucoma is a complex disease, for which the only modifiable risk factor is the reduction of intraocular pressure (IOP). In the first line of treatment for primary open-angle glaucoma or ocular hypertension, prostaglandin analogs (bimatoprost, latanoprost, travoprost, tafluprost) are typically used.
Meta-analyses have shown that bimatoprost 0.03% is comparable in reducing IOP with other prostaglandin analogs. Recently published studies support the use of bimatoprost in patients with ocular hypertension, normal-tension glaucoma, or open-angle glaucoma.
The Effect of Bimatoprost Monotherapy in Individuals with Poor Treatment Response
A study published in 2017 in the Journal of Ophthalmology evaluated the efficacy and safety of bimatoprost 0.03% monotherapy in patients with glaucoma and ocular hypertension with inadequate IOP control on existing therapy.
Initial Data
The study included patients who were non-responsive to existing therapy, with IOP measured above the expected range. These patients were switched from their current therapy to bimatoprost monotherapy. Data were obtained from 59 patients treated between 2011 and 2015; their average age was 64 years (range 42–88) years, and 53% were men. The average IOP before switching to bimatoprost was 23.2 ± 4.4 in the right eye and 23.3 ± 3.7 in the left eye. 66% of the patients were on latanoprost monotherapy. Patients were monitored over several visits. The analysis used Student's paired t-test with a 5% significance level.
Study Results
The average time between switching to bimatoprost and the first visit was 104 ± 44 days. The average reduction in IOP was −4.24 mmHg (95% confidence interval [CI] −5.49 to −2.1) for the right eye and −4.42 mmHg (95% CI −5.4 to −2.45; p < 0.001 for both eyes) for the left eye. In 27% of patients, IOP control was deemed unsatisfactory at this visit, leading to either selective laser trabeculoplasty or adjustment of their treatment.
Subgroup analysis revealed that in patients with ocular hypertension, the IOP reduction in both eyes was again statistically significant (p < 0.001 for both eyes) even at the first visit. For patients switched from latanoprost monotherapy to bimatoprost monotherapy, the IOP reduction at the first visit was even more pronounced than in the overall group: −5.27 mmHg (95% CI −6.87 to −3.67) for the right eye and −5.27 mmHg (95% CI −6.56 to −3.98) for the left eye (p < 0.001 for both eyes).
Summary and Conclusion
This study provided the largest independently obtained data on controlling high IOP after switching to bimatoprost monotherapy. The results suggest that in some patients whose glaucoma treatment failed despite adequate therapy (including combination therapy), treatment with bimatoprost yields statistically and clinically significant outcomes. The initial response appears to be sustained or even improves up to the 10-month therapy mark.
The findings thus support that patients with glaucoma with a poor response to current treatment may be treated with bimatoprost alone. This modality should be considered especially before indicating additional adjuvant or invasive therapies.
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Source: Brennan N., Dehabadi M. H., Nair S. et al. Efficacy and safety of bimatoprost in glaucoma and ocular hypertension in non-responder patients. Int J Opthalmol 2017; 10 (8): 1251–1254, doi: 10.18240/ijo.2017.08.11.
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