Abstract
Purpose :
Medical management remains the mainstay of glaucoma (Glc) treatment. Netarsudil (NET), the first medication in a new class of Glc medications called rho-kinase inhibitors, works by enhancing trabecular meshwork outflow. We hypothesized that NET would combine synergistically with other Glc medications due to its different mechanism of action.
Methods :
A retrospective chart review for patients started on adjunctive NET therapy in a tertiary care Glc clinic between 3/25/2018 and 6/27/2019 was performed. Patient demographics were recorded. Visual acuity, intraocular pressure (IOP), number of Glc medications, and adverse effects were recorded at three points: Baseline, first IOP check on NET (Visit1), and last IOP check on NET during the study period (Visit2). When used bilaterally, only the mean IOP change for both eyes was reported (one value per subject). Descriptive statistics were done. Student’s T-test was used to test for differences between groups.
Results :
92 patient charts had data at Visit1. 44% were male. Mean age (±SEM) was 72.9 ± 1.53 years. Glc diagnoses included: POAG 60.2%, exfoliation 8.6%, chronic angle-closure 6.3%, pigmentary 5.9%, ocular hypertension 5.4%, and other 13.6%. Prior surgeries included: ALT 25.8%, trabeculectomy 18.3%, seton 12.4%, trabectome 8.6%, and iStent 3.8%. Mean duration of NET treatment at Visit1 was 50 ± 4 days. The mean number of Glc medications at Baseline was 3.9 ± 0.1. At Visit1, mean IOP decreased 2.2 ± 0.5 mmHg (p<0.0001). Common adverse effects included: injection (19.5%), medicamentosa (9.7%), subconjunctival hemorrhage (8.6%), tearing (8.6%), pain/burning (6.5%), and itching(5.4). Vision and number of Glc medications were unchanged. At Visit2, 44 patients continued on NET therapy (181 ± 13 days after baseline). Side effects caused 10.8% of patients to discontinue therapy. At Visit2, mean IOP reduced by 3.7 ± 0.9 mmHg (p=0.0003). The distribution of IOP changes are seen in figures 1 and 2.
Conclusions :
NET is a safe, efficacious and useful new adjunctive therapy for Glc treatment. IOP reductions between 1-5 mmHg are typical, but more pronounced effects (>10 mmHg) are seen. Our results support the use of NET for refractory Glc. Further analysis may shed light on the etiology of NET’s variable IOP lowering effect in this patient cohort.
This is a 2020 ARVO Annual Meeting abstract.