EyeWorld Asia-Pacific September 2014 Issue

27 EWAP GLAUCOMA September 2014 groups.” There is also a preservative- free latanoprost. “The knock on latanoprost has always been that if you created a preservative- free version, it wouldn’t be as efficacious,” Dr. Bacharach said. However, he cited recent study results published in the January issue of the Journal of Glaucoma dispelling this. Long-acting therapy One of the holy grails for glaucoma medication is increasing the duration of therapy. These new prostaglandin analogue products could potentially be injected or placed where they will be chronically released. “The nice thing about that is you’re going to get a consistent pressure lowering over roughly a 3- to 4-month period of time,” Dr. Simmons said. “The injectable that is being worked on looks as if it’s going to be every 3 to 6 months.” Also in the pipeline are some unique long-term delivery systems. Dr. Katz said that may include devices that are placed inside the eye as an injection or pellets that will sit for an extended period and deliver drugs without the patient having to take eye drops. He mentioned a slow- delivery contact lens, dubbed TODDD (Topical Ophthalmic Drug Delivery Device, Amorphex Therapeutics, Andover, Mass., U.S.) as one example of what is possible. There are also punctal plugs in development by Mati Therapeutics (Austin, Texas, U.S.) and Ocular Therapeutix (Bedford, Mass., U.S.) for long-term drug delivery. “That slowly delivers drug from the punctal plug placement over a period of months,” Dr. Katz said. Dr. Bacharach said that Ocular Therapeutix is looking at sustained release of one of the prostaglandins in the plug. The plugs would be placed in the lower puncta just like a punctal plug for dry eye, Dr. Bacharach explained. Another unique design being developed involves bioerodible sustained- release latanoprost (pSivida, Watertown, Mass., U.S.). “That is a compact deliverable implant,” Dr.Bacharach said. “The implant is designed to provide a long-term sustained-release of latanoprost. It’s designed to be injected into the subconjunctival space in a minimally invasive outpatient procedure.” Also under consideration is long-term liposomal delivery of latanoprost with a product known as Lipolat. This involves nanoparticles delivering the latanoprost, Dr. Bacharach explained, adding that the first human pilot study with this, conducted by Tina T. Wong, MD , PhD, was promising. “There were 6 patients with ocular hypertension or open- angle glaucoma with unmedicated pressures greater than 24, and they received a single subconjunctival injection of 100 microliters of Lipolat, which is 100 micrograms of latanoprost,” he said. “They found the unmedicated pressure was between 25 and 33 mmHg, and all the patients experienced a reduction greater than or equal to 5 mmHg, with 3 out of 6 experiencing a reduction of greater than or equal to 10 mmHg.” Pressures here were measured for up to 3 months. Going forward, all eyes in glaucoma practices will most likely be on these new products. But will these compete with entrenched drugs such as latanoprost? Dr. Katz does not see why not. “In the beginning it’s hard to overtake the leading drug class, but it could happen,” he said. “The prostaglandins replaced beta blockers pretty quickly as a first- line therapy, so it’s conceivable if you get a great product out there it could happen.” EWAP Reference Cucherat M, Stalmans I, Rouland JF. Relative efficacy and safety of preservative- free latanoprost (T2345) for the treatment of openangle glaucoma and ocular hypertension: an adjusted indirect comparison meta- analysis of randomized clinical trials. J Glaucoma. 2014 Jan;23(1):e69–75. Editors’ note: Dr. Bacharach has financial interests with Aerie Pharmaceuticals, Alcon (Fort Worth, Texas, U.S.), Allergan (Irvine, Calif., U.S.), and Bausch + Lomb. Dr. Simmons has financial interests with Allergan, Aerie Pharmaceuticals, and Merck (Whitehouse Station, NJ, U.S.). Dr.Katz has financial interests with Aerie Pharmaceuticals, Allergan, Amorphex Therapeutics, Bausch + Lomb, and Mati Therapeutics. Contact information Bacharach: jb@northbayeye.com Katz: ljkatz@willseye.org Simmons: glaucomaconsult@aol.com New - from page 25