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1.
PLoS One ; 15(9): e0239233, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925955

RESUMO

PURPOSE: This study aimed to review previous articles and evaluate the influence of topical non-steroidal anti-inflammatory drugs (NSAIDs) on intraocular pressure (IOP) in glaucoma patients who were treated with prostaglandin analogues (PGs). METHOD: The presenting study was designed as a meta-analysis of previous research. Databases include PubMed, Web of science, Cochrane library, and Embase were searched with keywords of "intraocular pressure, prostaglandin analogues, NSAIDs, latanoprost, travoprost, bimatoprost, tafluprost, unoprostone, latanoprostene bunod, ketorolac, diclofenac, nepafenac, bromfenac, flurbiprofen". Inclusion criteria were: 1. Study population were glaucoma patients; 2. Comparison between PGs monotherapy and PGs in combination with topical NSAIDs; 3. Changes of IOP as final outcomes. Studies with non-randomized design, treatments combining other anti-glaucomatous drugs, or unavailable absolute IOP were excluded from the analysis. Estimated difference in IOP were calculated using STATA 14.0. RESULT: Seven studies were retrieved for this meta-analysis. Since there is a significant heterogeneity (I2 = 94%) in these studies, random-effect model was used to calculate pooled standardized mean differences (SMD). Our results showed a significantly favorable IOP lowering effect in glaucoma patients treated with combination of topical NSAIDs and PGEs (SMD: 1.3 and -0.03, 95% CI: 0.29 to 2.38 and -0.32 to 0.26, Z = 2.50 and 0.23, p = 0.013 and 0.820, respectively). CONCLUSION: Results of our meta-analysis suggested that topical NSAIDs may enhance the IOP lowering effect of topical PGs in glaucoma patients.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Glaucoma/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Prostaglandinas Sintéticas/uso terapêutico , Administração Tópica , Anti-Inflamatórios não Esteroides/classificação , Glaucoma/patologia , Humanos , Prostaglandinas Sintéticas/classificação , Tonometria Ocular
2.
Invest Ophthalmol Vis Sci ; 61(5): 46, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32455434

RESUMO

Purpose: Topical prostaglandin analogs (PGAs) are common treatment for primary open-angle glaucoma (POAG) but reportedly may cause adnexal fat atrophy. We asked if patients with POAG treated with PGAs have abnormalities in orbital fat volume (OFV). Methods: We studied 23 subjects with POAG who had never experienced intraocular pressure (IOP) exceeding 21 mm Hg and were treated long term with PGAs, in comparison with 21 age-matched controls. Orbital volume, non-fat orbital tissue volume, and OFV were measured using high-resolution magnetic resonance imaging. Results: Subjects with POAG had been treated with PGAs for 39 ± 19 months (SD) and were all treated within the 4 months preceding study. In the region from trochlea to orbital apex, OFV in POAG was significantly less at 9.8 ± 1.9 mL than in the control subjects at 11.1 ± 1.3 mL (P = 0.019). However, between the globe-optic nerve junction (GONJ) and trochlea, OFV was similar in both groups. Width and cross sectional area of the bony orbit were significantly smaller in POAG than in controls (P < 0.0001). Posterior to the GONJ, the average orbital cross-sectional area was 68.2 mm2 smaller, and the orbital width averaged 1.5 mm smaller throughout the orbit, in patients with POAG than in controls. Conclusions: Patients with POAG who have been treated with PGAs have lower overall OFV than controls, but OFV in the anterior orbit is similar in both groups. Lower overall OFV in POAG may be a primary association of this disorder with a horizontally narrower bony orbit, which may be a risk factor for POAG at nonelevated IOPs.


Assuntos
Tecido Adiposo/efeitos dos fármacos , Tecido Adiposo/diagnóstico por imagem , Glaucoma de Ângulo Aberto/tratamento farmacológico , Imagem por Ressonância Magnética , Prostaglandinas Sintéticas/efeitos adversos , Tecido Adiposo/patologia , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/anatomia & histologia , Órbita/diagnóstico por imagem , Tamanho do Órgão , Prostaglandinas Sintéticas/administração & dosagem , Prostaglandinas Sintéticas/uso terapêutico
3.
J Manag Care Spec Pharm ; 26(4): 562-567, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32223594

