Abstract
Purpose :
Netarsudil is a newly approved intraocular pressure (IOP) lowering agent with a novel mechanism of action. Although the efficacy of netarsudil has been shown in clinical trials, its real-world effectiveness is uncertain. This study assesses netarsudil’s effectiveness in reducing IOP in patients with advanced glaucoma already on maximally tolerated medical therapy.
Methods :
Medical records of all patients who received netarsudil between 6/1/2018 and 4/30/2020 from the West Los Angeles Veterans Administration Medical Center were retrospectively reviewed. Exclusion criteria included laser trabeculoplasty and glaucoma surgery within 6 months of initiation of netarsudil, ocular conditions interfering with reliable IOP measurement, documented noncompliance with baseline medical therapy, initiation of netarsudil prior to first visit, or if netarsudil was discontinued due to intolerability prior to first post-treatment visit. One eye per patient was enrolled. If both eyes were qualified, the more severely affected eye based on visual field was selected. Baseline average IOP was compared to average IOP within 4 months and more than 4 months after initiation of netarsudil with paired t-tests. Intolerability was reported.
Results :
Sixty-six out of the 202 patients that were prescribed netarsudil met the inclusion criteria. Mean age (±SEM) was 74.6±1.1 years. 98.5% were male, 65.2% were black, and 80.3% had open angle glaucoma. The mean LogMAR acuity score was 0.78±0.10 (equivalent to 20/120), cup/disc ratio was 0.87±0.01, the central corneal thickness was 527.4±6.2 µm, and the total number of medications at baseline was 3.6±0.1. Mean IOP was reduced from 17.2±0.4 at baseline to 15.0±0.5 within 4 months (n=66) and 15.0±0.5 mmHg between 4-18 months (n=40) after netarsudil initiation (p<0.0001). Thirty-three patients (50%) within 4 months and 18 patients (45%) between 4-18 months had ≥15% IOP reduction. There was no significant difference in absolute or percent IOP reduction between patients on ≤2 and >2 baseline glaucoma medications. Three patients could not tolerate and stopped netarsudil during follow-up, and 18 of the 136 excluded patients discontinued netarsudil before the first post-treatment visit. Total discontinuation rate was 10.4% (21/202).
Conclusions :
Netarsudil is moderately effective in lowering IOP even among patients who have exhausted all other pharmacologic options.
This is a 2021 ARVO Annual Meeting abstract.