The efficacy and safety of latanoprost 0.005% once daily versus brimonidine 0.2% twice daily in open-angle glaucoma or ocular hypertension

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Abstract

PURPOSE: To evaluate the efficacy and safety of latanoprost 0.005% given topically every evening versus brimonidine 0.2% given topically twice daily in primary open-angle glaucoma or ocular hypertensive patients.

METHODS: This was a multicenter, crossover, double-masked comparison. After a 28-day treatment-free period, patients with primary open-angle glaucoma or ocular hypertension were randomized for 6 weeks to brimonidine or latanoprost and then crossed over to the opposite treatment. At baseline and after each treatment period, patients underwent intraocular pressure measurements every 2 hours from 08:00 to 20:00.

RESULTS: In 33 patients the mean baseline trough (08:00) was 23.2 ± 2.1 mm Hg and the diurnal curve pressure was 19.8 ± 2.7 mm Hg. The trough and diurnal intraocular pressures for brimonidine were 19.6 ± 3.4 mm Hg and 17.6 ± 2.2 mm Hg, respectively. Brimonidine statistically reduced the pressure from baseline at each time point except hours 10 and 12 (P = .14 and P = .21, respectively). For latanoprost, the trough and diurnal pressures were 16.2 ± 2.9 mm Hg and 15.4 ± 2.5 mm Hg, respectively, and the pressure was statistically reduced at each time point (P < .001) and for the diurnal curve (P < .001). When compared directly, the intraocular pressure level for latanoprost was lower than brimonidine for the diurnal pressure and at each time point (P < .05). One patient was discontinued early from latanoprost treatment because of eyelid swelling; also, latanoprost caused more hyperemia than brimonidine (P = .04).

CONCLUSION: This study suggests latanoprost dosed daily in the evening statistically reduces intraocular pressure more during daytime and evening hours than brimonidine dosed twice daily. Brimonidine may not consistently decrease the pressure 10 and 12 hours past dosing from nontreated levels.

Section snippets

Material and methods

Patients were included in this study if they demonstrated the following criteria: 18 years of age or older; willingness to comply with the investigator’s and protocol’s instructions; a clinical diagnosis of primary open-angle, pigment dispersion, or exfoliation glaucoma, or ocular hypertension in at least one eye (study eye); at baseline (visit 2) an intraocular pressure at the 08:00 hour between 22 and 34 mm Hg in the study eye(s); and a visual acuity of 20/200 or better in the study eye(s).

Results

Thirty-three patients were randomized and completed this trial. The characteristics of patients included in this study are found in Table 1.

The mean intraocular pressures for each time point in this study are shown in Figure 1 for baseline and both active treatments. For brimonidine, there was a statistical reduction from baseline for the diurnal curve as well as each time point, except hours 10 and 12 (P = .14 and P = .21, respectively). The range of the mean pressure reduction over the

Discussion

Latanoprost was released commercially by Pharmacia, Inc, in 1996 as an ocular hypotensive agent. Latanoprost is an analog of an F2α prostaglandin and is highly selective for the F prostanoid receptor.6 Several studies have indicated that the mechanism of action of the intraocular pressure reduction by latanoprost is increased uveoscleral outflow.7, 8, 9, 10 When compared with timolol maleate given twice daily, latanoprost 0.005% once daily has demonstrated either an equal or statistically

References (31)

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This study was sponsored by an unrestricted grant from Pharmacia, Inc, Peapack, New Jersey.

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