RESUMO

BACKGROUND: Prostaglandin analogs are the most effective treatment for glaucoma, a common condition among older adults. Despite the availability of generic drugs, the costs associated with these prescription drugs are rising. OBJECTIVE: To characterize Medicare prescription drug plan (PDP) formulary coverage and beneficiary out-of-pocket cost for prostaglandin analogs from 2009 to 2017 and Medicare spending on prostaglandin analogs from 2013 to 2017. METHODS: This study was a retrospective analysis. We used 2009, 2013, and 2017 Medicare PDP formulary, beneficiary cost, and pricing files to determine beneficiary first-prescription out-of-pocket costs and plan coverage (unrestricted, restricted, or not covered) of branded latanoprost 0.005%, travoprost 0.004%, bimatoprost 0.03% and 0.01%, and tafluprost 0.0015% and of generic latanoprost 0.005% and generic bimatoprost 0.03%. We also used Medicare Part D spending data to determine aggregate spend in 2013 and 2017. RESULTS: In 2009, 92% of plans covered branded latanoprost, 83% covered branded bimatoprost; and 49% covered branded travoprost, whereas in 2017, 6% of plans covered branded latanoprost; 95% covered branded bimatoprost; and 96% covered branded travoprost. Although generic latanoprost was universally covered, generic bimatoprost was only covered by 35% of plans in 2017. Median out-of-pocket cost of branded prostaglandins without generic equivalents was $35 (IQR = $29-$40) in 2009, $45 (IQR = $42-$101) in 2013, and $90 (IQR = $45-$159) in 2017. Median out-of-pocket cost of all available generic prostaglandins was $10 (IQR = $5-$33) in 2013 and $10 (IQR = $4-$15) in 2017. In 2013, Medicare spent $733 million on prostaglandin analogs; in 2017, this increased to $1.09 billion, with $943 million (86%) spent on branded prostaglandins and $148 million (14%) spent on generics. CONCLUSIONS: Medicare PDP coverage of branded prostaglandins remained stable from 2009 to 2017. While median beneficiary out-of-pocket costs associated with generic prostaglandins remained stable, those associated with branded prostaglandins increased nearly 3-fold. DISCLOSURES: Research reported in this publication was supported by National Heart, Lung and Blood Institute of the National Institutes of Health under Award Number T35HL007649. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. Shah has received research support through Mayo Clinic from the U.S. Food and Drug Administration (FDA) to establish Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation (CERSI) program (U01FD005938); the Centers of Medicare and Medicaid Innovation under the Transforming Clinical Practice Initiative (TCPI); the Agency for Healthcare Research and Quality (U19HS024075, R01HS025164, R01HS025402, R03HS025517); and the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH) (R56HL130496, R01HL131535), National Science Foundation, and the Patient Centered Outcomes Research Institute to develop a clinical data research network. Ross has received research support through Yale University from Johnson & Johnson to develop methods of clinical trial data sharing; Medtronic and the FDA to develop methods for postmarket surveillance of medical devices (U01FD004585); the FDA to establish Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation program (U01FD005938); the Blue Cross Blue Shield Association to better understand medical technology evaluation; the Centers of Medicare & Medicaid Services to develop and maintain performance measures that are used for public reporting (HHSM-500-2013-13018I); the Agency for Healthcare Research and Quality (R01HS022882); the National Heart, Lung and Blood Institute of the NIH (R01HS025164); and the Laura and John Arnold Foundation to establish the Good Pharma Scorecard at Bioethics International and the Collaboration on Research Integrity and Transparency at Yale. The other authors have nothing to disclose.


Assuntos
Glaucoma/tratamento farmacológico , Gastos em Saúde/tendências , Medicaid/estatística & dados numéricos , Medicare Part D/estatística & dados numéricos , Prostaglandinas Sintéticas/economia , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Glaucoma/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , Medicaid/economia , Medicaid/tendências , Medicare Part D/economia , Medicare Part D/tendências , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/uso terapêutico , Prostaglandinas Sintéticas/uso terapêutico , Estudos Retrospectivos , Estados Unidos
4.
Adv Ther ; 37(4): 1436-1451, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32072493

RESUMO

INTRODUCTION: A non-interventional, multicenter, European, prospective evaluation of the effectiveness, tolerability, and safety of a topical preservative-free tafluprost (0.0015%) and timolol (0.5%) fixed-dose combination (PF tafluprost/timolol FC) in adults with open-angle glaucoma (OAG) and ocular hypertension (OHT) demonstrating insufficient response to topical beta-receptor blockers or prostaglandin analogue (PGA) monotherapy. METHODS: Mean intraocular pressure (IOP) change from baseline was measured at study visits following a switch to PF tafluprost/timolol FC. Primary endpoint was absolute mean IOP change at month 6. Change from baseline concerning ocular signs and symptoms was also explored. RESULTS: Analyses included 577 patients (59.6% female). Mean age (SD) was 67.8 (11.67) years. Mean (SD) IOP reduction from baseline was significant at all study visits; 5.4 (3.76) mmHg (23.7%) at week 4, 5.9 (3.90) mmHg (25.6%) at week 12, and 5.7 (4.11) mmHg (24.9%) at month 6 (p < 0.0001 for all visits). At month 6, 69.2%, 53.6%, 40.0%, and 25.8% were responders based on ≥ 20%, ≥ 25%, ≥ 30%, and ≥ 35% cutoff values for mean IOP, respectively. Significant reductions were observed concerning corneal fluorescein staining (p < 0.0001), dry eye symptoms, irritation, itching, and foreign body sensation (p < 0.001 for each parameter). Conjunctival hyperemia was significantly reduced at all study visits (p < 0.0001 at each visit). Overall, 69 treatment-related adverse events (AEs) were reported, one of which was serious (status asthmaticus). Most AEs were mild to moderate in severity, and the majority had resolved or were resolving at the end of the study period. CONCLUSION: In clinical practice, PF tafluprost/timolol FC provided statistically and clinically significant IOP reductions in patients with OAG and OHT insufficiently controlled on or intolerant to PGA or beta-receptor blocker monotherapy. The full IOP reduction appeared at week 4 and was maintained over the 6-month study period. Key symptoms of ocular surface health improved. TRIAL REGISTRATION: European Union electronic Register of Post-Authorisation Studies (EU PAS) register number, EUPAS22204.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Hipertensão Ocular/tratamento farmacológico , Prostaglandinas F/uso terapêutico , Prostaglandinas Sintéticas/uso terapêutico , Timolol/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Conservantes Farmacêuticos , Estudos Prospectivos , Prostaglandinas F/administração & dosagem , Prostaglandinas F/efeitos adversos , Prostaglandinas Sintéticas/administração & dosagem , Prostaglandinas Sintéticas/efeitos adversos , Timolol/administração & dosagem , Timolol/efeitos adversos , Tonometria Ocular
5.
Am J Ophthalmol ; 215: 112-117, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32087142

