Abstract
Purpose :
Although the pivotal trials for netarsudil demonstrated that it was effective in lowering IOP as a primary monotherapy, in clinical practice it is more commonly used as an adjunctive treatment for patients on multiple topical medications. It is not clear how well netarsudil performs as an adjunctive therapy in these circumstances. This study seeks to evaluate the efficacy of netarsudil in glaucoma patients with inadequately controlled IOP on otherwise maximally tolerated medical therapy.
Methods :
This is a retrospective, observational clinical study of patients started on netarsudil at Stanford University. All subtypes of glaucoma and pre-treatment IOPs were included. Exclusion criteria included glaucoma surgery or laser within 6 months of starting netarsudil and other modifications to the patient’s medication regimen within 4 weeks. The primary outcome measure was treatment success, defined as IOP reduction from pre-treatment baseline below a pre-determined, patient specific target, and no further medication, laser, or surgery recommended subsequent to starting netarsudil. Other outcome measures included extent of IOP reduction and adverse effects.
Results :
62 eyes of 45 patients were included. Most patients had a diagnosis of primary open angle glaucoma (59%). Most eyes were on 3 or more drops (88%). 36 eyes (58%) achieved treatment success at first follow up. The mean change in IOP for all patients at first follow up was -3.53 mmHg (-17%). In patients who achieved treatment success, mean IOP change was -5.22 mmHg (-28.0%). Of the eyes with baseline IOP of ≤ 20 mmHg, 69% achieved treatment success, compared to only 17% of eyes with baseline IOP ≥ 21 (Figure 1). All patients that failed treatment were offered surgery. 20% of patients reported an adverse reaction to netarsudil, which led to discontinuation in 4 (6%) of the patients with initial treatment success.
Conclusions :
Netarsudil is effective in lowering IOP for patients on otherwise maximally tolerated medical therapy, achieving treatment success in most patients for which glaucoma laser or surgery would be the only remaining therapeutic options, especially in eyes with baseline IOP under 20 mmHg. In addition, Netarsudil was overall well tolerated, with few patients opting to discontinue therapy due to local side effects.
This is a 2021 ARVO Annual Meeting abstract.