Latanoprostene Bunod 0.024% in Patients with Open-Angle Glaucoma Switched from Prior Pharmacotherapy: A Retrospective Chart Review.

Introduction: Latanoprostene bunod 0.024% (LBN, Vyzulta®) is a nitric oxide-donating prostaglandin analog (PGA). We investigated the real-world efficacy and safety of LBN in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) who switched their existing intraocular pressure (IOP)-lowering treatment(s) to LBN. Methods: This non-interventional, multicenter (United States), retrospective chart review included patients aged ≥18 years with OHT and/or mild-to-moderate OAG diagnoses taking 1-2 IOP-lowering treatments at the time of switch to LBN (index visit). Chart-extracted data included demographics, diagnoses, IOP and ocular assessments, other IOP-lowering treatments, adverse events (AEs), and reasons for discontinuation. The main study outcome was IOP change from the index visit to each of the next 2 chart-recorded follow-up visits. Analysis groups included the overall dataset and 2 subgroups of patients switched from PGA therapy to LBN: "PGA-all" subgroup [all patients previously on a PGA with/without another IOP-lowering product] and "PGA-monotherapy" subgroup [patients previously on a PGA alone]). Additional ocular outcomes (eg, visual acuity) were examined, if available. Results: The overall dataset included 49 patients (46 had OAD alone, 2 had OHT alone, and 1 had both). The PGA-all subgroup and PGA-monotherapy subgroups had 41 and 32 patients, respectively. Switching to LBN led to a ~25% IOP reduction from the index visit to Visit 1 that was sustained at Visit 2. IOP findings in the PGA-all and PGA-monotherapy subgroups were consistent with the overall dataset. No meaningful changes in other ocular outcomes were found. Of 14 ocular AEs, 3 were recorded as such (mild in severity, considered unrelated to treatment), and 11 were identified through review of interval ocular histories (no severity/relatedness information); none led to discontinuation. Conclusion: In this short-term retrospective chart review of mild-to-moderate OAG/OHT, switching prior IOP-lowering therapy to LBN produced an additional ~25% IOP reduction and appeared to be well tolerated.

Retrospective Chart Review on Real-World Use of Latanoprostene Bunod 0.024% in Treatment-Naïve Patients with Open-Angle Glaucoma.

INTRODUCTION: The objective of this study was to evaluate real-world effectiveness of latanoprostene bunod (LBN) ophthalmic solution 0.024% in treatment-naïve patients newly diagnosed with open-angle glaucoma (OAG) or ocular hypertension. METHODS: This multicenter retrospective chart review included patients aged ≥ 18 years, with no history of medical, laser, or surgical intraocular pressure (IOP)-lowering intervention and at least two follow-up visits (spanning ≥ 2 months) following initiation of LBN treatment. Extracted data included age, sex, race, cup-to-disk ratio, central corneal thickness, IOP, visual acuity (VA), concomitant medications, and adverse events. In patients treated bilaterally, the eye with the higher baseline IOP was the study eye. RESULTS: Medical charts for 65 patients (mean [SD] age, 59 [14] years; 53.8% female) encompassing 125 eyes treated with LBN were reviewed across nine clinical sites. Mean (SD) IOP at baseline was 21.7 (5.9) mmHg. Mean days to first and second follow-up visit were 43 and 141, respectively. LBN use resulted in a mean (SD) reduction from baseline of 7.1 (4.7) and 7.3 (5.1) mmHg at the first and second follow-up visits, respectively (P < 0.0001 for both). Reductions among patients with IOP > 21 mmHg (n = 30) at baseline were 10.0 (4.5) and 11.1 (4.6) mmHg at the first and second follow-up visits (P < 0.0001 for both). There were no meaningful changes in VA. Adverse events appeared infrequent, with only one report of ocular redness. CONCLUSION: In this real-world, retrospective chart review, LBN 0.024% use resulted in robust IOP lowering in newly diagnosed OAG patients new to treatment, and appeared well tolerated.

Trabectome success factors.

Our objective is to investigate which factors and patient characteristics are associated with success in Trabectome surgery.A total of 658 phakic cases with at least of 12 months follow-up were included in the analysis. Baseline demographics and medical data were collected. The main outcome measure was intraocular pressure (IOP), glaucoma medication (Rx), and secondary glaucoma surgery if any. Success was defined as IOP reduction of 20% or more from preoperative IOP and IOP < 21 mm Hg with no secondary surgery throughout the follow-up period. Risk factors for failure were determined by using univariate and multivariate cox regression.At baseline, the average IOP was 23.6 ±â€Š7.8 mm Hg and the average number of medications was 2.6 ±â€Š1.3 for all cases. At 12 months, the average IOP was 16.0 ±â€Š3.6 mm Hg (P < .01) and the average number of medications was 1.8 ±â€Š1.3 (P < .01). Based on the result of multivariate cox regression model, we found that the Trabectome + Phaco (TP) and Trabectome alone (TA) group had a 94% and 79% survival rate at 12 months, respectively. TP cases had 78% lower risk of failure than TA (95% confidence interval [CI]: 54-89), diagnosis of pseudoexfoliation glaucoma had a 54% lower risk of failure than primary open angle glaucoma patients (95% CI: 1-78). Hispanics had an estimated hazard ratio that is 60% lower than Caucasians (95% CI: 18-80); 20% of TA cases and 3% of TP cases were required to undergo additional secondary surgery (P < .01).Trabectome surgery, whether in combination with phacoemulsification cataract removal or stand alone, is associated with a significant reduction of IOP and glaucoma medication. Patients having a higher baseline IOP are expected to have a higher IOP reduction after Trabectome. Pseudoexfoliation glaucoma, combination with phacoemulsification cataract surgery and Hispanic race are factors associated with enhanced Trabectome survival.