RESUMO

PURPOSE: To test the hypothesis that the correlation between office-hour intraocular pressure (IOP) and peak nocturnal IOP is weakened after using a prostaglandin analog. DESIGN: Before-and-after study. METHODS: Twenty-four-hour IOP data obtained in a sleep laboratory of 51 patients (22 patients with open-angle glaucoma and 29 patients with ocular hypertension) were reviewed. Patients had no IOP-lowering medication upon study entry and were then treated with prostaglandin monotherapy for 4 weeks. Measurements of IOP were taken every 2 hours in the sitting and supine positions during the diurnal/wake period (7:30 AM-9:30 PM) and in the supine position during the nocturnal/sleep period (11:30 PM-5:30 AM). Individual and average IOP readings during office hours (9:30 AM-3:30 PM) and peak IOP during the nocturnal/sleep hours were analyzed using the Pearson correlation coefficient and linear regression. RESULTS: There were statistically significant correlations for all the paired variables for the analyses. Average office-hour IOP had a higher correlation with peak nocturnal IOP than individual office-hour IOP. After the treatment with prostaglandin analog, the correlation between average office-hour IOP and nocturnal peak IOP in the sitting position (r = 0.373) and the supine position (r = 0.386) were reduced from the sitting baseline (r = 0.517) and the supine baseline (r = 0.573) in right eyes. Similar change patterns appeared in left eyes. CONCLUSION: There is a correlation between office-hour IOP reading and peak nocturnal IOP under no IOP-lowering treatment as well as under prostaglandin monotherapy. The strength of correlation was weaker under the treatment compared with baseline.


Assuntos
Anti-Hipertensivos/uso terapêutico , Ritmo Circadiano/fisiologia , Glaucoma de Ângulo Aberto/tratamento farmacológico , Pressão Intraocular/fisiologia , Prostaglandinas Sintéticas/uso terapêutico , Idoso , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/fisiopatologia , Postura , Estudos Retrospectivos , Tonometria Ocular
6.
PLoS One ; 15(1): e0227595, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929565

RESUMO

OBJECTIVE: To evaluate the prescribing trends of glaucoma drugs in six major cities of China from 2013 to 2017. METHODS: A descriptive analysis using pharmacy prescription data was conducted. Outpatient prescription data was extracted from the Hospital Prescription Analysis Cooperative Project. Prescribing patterns, trends of visits, and corresponding expenditures for glaucoma medications were analyzed. RESULTS: A total of 84297 ambulatory prescriptions were included in the current study. Visits by glaucoma patients increased from 13808 in 2013 to 20060 in 2017. Over the same period, the yearly expenditure for glaucoma drugs increased from 2.33 million to 3.95 million Chinese Yuan (CNY). Among all the six classes of glaucoma drugs (prostaglandin analogues, carbonic anhydrase inhibitors, α-receptor agonists, ß-receptor antagonists, cholinergic agonists and fixed combinations), ß-receptor antagonists were the most commonly prescribed in 2013, accounting for 34.3% of patients, but gradually decreased to 27.1% in 2017. Prostaglandin analogues became the most frequently prescribed drugs in 2017, accounting for 30.2% of the visits. Prostaglandin analogues are the most expensive and yielded a total expenditure of 2.34 million CNY in 2017, followed by carbonic anhydrase inhibitors, α-receptor agonists, ß-receptor antagonists, fixed combinations, and cholinergic agonists. Combination therapy became increasingly prescribed in 2017. CONCLUSION: Glaucoma prescribing practices exhibited substantial changes over the study period. The number of glaucoma prescriptions continuously increased from 2013 to 2017, leading to increased prescription costs. These findings implied a similar trend observed in previous studies, as well as recommendations in the appropriate guidelines.


Assuntos
Glaucoma/tratamento farmacológico , Padrões de Prática Médica/tendências , Adolescente , Agonistas alfa-Adrenérgicos/economia , Agonistas alfa-Adrenérgicos/uso terapêutico , Antagonistas Adrenérgicos beta/economia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Inibidores da Anidrase Carbônica/economia , Inibidores da Anidrase Carbônica/uso terapêutico , China , Agonistas Colinérgicos/economia , Agonistas Colinérgicos/uso terapêutico , Cidades , Quimioterapia Combinada/economia , Quimioterapia Combinada/tendências , Feminino , Glaucoma/economia , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/economia , Prostaglandinas Sintéticas/economia , Prostaglandinas Sintéticas/uso terapêutico , Estudos Retrospectivos , Adulto Jovem
9.
Vestn Oftalmol ; 135(4): 70-77, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31573559

