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A. G. Konstas, D. Mikropoulos, A. T. Dimopoulos, G. Moumtzis, L. A. Nelson, W. C. Stewart; Second Line Therapy With Dorzolamide/Timolol or Latanoprost/Timolol Fixed Combination versus Adding Dorzolamide/Timolol Fixed Combination to Latanoprost Monotherapy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1210.
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To evaluate open-angle glaucoma patients, who were insufficiently controlled on latanoprost monotherapy, to determine the 24-hour intraocular pressure (IOP) efficacy and safety when changing them to dorzolamide/timolol (DTFC) or latanoprost/timolol fixed combination (LTFC) or adding DTFC.
Qualified primary open-angle or exfoliative glaucoma patients with a baseline IOP > 21 mm Hg on latanoprost monotherapy were randomized for 3 months to: DTFC, LTFC or DTFC and latanoprost. Patients were then crossed over to the next treatment for Periods 2 and 3. At the end of the latanoprost run-in and after each 3-month treatment period patients underwent 24-hour IOP monitoring.
Thirty-one completed this study. The mean 24-hour baseline IOP on latanoprost was 22.1 ± 3.5 mm Hg. All 3 adjunctive therapies significantly reduced the IOP at each time point and for the mean 24-hour curve, except at 18:00 and 02:00 with DTFC and 02:00 with LTFC. No statistical differences were found between DTFC (19.9 ± 3.2 mm Hg) and LTFC (19.5 ± 3.1 mm Hg) in a pairwise comparison (P > 0.39). The addition of DTFC to latanoprost provided the lowest mean 24-hour IOP (16.5 ± 2.8 mm Hg) versus latanoprost monotherapy (P < 0.0001) and the lowest IOP at each individual time point (P < 0.0032). However, there was no difference between all therapies for 24-hour IOP fluctuation (P = 0.31). All treatments were well tolerated but DTFC and latanoprost showed more burning/stinging (P = 0.002).
This study showed DTFC, LTFC and the addition of DTFC to latanoprost significantly decrease the IOP compared to latanoprost alone, but the latter therapy regime obtains the greatest IOP reduction.
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