Daily cost of newer glaucoma agents.

The purpose of this study was to evaluate the drop characteristics of newer glaucoma medicines compared to timolol solution and timolol gel forming solution (Timoptic-XE, Merck). We evaluated latanoprost 0.005% (2.5 ml bottle), brimonidine 0.2%, apraclonidine 0.5%, dorzolamide 2%, timolol solution 0.5% (5 and 10 ml bottles), and timolol gel forming solution 0.5% (5 ml bottle) in 14 patients with primary open-angle glaucoma or ocular hypertension. Each patient placed 10 drops onto an analytical scale (one drop every 10 seconds) for all ten preparations. Patients then attempted to instill 10 drops of a tear replacement solution into their ocular cul-de-sac. Medication bottles were weighed before and after patients dispensed from the bottle and then after the bottle was emptied. Weights were converted to volume using the density of the medicine. A statistical difference existed between groups for mean drop volume with latanoprost having the smallest drop volume (.0273 +/- .004 ml) (P<0.005). All manufacturers filled correctly or overfilled their bottles with product and had <10% of medicine wasted. Patients instilled 77.9% of the tear solution correctly. When dosed according to labeling, latanoprost had the lowest cost of therapy at $0.87 daily compared to the other newly released medications (range $1.05 to $1.40). Latanoprost was more expensive, however, than timolol maleate solution or gel (range $0.45 to $0.54 per day). Latanoprost therapy is less expensive per day than dorzolamide, brimonidine or apraclonidine, but more expensive than timolol maleate. Cost per day could be further reduced by limiting medicine wastage upon instillation, however.

Comparison of 24-hour intraocular pressure reduction with two dosing regimens of latanoprost and timolol maleate in patients with primary open-angle glaucoma.

PURPOSE: To compare the 24-hour diurnal ocular hypotensive efficacy of two dosing regimens of latanoprost, once daily (8 AM or 10 PM), vs timolol maleate, twice daily. METHODS: We measured six diurnal intraocular pressure curves (6 AM, 10 AM, 2 PM, 6 PM, 10 PM, and 2 AM) in one randomly selected eye of 34 Greek patients newly diagnosed with primary open-angle glaucoma. The first diurnal curve was an untreated baseline. Patients began taking timolol 0.5%, twice daily, for 2 months. Patients were randomly assigned to latanoprost 0.005% given at 8 AM or 10 PM for 1 month and then changed to the other dosing regimen for 1 month. A diurnal curve was performed after each dosing period. RESULTS: The baseline diurnal pressure for all 34 subjects was 23.1 +/- 3.7 mm Hg. The average intraocular pressures at 6 AM for patients who were given latanoprost in the evening (17.9 +/- 2.9 mm Hg) was statistically lower than that in patients given timolol solution (20.1 +/- 2.5 mm Hg, P = .003); however, patients who were given timolol demonstrated a similar diurnal intraocular pressure (19.1 +/- 2.8 mm Hg) to both morning (18.8 +/- 3.7 mm Hg) and evening doses (18.8 +/- 3.6 mm Hg) of latanoprost (P =.329). When the two latanoprost dosages were compared directly, evening administration provided a statistically lower intraocular pressure at 10 AM (P = .0001) and morning administration at 10 PM (P = .0001). This study had an 80% power to exclude a 1.2-mm Hg difference between groups. CONCLUSIONS: This study indicates that in a small population, both latanoprost and timolol are effective in lowering intraocular pressure throughout a 24-hour period; however, latanoprost is most effective in the 12-hour to 24-hour period after administration.

The use of latanoprost 0.005% once daily to simplify medical therapy in patients with primary open-angle glaucoma or ocular hypertension.