RESUMO

PURPOSE: To assess the effect of latanoprost and fixed combination of dorzolamide/timolol on ocular hemodynamics in patients with primary open-angle glaucoma (POAG). MATERIAL AND METHODS: The study examined 34 patients (56 eyes) aged 51 to 69 years (average - 62.4±9.7 years) diagnosed with POAG in the initial (31 eyes) or advanced stage (25 eyes). Patients of the first group (20 patients, 36 eyes) were receiving latanoprost (Glauprost, Rompharm Company, Romania). The second group (14 patients, 20 eyes) was assigned to receive a fixed combination of dorzolamide/timolol (Dorzopt plus, Rompharm Company, Romania). Patient examination before and at 6 and 12 months included tonometry (ICare PRO), perimetry (Heidelberg Edge Perimeter), HRT and OCT of the optic nerve (Heidelberg Retina Tomograph 3 and Spectralis OCT2), as well as measurement of the density of surface (SVL) and deep (DVL) vascular plexus, and the Bruch's membrane opening minimum rim width (BMO-MRW). Additionally, we evaluated microcirculation in the choroid (MC) according to our original technique that uses Spectralis OCT2, and calculated rheographic index (RI) and stroke volume using transpalpebral rheoophthalmography. RESULTS: The decrease in IOP in the Latanoprost group was on average 27% and in the control group receiving timolol and dorzolamide - on average 22% and remained stable until the end of the study. The value of the area and volume of the disc rim band, BMO-MRW did not exhibit statistically significant changes in both groups by the 12th month of observation. A tendency to increase the RI from 51.5±24.5 to 62.2±19 (p=0.084) and the median of the index of microcirculation of the choroid (MC) from 16476 up to 23767 (p=0.062) in 1st group was observed. CONCLUSION: The study confirms the feasibility of using latanoprost and a fixed combination of dorzolamide and timolol in ocular hypotensive therapy of glaucoma thanks to their pronounced hypotensive effect. Patients were noted to have a tendency for improvement of ocular hemodynamics when using latanoprost.


Assuntos
Glaucoma de Ângulo Aberto , Idoso , Anti-Hipertensivos , Inibidores da Anidrase Carbônica/uso terapêutico , Combinação de Medicamentos , Glaucoma de Ângulo Aberto/tratamento farmacológico , Hemodinâmica , Humanos , Pressão Intraocular , Pessoa de Meia-Idade , Prostaglandinas Sintéticas/uso terapêutico
10.
J Manag Care Spec Pharm ; 25(9): 1001-1010, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456491

RESUMO

BACKGROUND: Prostaglandin analogs (PGAs) are considered an initial therapy to manage increased intraocular pressure (IOP) for patients with glaucoma. When the initial PGA treatment fails to lower IOP adequately, the patient may add or change medications or have surgery/laser treatment. OBJECTIVE: To compare medication adherence, duration of therapy, and treatment patterns among 3 PGAs-latanoprost, travoprost, and bimatoprost-as initial therapies for patients with glaucoma or ocular hypertension. METHODS: This was a retrospective cohort study using administrative claims data. The cohort consisted of patients newly diagnosed with glaucoma or ocular hypertension with at least 1 prescription claim for latanoprost, travoprost, or bimatoprost and enrolled in a Medicare Advantage plan between 2007 and 2012. The 24-month medication possession ratio (MPR) was used to measure medication adherence. Discontinuation of first-line PGA therapy was defined as nonpersistence (90-day gap allowance) of the index PGA or a change in therapy during the 24-month follow-up period. Types of second-line therapy (i.e., switch, addition, and surgery) were identified. The 1:1:1 propensity score matching was used. RESULTS: Patients who met the inclusion criteria were propensity score matched, resulting in 1,296 patients per PGA group. Latanoprost users showed higher adherence (50.1%) than travoprost (48.8%) and bimatoprost (43.0%) users. The latanoprost and travoprost groups had significantly higher MPRs than bimatoprost (P < 0.0001). The latanoprost group showed significantly longer duration of first-line therapy (372 days) than the bimatoprost group (343 days; P = 0.003) but not the travoprost group (361 days). After controlling for demographic and clinical characteristics, a Cox proportional hazards model showed that the travoprost and bimatoprost groups had a higher risk of discontinuation of first-line therapy than the latanoprost group (P < 0.0001). The percentage of patients continuing on the index PGA without treatment pattern change (i.e., switches, additions, and surgery) was higher for latanoprost users (52.9%) compared with travoprost (39.0%) or bimatoprost users (42.1%; P < 0.001). CONCLUSIONS: Patients who used latanoprost as their initial therapy were more likely to adhere and persist to the index PGA compared with bimatoprost users. The latanoprost group demonstrated a lower risk of discontinuing first-line therapy than the travoprost and bimatoprost groups. The results may assist ophthalmologists in determining the optimal management of this patient population with respect to treatment patterns. DISCLOSURES: No outside funding supported this study. All authors except Heo and Nair are employed by The University of Texas at Austin College of Pharmacy. Heo was with the Health Outcomes Division, The University of Texas at Austin College of Pharmacy during a portion of this study and is employed by Genesis Research. Nair is employed by Humana. The authors have no financial relationships relevant to this article to disclose. This study was presented as a poster at the 2016 International Society for Pharmacoeconomics and Outcomes Research Annual Meeting, May 2016, Washington, DC.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glaucoma/tratamento farmacológico , Hipertensão Ocular/tratamento farmacológico , Prostaglandinas Sintéticas/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Medicare , Adesão à Medicação , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
11.
Medicine (Baltimore) ; 98(30): e16597, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348303

