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A significant number of glaucoma patients are currently being treated with more than one medication. In the Ocular Hypertension Treatment Study, 40% of patients were being treated with two or more medications after 5 years.1 This was with a very modest IOP reduction goal of 20%. These figures most likely would have been higher with a more aggressive treatment goal.
1. Kass MA, Heuer DK, Higginbotham EJ et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120:701-713.
The correlation between elevated IOP and progressive visual field loss has been well documented in the literature.1
Moreover, studies show that as many as 50% of glaucoma patients do not comply with dosing instructions of their medications.
Dosing frequency and convenience are important factors contributing to patient compliance and ultimately to the success of therapy.2,3
This slide set provides an overview of the Phase III clinical studies with Travoprost 0.004% / Timolol 0.5% fixed combination.
The trade name for this product is EXTRAVAN™.
EXTRAVAN™ provides the benefits of dual mechanisms of lowering IOP and the convenience of a single once-a-day drop.
Goldberg I. Relationship between intraocular pressure and preservation of visual field in glaucoma. Surv Ophthal. 48[Suppl 1]:S3-S7, 2003.
Patel SC, Spaeth GL. Compliance in patients prescribed eyedrops for glaucoma. Ophthalmic Surg. 1995; 26: 233-236.
Weinreb RN. Compliance with medical treatment of glaucoma. J Glaucoma 1992; 1: 134-136.
Voici les différentes molécules que vous connaissez bien, que vous retrouvez dans les associations existantes :
En jaune les inhibiteurs de l’anhydrase carbonique
En bleu les analogues de prostaglandines
En gris les -bloquants
En vert les α2 agonistes
pour citer les plus utilisées.
Le cœur de l’association fixe, c’est le timolol, aujourd’hui (ne figurent ici que les 6 associations fixes « modernes ») comme hier.
Previously published data has demonstrated, that non-compliance is a serious issue, however patients are more compliant on one medication versus two medications.1
1. Patel SC, Spaeth GL. Compliance in patients prescribed eyedrops for glaucoma. Ophthalmic Surg. 1995;26(3):234-236
Besides a decrease in the percentage of patients who are compliant, other potential problems can develop with patients on multiple medications. Although we ask patients to wait a minimum of 5 minutes between dosing different medications, how many actually do this? This slide demonstrates the issue of “washout effect”. If patients only wait 30 seconds between dosing medications, up to 45% of the first medication can be washed out by the second. If the patient waits two minutes, 17% of the first medication is washed out. Patients should wait at least 5 minutes, to eliminate the potential to washout the first medication. 1
1. Chrai SS, Makoid MC, Eriksen SP, Robinson JR. Drop size and initial dosing frequency problems of topically applied ophthalmic drugs. J Pharm Sci. 1974; 63(3): 333-338.
Les résultats montrent une réduction de la PIO moyenne à 8h comparable dans les 2 groupes.
De plus, l’association fixe a permis d’obtenir des réductions de PIO avec des valeurs comprises dans l’ensemble entre 15,2 et 16,5mmHg.
La non infériorité entre les 2 groupes a été prouvée pour 7 points sur 9 (pour un inférieur à l’IC 95% = 1,5mmHg) ; ce qui est meilleur ce que le schéma veut bien montrer avec 4 points sur 9 significativement inférieurs à 10h et 16h car différence supérieure à 5%.
The numbers in the chart represent the percentage of patients whose hyperaemia worsened by at least one severity grade from baseline. The overall incidences of hyperaemia were 19.3% (GANfort), 25.6% (unfixed combination) and 27.8% (bimatoprost). From Hommer et al. Eur J Ophthalmol 2007; 17: 53–62
Non-inferior at 2 hours, but not at 8 hours, probably due to the three times daily dosing of dorzolamide vs twice daily COSOPT. The study met the pre-defined criterion for establishing treatment equivalence, of 95% or greater confidence that the difference between treatments in mean change in IOP lies between -1.5 and 1.5 mmHg.
Xalacom was administered in the morning in this study, vs latanoprost in the evening and timolol twice daily.
Primary endpoint was within-patient variability of IOP within 1 mmHg of unfixed combination. This was not met.