Interventions improve poor adherence with once daily glaucoma medications in electronically monitored patients.

PURPOSE: To investigate the impact of an intervention program to improve adherence with topical, once daily therapy for glaucoma. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Sixty-six patients with glaucoma being treated with a prostaglandin analog in 1 or both eyes at the Scheie Eye Institute or Wilmer Eye Institute between November 2006 and June 2007. METHODS: In an observational study, participants who took 75% or fewer doses (as measured using the travoprost Dosing Aid [DA]) during an initial 3-month period were randomized into 2 groups. The intervention group watched an educational video, reviewed current barriers to drop-taking and possible solutions with a study coordinator, received regular phone call reminders, and had audible and visible reminders activated on their DA devices. The control group was told to take drops as prescribed and received no additional intervention. MAIN OUTCOME MEASURES: Change in drop use adherence as determined by the DA device. RESULTS: In the 3-month observation period before randomization, intervention group patients had used a mean of 54+/-17% of scheduled doses, and this increased to 73+/-22% during the following 3-month period (P<0.001, n = 35). The control mean adherence rate of 46+/-23% at baseline was statistically unchanged during the follow-up observation period (51+/-30%, P = 0.16, n = 31). In a multivariate analysis, intervention, baseline compliance rate of <50%, and white ethnicity were predictors of improved adherence during the 3 months of intervention. The intraocular pressure (IOP) of the intervention and control groups did not change between months 3 and 6 after intervention (P = 0.96, 0.34, respectively), and there was no correlation of IOP change with adherence rate change between both groups (Pearson correlation r = 0.06, P = 0.51). CONCLUSIONS: A multifaceted intervention significantly increased adherence with glaucoma medications. Those with improved adherence were in the intervention group, had very low adherence rates at baseline, and were white. IOP did not correlate with adherence. Further research is needed to determine which components of this intervention were most effective.

Risk factors for poor adherence to eyedrops in electronically monitored patients with glaucoma.

PURPOSE: To identify risk factors for poor adherence to topical once daily therapy for glaucoma. DESIGN: Prospective, observational cohort study. PARTICIPANTS: A total of 196 patients with glaucoma who were being treated with a prostaglandin analog in 1 or more eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007. METHODS: Demographics, ocular history, and responses to interview questions about glaucoma knowledge, health beliefs, and drop-taking behaviors were obtained from each patient. All patients used the Travatan Dosing Aid (DA; Alcon Laboratories Inc., Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months, and the data of drop use were downloaded using software provided with the DA. Patients taking 75% of doses. MAIN OUTCOME MEASURES: Risk factors for poor adherence. RESULTS: Eighty-seven patients (44.4% of the 196 subjects with evaluable data at 3 months) used the DA on 75% or less of the monitored days. In univariate analysis, poorer adherers were more likely to be <50 or >or=80 years of age, to be African American, to report less than excellent health, to report higher amounts of depression, to have lower income, and to be treated at the Scheie Eye Institute. Multivariate analysis (adjusting for education and income) found that age, race/ethnicity, and less than excellent health were associated with poor adherence. CONCLUSIONS: Those who failed to take more than 75% of eyedrop doses were more likely to be African American and to report poor health. Those in the youngest and oldest age groups were less adherent, although this finding was not always statistically significant. Further research into the factors driving these associations and into developing predictive models to assist in screening for low adherence are warranted. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study.

PURPOSE: To assess patient adherence and behaviors with topical once-daily therapy for glaucoma. DESIGN: Prospective, observational cohort study. PARTICIPANTS: One hundred ninety-six patients with glaucoma who were being treated with a prostaglandin analog in 1 or both eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007. METHODS: Detailed medical history was obtained from each patient. All subjects used the Travatan Dosing Aid (DA; Alcon, Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months and the data of drop usage was downloaded using software provided with the dosing aid. Data were analyzed for the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit. MAIN OUTCOME MEASURES: Assessment of adherence and patterns of drop usage as indicated by the DA. RESULTS: A total of 282 subjects consented to be in the study and 86 (30%) withdrew before study completion or had device errors, leaving 196 subjects (70%) with evaluable data at 3 months. The overall mean (+/-standard deviation) adherence rate was 0.71 (+/-0.24), ranging from 0.02 to 0.97. One hundred nine of these patients (55.6%) took greater than 75% of the expected doses. Those with adherence of less than 50% of expected doses showed substantially increased dose taking immediately after the office visit and just before the return visit at 3 months (P = 0.03). The mean adherence rate estimates of the physician and patient self-report were 0.77 and 0.95, respectively. The agreement between the physician assessment and DA-recorded adherence rate showed poor correlation for individual cases (intraclass correlation coefficient, 0.09; 95% confidence interval, 0.00-0.19). CONCLUSIONS: Nearly 45% of patients using an electronic monitoring device who knew they were being monitored and were provided free medication used their drops less than 75% of the time. Patients reported far higher medication use than their actual behavior. The ability of the physician to identify which persons are poorly adherent from their self-report or from other subjective clues is poor. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.