RESUMO

BACKGROUND: To evaluated and compared the efficacy and safety of 3 prostaglandin analogues (0.005% latanoprost, 0.004% travoprost, and 0.03% bimatoprost) in treatment of primary open-angle glaucoma (POAG) or ocular hypertension (OHT). METHODS: PubMed, Embase, Cochrane library, Web of science, CNKI, Wanfang, and Vip database, published between January 1, 2000 and June 1, 2018, were systematically examined for randomized controlled trials (RCT) based on prostaglandin analogues for POAG or OHT treatment. Statistical analyses including weighted mean difference (WMD) calculation and odds ratio (OR) were performed using Review Manager Software version 5.3. RESULT: The 17 studies were included in this analysis (N = 2433 participants) with 1∼12 months' follow-ups. The difference of intraocular pressure (IOP) reduction between latanoprost and travoprost group had not significant; there was significant difference of IOP reduction between latanoprost and bimatoprost group in the third month and sixth month; Travoprost was significantly different from bimatoprost in reducing IOP in the third month. Travoprost revealed an elevated risk of conjunctival hyperemia compared with latanoprost. An elevated risk of conjunctival hyperemia and growth of lashes compared with latanoprost. Bimatoprost shows lower ocular tolerability with higher incidence of side effects such as conjunctival hyperemia. CONCLUSIONS: 0.03% bimatoprost appears more effective following long time use (3 and 6 month post-treatment) for IOP control compared to 0.005% latanoprost, and is more effective compared to 0.004% travoprost after being used for a certain period of time (3 months post-treatment); nevertheless, 0.005% latanoprost is better tolerated in patients with POAG or OHT.


Assuntos
Glaucoma de Ângulo Aberto/tratamento farmacológico , Hipertensão Ocular/tratamento farmacológico , Prostaglandinas Sintéticas/uso terapêutico , Bimatoprost/uso terapêutico , Humanos , Pressão Intraocular/efeitos dos fármacos , Latanoprosta/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Travoprost/uso terapêutico
12.
BMJ ; 366: l4235, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31292128

RESUMO

The studyGazzard G, Konstantakopoulou G, Garway-Heath E, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet 2019; doi:10.1016/S0140-6736(18)32213-XThis project was funded by the NIHR Health Technology Assessment Programme (project number 09/104/40) and was sponsored by the Moorfields Eye Hospital NHS Foundation Trust.To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000774/early-glaucoma-laser-eye-treatment-trabeculoplasty.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Terapia a Laser/métodos , Hipertensão Ocular/cirurgia , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Terapia a Laser/efeitos adversos , Hipertensão Ocular/tratamento farmacológico , Soluções Oftálmicas , Complicações Pós-Operatórias , Prostaglandinas Sintéticas/efeitos adversos , Prostaglandinas Sintéticas/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento
13.
PLoS One ; 14(6): e0218886, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31242247

RESUMO

PURPOSE: To investigate the usefulness of meibomian gland (MG) dropout rate in the evaluation of MG morphological change associated with the use of prostaglandin for glaucoma treatment through the association between MG and the ocular surface parameters and medication duration and presence of preservative. METHODS: This cross-sectional study was conducted on 88 eyes of 88 patients who were diagnosed with glaucoma and used only Tafluprost as treatment. The patients were divided into four "user" groups: 1) 23 patients used preservative-free (PF) Tafluprost for 6 months; 2) 21 patients used preservative-containing (PC) Tafluprost for 6 months; 3) 23 patients used PF-Tafluprost for 24 months; 4) 21 patients used PC-Tafluprost for 24 months. Ocular surface parameters and the MG condition, including MG dropout rate and meiboscale, were evaluated. Multiple regression was used to identify associations. RESULTS: There were significant differences in age (p = 0.003), tear breakup time (p = 0.016), lid margin abnormality (p = 0.016), expressibility (p = 0.039), meiboscale (p<0.001), and MG dropout rate (p<0.001) among the 4 groups. MG dropout rate and meiboscale showed significant differences in all post hoc analyses, except for the comparison between the PF-Tafluprost and PC-Tafluprost 6-month user groups. Medication duration, preservative status, and meiboscale were significantly correlated with MG dropout rate (p<0.001, p = 0.024, p<0.001, respectively). In the 6-month user group, preservative status significantly correlated with MG dropout rate (p = 0.015). However, in the 24-month user group, meiboscale was the only parameter significantly associated with MG dropout rate (p<0.001). CONCLUSION: MG dropout rate in patients using Tafluprost showed a significant correlation with medication duration and preservative status. This result indicates MG dropout rate reflects MG morphologic change associated with prostaglandin.


