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R.M. Feldman, T.C. Prager, L. Baker, A.Z. Chuang, Additivity Study Group; Additivity of Brinzolamide vs. Brimonidine 0.15% to Travoprost 0.004% . Invest. Ophthalmol. Vis. Sci. 2006;47(13):435.
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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.
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.
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.
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.
Adding brinzolamide to travoprost lowers IOP more than adding brimonidine at 8 AM, 4 PM, and diurnal.
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