Evolution of the treatment paradigm for maximum medical therapy in glaucoma. (2nd January 2019)

• Record Type: Journal Article
• Authors: Costa, Vital Paulino; Aung, Tin; Konstas, Anastasios G.
• Is Part Of: Expert review of ophthalmology. Volume 14:Number 1(2019)
• Page Start: 33
• Page End: 42
• Publication Date: 2019-01-02
• Subjects: Glaucoma -- combination -- fixed dose -- intraocular pressure -- maximum medical therapy; Ophthalmology -- Periodicals; 617.7005
• DOI: 10.1080/17469899.2019.1570138
• Languages: English
• ISSNs: 1746-9899

Abstract

ABSTRACT: Introduction : Glaucoma therapy is typically started with a single drug that is considered most effective for IOP control and is relatively safe. Several classes of agents are available, including prostaglandin analogs (PGAs), β-blockers, carbonic anhydrase inhibitors (CAIs), cholinergic agonists, and α2 -agonists. Most patients will require combined therapy to achieve predetermined target intraocular pressure (IOP), which can be difficult to sustain over time. Currently, maximum medical therapy (MMT) in glaucoma refers to ≤3 classes of medications combined to substantially lower IOP. MMT can be achieved using multiple single agents, double, or triple fixed-dose combinations. Areas covered : Several randomized controlled clinical trials demonstrated that 3-drug combination regimens are superior to 2-drug regimens for lowering 24-hour IOP, which may prevent glaucoma progression. However, long-term clinical evidence with 3- or 4-drug MMT regimens is scarce. Expert commentary: The next logical step in evolution of effective MMT may be the use of 4 classes of medications, adding triple fixed-combination to single agent or combining fixed-dose combinations of CAI plus α2 -agonist and fixed-dose β-blocker plus PGA. Availability of novel fixed-dose combinations may optimize efficacy, tolerability, adherence, and improve long-term outcomes. Further controlled evidence is required to accurately delineate the value of current and future MMT regimens.