Assuntos
Glaucoma/tratamento farmacológico , Glândulas Tarsais/efeitos dos fármacos , Prostaglandinas F/uso terapêutico , Prostaglandinas Sintéticas/uso terapêutico , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Conservantes Farmacêuticos/efeitos adversos , Prostaglandinas F/química , Prostaglandinas F/farmacologia , Prostaglandinas Sintéticas/química , Prostaglandinas Sintéticas/farmacologia , Análise de Regressão , Fatores de Tempo , Resultado do Tratamento
14.
J Colloid Interface Sci ; 539: 457-467, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30611041

RESUMO

HYPOTHESIS: Glaucoma is effectively treated by prostaglandin analogs. Low corneal bioavailability (<5%) of daily-instilled prostaglandin drops complemented by frequent application results in low patient compliance (<50%). One alternative route is ocular delivery via commercial hydrogel contact lens. Commercial lenses, however, release prostaglandins rapidly in a few hours owing to their small molecular size, resulting in toxic side-effects. Here, the feasibility of sustained prostaglandin, namely bimatoprost and latanoprost delivery by vitamin-E integrated polymeric hydrogels is explored. Inclusion of these barriers is expected to augment transport resistance and influence delivery rates. EXPERIMENTS: Lens immersion in vitamin-E concentrated ethanol is done to enable formation of nano-barrier depots. FINDINGS: Pilot in vitro studies indicate that ACUVUE® OASYS® and ACUVUE® TruEye™ lenses loaded with ∼0.2 g of vitamin-E/g of hydrogel effectively prolong bimatoprost dynamics by 10-40-fold, delivering therapeutic dosages for >10 days. Incorporation of vitamin-E into the lenses retains visible light transmission and other properties. Further, vitamin-E integration does not influence latanoprost transport. An in vivo model involving coupled mass transport in the lens and post-lens tear film (POLTF) domains predicts >50% corneal bioavailability of bimatoprost delivered via modified lenses.


Assuntos
Lentes de Contato , Sistemas de Liberação de Medicamentos , Prostaglandinas Sintéticas/administração & dosagem , Prostaglandinas Sintéticas/uso terapêutico , Vitamina E/química , Humanos , Tamanho da Partícula , Prostaglandinas Sintéticas/química , Vitamina E/administração & dosagem
15.
Medicine (Baltimore) ; 98(4): e14128, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30681574

RESUMO

To determine whether cataract or glaucoma and combined cataract and glaucoma surgery (CGS) affect glaucoma medication usage.We recruited patients who received new diagnoses of glaucoma, either primary open-angle glaucoma (POAG) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 365.1) or primary angle-closure glaucoma (PACG) (ICD-9-CM code 365.2), between 1998 and 2011 and had undergone cataract surgery alone (CS), glaucoma surgery alone (GS), or CGS under the National Health Insurance program in Taiwan. CS, GS, and CGS in all the patients were performed after the glaucoma diagnosis date. The patients were subdivided into CS, CGS, and GS groups. The number of glaucoma medications, including prostaglandin analogs, ß-blockers, carbonic anhydrase inhibitors, α-agonists, pilocarpine, and a combination of drugs, in each prescription, were compared before and after surgery.The mean number of glaucoma medications in each prescription before the surgery increased from approximately 0.5/1 (CS/CGS + GS) to a peak of 1.75/3 within 3 months before the index date. The mean number of glaucoma medications in each prescription reduced to 0 (CS group) and to approximately 0.5 (CGS and GS) at the end of the 3-year follow-up period. The mean number of glaucoma medications in each prescription significantly reduced at the time points within 6 months, between 6 months and 2 years, and during 2 to 3 years after surgery in each group. At the end of the 3-year period, the reduction effect was most evident in the CS group. Similar trends were also observed in the POAG and PACG group.CS, GS, and CGS significantly reduced the number of glaucoma medications used by the glaucoma patients.


Assuntos
Extração de Catarata/estatística & dados numéricos , Glaucoma de Ângulo Fechado/tratamento farmacológico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Prescrições/estatística & dados numéricos , Trabeculectomia/estatística & dados numéricos , Agonistas alfa-Adrenérgicos/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Anti-Hipertensivos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Estudos de Casos e Controles , Catarata/complicações , Bases de Dados Factuais , Feminino , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Pilocarpina , Prostaglandinas Sintéticas/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
16.
Eur J Ophthalmol ; 29(6): 645-653, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30301370

