Introduction:
Glaucoma is treated with IOP lowering medications or surgery to reduce the risk of visual field loss. The current treatment regimen often begins with a prostaglandin. If IOP lowering is insufficient, a second drug is frequently added. Topical carbonic anhydrase inhibitors and α2 agonists are common choices. There are few citations on the additive effect of the drugs to prostaglandins.
Purpose:
To compare the additive effect on IOP of adding brinzolamide 1% BID or brimonidine 0.15% BID to travoprost 0.004% in patients with primary open angle glaucoma, pseudoexfoliation or ocular hypertension. Main Outcomes Measures: ANCOVA baseline adjusted mean decrease in diurnal IOP to month 3, Adjusted mean IOP at 8 AM (prior to dosing), 12 Noon, 4 PM and diurnal at month 3.
Methods:
Double masked randomized parallel group, 17 center trial. After travoprost 0.004% QHS run in, subjects were randomized to receive brinzolamide 1% or brimonidine 0.15% BID in addition to travoprost and were followed at 1 and 3 months.
Results:
163 subjects were randomized and 151 evaluable. Adjusted mean (+/– SEM) reductions in diurnal IOP from baseline to month 3 were 2.9+/– 0.26 mmHg in the brinzolamide group, versus 2.1 +/– 0.26 mmHg in patients receiving brimonidine (p=0.035). Computed power to detect a difference of 1.5 mm Hg with a beta of 0.8 and alpha of 0.05 was 0.98. Both treatments were well tolerated with few withdrawals.
Conclusions:
Adding brinzolamide to travoprost lowers IOP more than adding brimonidine at 8 AM, 4 PM, and diurnal.
Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • intraocular pressure • drug toxicity/drug effects