24-Hour Intraocular Pressures with Brimonidine Purite versus Dorzolamide Added to Latanoprost in Primary Open-Angle Glaucoma Subjects

University of South Carolina, Columbia, South Carolina, United States
Ophthalmology (Impact Factor: 6.14). 05/2005; 112(4):603-8. DOI: 10.1016/j.ophtha.2004.11.032
Source: PubMed

ABSTRACT To evaluate the 24-hour efficacy of brimonidine purite versus dorzolamide, each added to latanoprost.
Double-masked, 2-center, prospective, crossover comparison.
Primary open-angle glaucoma (POAG) subjects.
Subjects were randomized to brimonidine purite or dorzolamide, each given twice daily, for the first 6-week treatment period after a 6-week latanoprost run-in. Subjects began the opposite treatment for the second 6-week period after a 6-week latanoprost-only treatment between periods. Intraocular pressure (IOP) was measured at 8 am, 12 pm, 4 pm, 8 pm, 12 am, 4 am, and 8 am at each baseline and at the end of each treatment period. This study provided an 80% power that a 1.5-mmHg difference could be excluded between groups if 27 subjects completed the study. A standard deviation (SD) of 2.8 mmHg was assumed.
Twenty-four-hour efficacy of intraocular pressures of brimonidine purite versus dorzolamide, each added to latanoprost.
In 31 completed subjects, the baseline mean diurnal 24-hour IOP (+/- SD) was 19.0+/-1.7 mmHg for brimonidine purite and 19.0+/-1.6 mmHg for dorzolamide (P = 0.52). The 8 am IOP after 6 weeks of therapy was 18.4+/-2.1 mmHg for brimonidine purite and 18.9+/-1.9 mmHg for dorzolamide (P = 0.40). The mean diurnal IOP was 16.9+/-1.5 mmHg for brimonidine purite and 16.8+/-1.5 mmHg for dorzolamide (P = 0.66). Dorzolamide caused a more bitter taste (P = 0.01) than brimonidine purite.
This study suggests that brimonidine purite and dorzolamide, added to latanoprost, have similar efficacy and safety in POAG or ocular hypertensive subjects.

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Available from: Constantinos H Karabatsas, Sep 29, 2014
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    • "The average IOP had decreased by 3.9 mmHg (17.4%) after four (n = 78) and by 4.2 mmHg (18.4%) after 12 (n = 71) weeks of combined travoprost and brinzolamide therapy when compared with the monotherapy baseline of travoprost ophthalmic solution 0.004%. After four weeks of adjunctive treatment, 56% of patients (n = 78) and 63% of patients after 12 weeks (n = 71) had at least an additional 15% reduction in IOP.35 "
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    ABSTRACT: Travoprost is a prostaglandin analog used in the management of glaucoma and ocular hypertension for reducing intraocular pressure (IOP). The IOP-lowering efficacy of travoprost has been shown to be similar to that of other prostaglandins, including latanoprost and bimatoprost. When compared with fixed combinations of timolol and either latanoprost or dorzolamide, travoprost alone can reduce mean IOP in a similar or superior manner. Concomitant therapy of travoprost and timolol can reach even greater IOP reductions than fixed combinations at some time points, but with no difference in the early morning, when IOP is usually higher. In addition, the long duration of action of travoprost can also provide better control of IOP fluctuation, probably due to its stronger prostaglandin F receptor mechanism. The side effects of travoprost do not represent a risk to the vision or health of the patient. The proven efficacy and safety combined with convenient once-daily dosing for travoprost increases patient compliance with treatment for glaucoma.
    Clinical Ophthalmology 10/2010; 4:1165-71. DOI:10.2147/OPTH.S6289 · 0.76 Impact Factor
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    • "When added to ongoing beta-blocker therapy, brimonidine was shown to reduce IOP significantly.40,41 Similarly, when added to latanoprost, brimonidine demonstrated significant additional IOP lowering capacity.41,42 "
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    ABSTRACT: Elevated intraocular pressure (IOP) is a significant risk factor for the development and progression of glaucomatous optic neuropathy, but increasingly we appreciate that non-pressure dependent factors, are key to our understanding of the pathophysiology of these neurodegenerative diseases, that target the retinal ganglion cell. As we try to expand therapy beyond IOP control, medications are being assessed for their neuroprotective abilities. Brimonidine is an effective ocular hypotensive treatment both as a first and second line agent, in the management of glaucoma and ocular hypertension. Brimonidine tartrate 0.2% is generally safe and well tolerated, with its safety profile further enhanced in the altered formulation brimonidine-Purite() 0.1%. Beyond brimonidine's pressure lowering capacity, laboratory and early clinical evidence supports its neuroprotective potential. We await validation of this in human clinical trials.
    Clinical ophthalmology (Auckland, N.Z.) 02/2009; 3:117-22.
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    • "Several randomized controlled clinical studies in patients with glaucoma or OHT subsequently confirmed that brimonidine provides significant additional mean decreases in IOP when added to ongoing beta-blocker therapy (Simmons 2001; Simmons and Earl 2002; Sall et al 2003; Solish et al 2004). Other randomized controlled trials showed that brimonidine effectively reduces IOP when used adjunctively with a prostaglandin analogue (bimatoprost or latanoprost) (Netland et al 2003; Zabriskie and Netland 2003; Konstas et al 2005). "
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    ABSTRACT: Treatment in glaucoma aims to lower intraocular pressure (IOP) to reduce the risk of progression and vision loss. The alpha2-adrenergic receptor agonist brimonidine effectively lowers IOP and is useful as monotherapy, adjunctive therapy, and replacement therapy in open-angle glaucoma and ocular hypertension. A fixed combination of brimonidine and timolol, available in some countries, reduces IOP as effectively as concomitant therapy with brimonidine and timolol and offers the convenience of 2 drugs in a single eyedrop. Brimonidine is safe and well tolerated. Its most common side-effects are conjunctival hyperemia, allergic conjunctivitis, and ocular pruritus. The newest formulation of brimonidine, brimonidine-Purite 0.1%, has a higher pH to improve the ocular bioavailability of brimonidine. This formulation contains the lowest effective concentration of brimonidine and is preserved with Purite(R) to enhance ocular tolerability. Brimonidine-Purite 0.1% is as effective in reducing IOP as the original brimonidine 0.2% solution preserved with benzalkonium chloride. Recent results from preclinical and clinical studies suggest that brimonidine may protect retinal ganglion cells and their projections from damage and death independently of its effects on IOP. The potential for neuroprotection with brimonidine is an added benefit of its use in glaucoma and ocular hypertension.
    Therapeutics and Clinical Risk Management 01/2007; 2(4):337-46. DOI:10.2147/tcrm.2006.2.4.337 · 1.47 Impact Factor
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