RESUMO

PURPOSE: Preservatives in glaucoma medications have been associated with ocular toxicity. We compared ocular signs and symptoms in patients with open-angle glaucoma or ocular hypertension treated in monotherapy with preserved or preservative-free prostaglandin analogues. METHODS: Observational cross-sectional clinical study in real life. 82 patients treated for at least 6 months with prostaglandin analogue were assessed for intraocular pressure, ocular symptoms and ocular signs including conjunctival hyperaemia, tear break-up time and tear meniscus height measured using objective and non-invasive methods (OCULUS Keratograph 5M). Patients presenting with symptoms of ocular toxicity with preserved prostaglandin analogues were switched to preservative-free latanoprost, and a second assessment was processed 6 months after. RESULTS: At inclusion, 30 (36.6%) patients were treated with preservative-free latanoprost, 25 (30.5%) with preserved latanoprost, 16 (19.5%) with preserved travoprost and 11 (13.4%) with preserved bimatoprost. Patients treated with preservative-free latanoprost reported significantly less ocular symptoms upon instillation (mainly burning) and between instillations than patients treated with preserved prostaglandin analogues. The mean conjunctival hyperaemia (limbal + bulbar) was significantly lower with preservative-free latanoprost (2.08 ± 0.55) compared to preserved latanoprost (2.50 ± 0.7, p = 0.0085), preserved travoprost (2.67 ± 0.82, p = 0.0083) and preserved bimatoprost (2.68 ± 0.67, p = 0.0041). There were no relevant between-group differences in mean tear meniscus height and break-up time. Ocular symptoms and conjunctival hyperaemia improved when preserved prostaglandin analogues were switched to preservative-free latanoprost for 6 months while intraocular pressure reduction was maintained. CONCLUSION: Overall, this study suggests a better subjective and objective ocular tolerance when patients were treated with preservative-free latanoprost than with other preserved prostaglandin analogues monotherapy. Switching to preservative-free latanoprost maintained intraocular pressure at the same level as preservative prostaglandin analogue, but improved ocular surface tolerance.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Conservantes Farmacêuticos/uso terapêutico , Prostaglandinas Sintéticas/uso terapêutico , Administração Oftálmica , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/efeitos adversos , Bimatoprost/efeitos adversos , Bimatoprost/uso terapêutico , Doenças da Túnica Conjuntiva/induzido quimicamente , Estudos Transversais , Feminino , Humanos , Hiperemia/induzido quimicamente , Pressão Intraocular/efeitos dos fármacos , Latanoprosta/efeitos adversos , Latanoprosta/uso terapêutico , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/tratamento farmacológico , Soluções Oftálmicas , Conservantes Farmacêuticos/efeitos adversos , Prostaglandinas Sintéticas/efeitos adversos , Tonometria Ocular , Travoprost/efeitos adversos , Travoprost/uso terapêutico
17.
Retina ; 39(4): 636-647, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29517580

RESUMO

PURPOSE: To evaluate the effect of intraocular pressure-lowering medications on treatment outcomes in the Comparison of AMD Treatments Trials. METHODS: Secondary analysis of Comparison of AMD Treatments Trials data. Medication logs were reviewed for continuous 2-year use of agents that increased aqueous outflow (Group A: topical prostaglandins) or suppressed aqueous production (Group B: topical beta blockers and carbonic anhydrase inhibitors). Eyes were excluded if mixed-mechanism intraocular pressure-lowering agents or medications from more than one group were taken. Anatomical and vision responses to treatment at years 1, 2, and over the entire 2-year period in each group were compared with controls (no intraocular pressure-lowering medications). RESULTS: Inclusion criteria were met by 28 Group A patients, 19 Group B patients, and 857 controls. After 2 years, the control group had a mean visual acuity improvement of +6.3 letters from baseline, compared with +3.5 letters in Group A (P = 0.38), and +13.8 letters in Group B (P = 0.052). Mean retinal thickness change from baseline was -54.9 µm in controls, -80.6 µm in Group A (P = 0.26), and -96.8 µm in Group B (P = 0.13). Mean total thickness change from baseline was -163 µm in controls, -180 µm in Group A (P = 0.63), and -238 µm in Group B (P = 0.08). In longitudinal analysis with adjustment by their baseline values, anti-vascular endothelial growth factor treatment drug and regimen, Group B had more visual acuity improvement (difference of 2.6 letters, 95% confidence interval: -3.4-8.5 letters), more reduction in the retinal thickness (-17.9 µm, 95% confidence interval: -36.5 to 0.7 µm), and total thickness from baseline (mean difference of -54.7 µm, 95% confidence interval: -103 to 6.2 µm) compared with the control group. CONCLUSION: Concurrent aqueous suppressant use during anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration was associated with a trend toward greater reductions in retinal and total thickness as well as improved visual outcomes over 2 years. A similar effect was not observed to the same extent with agents that increase aqueous outflow. Because of the small sample size and secondary analysis, these findings must be cautiously interpreted and perhaps serve as a basis for future prospective studies.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Degeneração Macular Exsudativa/tratamento farmacológico , Administração Oftálmica , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Bevacizumab/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/fisiopatologia , Método Duplo-Cego , Feminino , Angiofluoresceinografia , Seguimentos , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Injeções Intravítreas , Masculino , Hipertensão Ocular/tratamento farmacológico , Estudos Prospectivos , Prostaglandinas Sintéticas/uso terapêutico , Ranibizumab/uso terapêutico , Retina/patologia , Tomografia de Coerência Óptica , Tonometria Ocular , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/fisiopatologia
18.
Arq. bras. oftalmol ; 81(6): 490-493, Nov.-Dec. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-973846

RESUMO

ABSTRACT Purpose: To evaluate whether any topical anti-glaucoma medications increase the risk of lacrimal drainage system obstruction or whether the presence of preservatives alone is sufficient to generate obstruction. Methods: This nested case-control study compared a group of patients with lacrimal duct obstruction who received topical anti-glaucoma medications to a control group of patients without obstruction. Results: The medical records of 255 patients with glaucoma who consulted the Oculoplastic Section with complaints of watery eyes were reviewed. Among these patients, 59 exhibited lacrimal drainage obstruction. Ninety-four percent of patients with lacrimal drainage obstruction used beta-blockers, and 41% used prostaglandin analogs. A logistic regression model was used to adjust for age, sex, and the use of other medications. No significant differences were observed regarding the topical anti-glaucoma medications used between groups. Conclusion: No single topical anti-glaucoma medication demonstrated a stronger association with the development of lacrimal duct obstruction.