PURPOSE: To evaluate the use of latanoprost 0.005% given once daily to simplify a patient's glaucoma medical regimen. METHODS: We reviewed 527 charts of which we included 61 patients (61 eyes) with either ocular hypertension or primary open-angle glaucoma who were prescribed latanoprost for the purpose of simplifying their glaucoma medical regimen. The successful substitution of latanoprost was defined as a reduction in the number of dosages given daily with the maintenance of intraocular pressure for at least three months no higher than 2 mmHg from the previous medical regimen. RESULTS: This study showed that 43 of 61 patients (70.4%) had latanoprost substituted allowing for fewer dosages per day. Following the substitution the intraocular pressure in the success group fell from 22.5+/-5.9 mmHg to 18.3+/-3.8 mmHg (p<0.001) over an average follow-up of 6.6+/-1.9 months. The total number of dosages per day in the success group fell from 4.8+/-2.4 to 1.7+/-1.3 at exit (p<0.001). Twenty-two patients had one medicine, 14 patients two, and seven patients three medicines discontinued after latanoprost was added. Reasons for failure after the substitution were ineffectiveness of latanoprost (n=11) or an adverse event (n=7). No trends in the number or types of medicines at baseline discontinued were observed in the success or failure groups. CONCLUSION: This study shows that latanoprost 0.005% once daily can be substituted for one or more medicines in the majority of ocular hypertension and primary open-angle glaucoma patients to simplify the medical regimen.

Effects of carteolol and timolol on plasma lipid profiles in older women with ocular hypertension or primary open-angle glaucoma.

PURPOSE: To determine the effect on serum lipid levels of carteolol hydrochloride 1.0% or timolol maleate 0.5% given twice a day to women age 60 years and older with primary open-angle glaucoma or ocular hypertension. METHOD: We included 112 patients in this double-masked, randomized, multicenter trial. Fasting clinical laboratory studies were evaluated at baseline and at 12 weeks. Patients were instructed not to change their dietary, alcohol consumption, or exercise habits during the study. RESULTS: For the carteolol group, the high-density lipoprotein (HDL) and total cholesterol/high-density lipoprotein (TC/HDL) ratio at baseline of 50.1 +/- 1.5 mg/dl and 4.7 +/- 0.2 changed by the 12-week visit to 51.3 +/- 1.9 mg/dl (P = .25) and 4.6 +/- .02 (P = .47), respectively. For the timolol maleate group, the baseline HDL and TC/HDL ratio of 53.6 +/- 2.2 mg/dl and 4.4 +/- 0.2 changed to 50.2 +/- 1.9 mg/dl (P < .001) and 4.7 +/- 0.2 (P = .001), respectively, at the 12-week visit. Carteolol patients showed no significant change from baseline, whereas the HDL (P < .001) and TC/HDL ratio decreased (P = .001) significantly in the timolol maleate group. There also was a significant difference in the change from baseline at 12 weeks between carteolol and timolol maleate groups for the HDL and TC/HDL ratio (P = .01 and .012, respectively). No differences in TC, low-density lipoprotein (LDL), or triglycerides (TG) or in changes from baseline were observed between groups at 12 weeks (P > .05). At 12 weeks, no differences were observed between carteolol and timolol maleate groups in intraocular pressure or safety (P > .05), except that patients given carteolol demonstrated fewer solicited ocular symptoms (P = .007). CONCLUSIONS: Carteolol appears to be neutral in its effect on serum lipid levels, whereas timolol maleate adversely affects the HDL and TC/HDL ratio in women age 60 years and older with ocular hypertension or primary open-angle glaucoma.

Latanoprost 0.005% and anterior segment uveitis.

PURPOSE: To evaluate the association of latanoprost with anterior chamber uveitis in glaucoma patients. METHODS: We retrospectively reviewed 527 charts in latanoprost treated patients with: no prior uveitis (Group 1); prior uveitis but were inactive at the time of the study (Group 2); and active uveitis (Group 3). RESULTS: In Group 1 five (1.0%) of 505 patients developed uveitis after beginning latanoprost. The uveitis was trace to 1+ cell in severity and delayed in onset 99.8+/-73.9 days In Group 2 three of 13 (23.1%) patients developed delayed uveitis (trace to 1+ cell). In Group 3 zero of nine (0%) patients had worsened inflammation and the intraocular pressure remained unchanged (22.8+/-7.8 mmHg to 22.0+/-7.3 mmHg) after beginning latanoprost (p=0.38). CONCLUSION: In patients without a prior history a mild delayed uveitis with latanoprost treatment may develop rarely. In patients with a uveitis history, a mild delayed exacerbation potentially may occur and the intraocular pressure may not be decreased in active uveitis.