24-hour intraocular pressures with brimonidine purite versus dorzolamide added to latanoprost in primary open-angle glaucoma subjects.

OBJECTIVE: To evaluate the 24-hour efficacy of brimonidine purite versus dorzolamide, each added to latanoprost. DESIGN: Double-masked, 2-center, prospective, crossover comparison. PARTICIPANTS: Primary open-angle glaucoma (POAG) subjects. METHODS: Subjects were randomized to brimonidine purite or dorzolamide, each given twice daily, for the first 6-week treatment period after a 6-week latanoprost run-in. Subjects began the opposite treatment for the second 6-week period after a 6-week latanoprost-only treatment between periods. Intraocular pressure (IOP) was measured at 8 am, 12 pm, 4 pm, 8 pm, 12 am, 4 am, and 8 am at each baseline and at the end of each treatment period. This study provided an 80% power that a 1.5-mmHg difference could be excluded between groups if 27 subjects completed the study. A standard deviation (SD) of 2.8 mmHg was assumed. MAIN OUTCOME MEASURES: Twenty-four-hour efficacy of intraocular pressures of brimonidine purite versus dorzolamide, each added to latanoprost. RESULTS: In 31 completed subjects, the baseline mean diurnal 24-hour IOP (+/- SD) was 19.0+/-1.7 mmHg for brimonidine purite and 19.0+/-1.6 mmHg for dorzolamide (P = 0.52). The 8 am IOP after 6 weeks of therapy was 18.4+/-2.1 mmHg for brimonidine purite and 18.9+/-1.9 mmHg for dorzolamide (P = 0.40). The mean diurnal IOP was 16.9+/-1.5 mmHg for brimonidine purite and 16.8+/-1.5 mmHg for dorzolamide (P = 0.66). Dorzolamide caused a more bitter taste (P = 0.01) than brimonidine purite. CONCLUSIONS: This study suggests that brimonidine purite and dorzolamide, added to latanoprost, have similar efficacy and safety in POAG or ocular hypertensive subjects.

Latanoprost 0.005% versus bimatoprost 0.03% in primary open-angle glaucoma patients.

OBJECTIVE: To evaluate latanoprost versus bimatoprost given each evening over the 24-hour diurnal curve. DESIGN: Double-masked, 2-center, crossover comparison. PARTICIPANTS: Forty-two of 44 patients with primary open-angle glaucoma (POAG) completed the study. METHODS: Consecutive patients were not treated during a baseline 24-hour curve after a glaucoma medicine-free period. They then were randomized to either latanoprost or bimatoprost for a 7-week treatment period. Diurnal curve intraocular pressures (IOPs) were measured at treatment period end at 2 am, 6 am, 10 am, 2 pm, 6 pm, and 10 pm. After the first treatment period, patients were changed to the opposite medicine without a medicine-free period. Diurnal curve measurements were performed again at the end of the second 7-week treatment period. MAIN OUTCOME MEASURE: The 24-hour diurnal IOP. RESULTS: On the last day of treatment, mean 24-hour IOPs were 17.3+/-2.8 mmHg for latanoprost and 16.7+/-2.4 mmHg for bimatoprost (P = 0.01). The 6 pm individual time point for IOP was statistically lower for bimatoprost after a Bonferroni correction (P = 0.008). The largest IOP difference at any time point was 0.9 mmHg at 6 pm. The most common side effect was conjunctival hyperemia, which occurred less with latanoprost (n = 6) than with bimatoprost (n = 15) (P = 0.004). Two patients had their treatments discontinued while on bimatoprost, one due to conjunctival hyperemia and the other due to ocular intolerance. CONCLUSION: This study indicates that the 24-hour diurnal IOP is statistically lower in POAG with bimatoprost, compared with latanoprost, among patients who tolerated bimatoprost. However, the IOP difference between groups was small and may not be clinically meaningful. In contrast, conjunctival hyperemia seems statistically greater with bimatoprost. The exact clinical importance of conjunctival hyperemia, if any, needs to be clarified further.

A comparison of once-daily morning vs evening dosing of concomitant latanoprost/timolol.

PURPOSE: To evaluate morning vs evening once daily concomitant latanoprost 0.005%/timolol maleate 0.5% therapy in ocular hypertensive or primary open-angle glaucoma patients. DESIGN: Prospective single-center double-masked crossover comparison. METHODS: Patients who responded to timolol maleate 0.5% given twice daily were randomized to either evening or morning dosing of concomitant latanoprost 0.005% and timolol maleate 0.5% therapy for 7 weeks. Twenty-four hour diurnal curve intraocular pressure (IOP) testing was performed following each period. RESULTS: Thirty-six patients completed this study. There was a significant reduction at each time point in the 24-hour diurnal curve of both evening (17.1 +/- 2.7 mm Hg) and morning (17.3 +/- 3.1 mm Hg) dosed latanoprost/timolol maleate compared with timolol maleate given twice daily (21.1 +/- 3.3 mm Hg) (P <.0001). When the morning and evening dosing groups were compared directly, the 06:00 time point was statistically lower with evening dosing (16.4 +/- 2.3 mm Hg) vs morning dosing (17.9 +/- 2.8 mm Hg) (P =.01). Overall, a trend existed for greater daytime reduction with night-time dosing of the concomitant therapy, whereas morning dosing tended to give lower night-time pressures. There was a significantly lower mean range of diurnal pressure with evening (3.6 mm Hg) vs morning (4.3 mm Hg) dosing (P =.02). No differences in adverse events existed between the treated arms. CONCLUSIONS: This study suggests that latanoprost and timolol maleate, both given once daily in the morning or evening, effectively reduce the IOP for the 24-hour diurnal curve when compared with timolol maleate twice daily.