RESUMO Objetivo: Avaliar se algum medicamento tópico anti-glaucoma aumenta o risco de obstrução do sistema de drenagem lacrimal ou se a presença de conservantes é su fi cien te para gerar obstrução. Métodos: Este estudo de caso-controle aninhado comparou um grupo de pacientes com obstrução do ducto lacrimal que receberam medicações tópicas anti-glaucoma contra um grupo controle de pacientes sem obstrução. Resultados: Foram revistos os prontuários de 255 pacientes com glaucoma que consultaram a Seção de Oculoplástica com queixas de olhos lacrimejantes. Dentre esses pacientes, 59 apresentavam obstrução da via lacrimal de drenagem. Noventa e quatro por cento dos pacientes com obstrução usaram betabloqueadores e 41% usaram análogos de prostaglandinas. Um modelo de regressão logística foi utilizado para ajustar a idade, sexo e o uso de outros medicamentos. Não foram observadas diferenças significativas em relação às medicações tópicas anti-glaucoma usadas entre os grupos. Conclusão: Nenhum medicamento anti-glaucoma tópico único demonstrou uma associação mais forte com o desenvolvimento de obstrução do ducto lacrimal.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Soluções Oftálmicas/uso terapêutico , Glaucoma/tratamento farmacológico , Obstrução dos Ductos Lacrimais/complicações , Conservantes Farmacêuticos/uso terapêutico , Prostaglandinas Sintéticas/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Estudos de Casos e Controles , Glaucoma/complicações , Estudos Retrospectivos , Antagonistas Adrenérgicos beta/uso terapêutico , Administração Oftálmica
19.
Arq Bras Oftalmol ; 81(6): 490-493, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30304090

RESUMO

PURPOSE: To evaluate whether any topical anti-glaucoma medications increase the risk of lacrimal drainage system obstruction or whether the presence of preservatives alone is sufficient to generate obstruction. METHODS: This nested case-control study compared a group of patients with lacrimal duct obstruction who received topical anti-glaucoma medications to a control group of patients without obstruction. RESULTS: The medical records of 255 patients with glaucoma who consulted the Oculoplastic Section with complaints of watery eyes were reviewed. Among these patients, 59 exhibited lacrimal drainage obstruction. Ninety-four percent of patients with lacrimal drainage obstruction used beta-blockers, and 41% used prostaglandin analogs. A logistic regression model was used to adjust for age, sex, and the use of other medications. No significant differences were observed regarding the topical anti-glaucoma medications used between groups. CONCLUSION: No single topical anti-glaucoma medication demonstrated a stronger association with the development of lacrimal duct obstruction.


Assuntos
Glaucoma/tratamento farmacológico , Obstrução dos Ductos Lacrimais , Soluções Oftálmicas/uso terapêutico , Administração Oftálmica , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Anidrase Carbônica/uso terapêutico , Estudos de Casos e Controles , Feminino , Glaucoma/complicações , Humanos , Obstrução dos Ductos Lacrimais/complicações , Masculino , Pessoa de Meia-Idade , Conservantes Farmacêuticos/uso terapêutico , Prostaglandinas Sintéticas/uso terapêutico , Estudos Retrospectivos
20.
Expert Opin Investig Drugs ; 27(10): 777-785, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30227753

RESUMO

INTRODUCTION: Prostaglandin F2α analogs were the first prostaglandin agonists introduced for glaucoma treatment. Thanks to their efficacy and favorable tolerability they set a high bar in competition, with a resultant paucity in new hypotensive drug development for many years. However, the scientific community has shown recently a new interest in exploring new options for glaucoma treatment, generating a remarkable incentive in the marketplace for new drugs. AREAS COVERED: This article reviews agents targeting prostaglandin receptors that are currently being investigated for glaucoma treatment. We searched published literature for agonists targeting all subtypes of prostaglandin receptors found in ocular tissues. EP and FP receptor agonists are currently in the spotlight of clinical research, while less attention is paid in DP receptor agonists. EXPERT OPINION: Prostaglandin analogs, targeting different and combinations of receptor subtypes and compounds that exhibit additivity to commonly prescribed medications seem to be highly promising options. New treatments need to be safe, more effective, superior to existing therapies, tolerable and cost-effective. New generation compounds with multiple mechanisms of action or multiagent formulations are vigorously being investigated and generated in laboratories around the world.


Assuntos
Glaucoma/tratamento farmacológico , Prostaglandinas Sintéticas/uso terapêutico , Receptores de Prostaglandina/efeitos dos fármacos , Animais , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Desenho de Fármacos , Drogas em Investigação/farmacologia , Drogas em Investigação/uso terapêutico , Glaucoma/fisiopatologia , Humanos , Prostaglandinas Sintéticas/efeitos adversos , Prostaglandinas Sintéticas/farmacologia , Receptores de Prostaglandina/metabolismo
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