Current status of drug therapy in patients with glaucoma
At present, drug therapy for glaucoma patients in China is often combined with drugs. Due to the timing of the visitors to the hospital and the characteristics of glaucoma, it is often difficult for domestic glaucoma patients to control IOP perfectly by single drug therapy, or to achieve the target IOP, and then it's difficult to control the progress of optic nerve damage, in which case the combined use of drugs came into being. Traditional combination treatment is often increased by second or third drugs based on the original treatment, but the recent 3~5 years, in both international and domestic applications, a new trend of combination therapy is fixed compound preparation—form the same effect that the combination treatment of each drug can produce and reduce the number of drugs—which can bring many benefits for patients. Firstly, it reduces the number of drugs, which means that it reduces the number of drug preservatives in ocular surface contact. Secondly, the reduction of the number of drugs can reduce intervention with patients’ life and work, so as to improve patients' compliance.
Currently, the combination of prostaglandins and β -blockers is the most commonly used in clinical use, including travoprost combined with timolol, latter prostaglandin latanoprost and timolol and Bimatoprost combined with timolol. If a compound such as Travoprostaglandin thiamolol still cannot control IOP to the target IOP, then other drugs must be added. The addition of carbonic anhydrase inhibitors or α -adrenergic agonists is a good choice in terms of pharmacological and hypotensive effects. In terms of the extent of IOP reduction, carbonic anhydrase inhibitors may be higher than α-adrenergic agonists. There is also a clinical practice of stopping the combination of prostaglandins and β -blockers and replacing them with a combination of prostaglandins, carbonic anhydrase inhibitors or beta-blockers. This is also a new method of drug use, which is a more choice in foreign countries. However, because a fixed compound preparation, the combination of carbonic anhydrase inhibitors and β -blockers, will soon be available in China, this method may be an important choice in the future.
As a first-line monotherapy, Prostaglandin drugs' treatment effect is still very good. About prostaglandin drugs, now we can see from the limited clinical reports at home and abroad that it is the best medicine of a single application of lowering intraocular pressure in all amplitude clinical hypotensive drugs, which is also a major feature of prostaglandin drugs. At present, there are many kinds of prostaglandins used in clinics and each drug has its own advantages and disadvantages. If a meta-analysis is based on large clinical results, When different kinds of prostaglandins are used to treat glaucoma, especially open-angle glaucoma and high intraocular pressure, the two most important indicators of evaluation are to reduce the efficacy and safety of IOP and adverse reactions.
There is no significant difference between the effects of various prostaglandins on intraocular pressure reduction if compared with existing clinical studies of larger samples; in terms of the incidence of eye surface and other adverse reactions, travoprost was slightly higher than Lattan prostaglandin and lower than that of Bima prostaglandin. In addition, for patients receiving long-term drug therapy, the cost of long-term drug use should be considered. In this respect, travoprost is also located between Lattan prostaglandin and Bima prostaglandin.
Reference: Chinese Ophthalmologist May 11th, 2017. Drugs for Glaucoma