Article

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
    • "Three studies have evaluated the 24-h efficacy of dorzolamide when used as an adjunctive therapy to latanoprost. First, a double-masked, crossover study with 31 POAG patients (Konstas et al., 2005b) examined the 24-h IOP-lowering effect of dorzolamide versus that of brimonidine purite when added to latanoprost. The mean latanoprost-treated 24-h IOP (19.0 mm Hg) in this trial was significantly reduced to 16.9 and 16.8 mm Hg following the addition of brimonidine purite and dorzolamide , respectively. "
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    ABSTRACT: Current medical therapy of glaucoma aims to attain a meaningful and consistent reduction of intraocular pressure (IOP) to a predetermined level of target IOP, which will commensurate with either stability, or delayed progression of visual loss. Glaucoma is a 24-h disease and the damaging effect of elevated IOP is continuous. Therefore, it is reasonable that we should endeavor to identify the true efficacy of currently available and future antiglaucoma medications throughout the 24-h period. This review chapter deals first with the concept and value of diurnal and 24-h pressure monitoring. It then evaluates existing evidence on the 24-h efficacy of medical therapy options. Unfortunately, significant gaps exist in our present understanding of the short-term and particularly the long-term 24-h efficacy of most antiglaucoma medications. More long-term controlled evidence is needed in the future to improve our understanding of the 24-h efficacy of current medical glaucoma therapy, the ideal 24-h target pressure and the precise impact of IOP characteristics upon the different stages of the various forms of glaucoma.
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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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    • "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.
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