EyeWorld India December 2017 Issue

69 EWAP PHARMACEUTICALS December 2017 Glaucoma medications update by Maxine Lipner EyeWorld Senior Contributing Writer Experts discuss new drops O ver the next few years, many developments will occur in the glaucoma pharma- ceutical space, with several new drugs set to emerge, according to Nathan Radcliffe, MD , New York University Langone Medi- cal Center, New York. “They all involve medications that aid in the outflow of the aqueous humor through the trabecular pathway,” Dr. Radcliffe said. The idea likely resonates with those doing MIGS procedures because practition- ers are trying to do many of the same things, namely reestablish natural outflow of aqueous humor through the trabecular pathway. Constance Okeke, MD , Eastern Virginia Medical School, Norfolk, Virginia, pointed out that there hasn’t been a new glaucoma medication in years. “Even though we have this explo- sion of new minimally invasive glaucoma surgeries, there’s still a huge window of opportunity for a new drop,” Dr. Okeke said. This may be especially true for the patient who is apprehensive about surgery, has allergies, or has developed tolerances to drops. Vyzulta on deck Of three new agents being ex- plored, the first to emerge will likely be Vyzulta (latanoprostene bunod, Bausch + Lomb, Bridgewa- ter, New Jersey), Dr. Radcliffe not- ed. “It’s a nitric oxide donating prostaglandin analogue,” he said, adding that as far as the U.S. Food & Drug Administration (FDA) is concerned, it’s going to be classi- fied as a prostaglandin analogue, which may have implications for insurance. “It may be tough to get for our patients because Bausch + Lomb will have to compete with the other prostaglandin ana- logues,” Dr. Radcliffe said. “But it has potency that looks to be better than latanoprost, and that could make it a very appealing first-line treatment for glaucoma.” Dr. Okeke agreed that Vyzulta is an intriguing new agent. “It has a dual mechanism of action; one is similar to prostaglandins, which is increasing the uveal scle- ral outflow pathways,” Dr. Okeke said. “The other exciting thing about it is its effect on nitric ox- ide.” In addition to relaxing tissue within the trabecular meshwork, the nitric oxide mechanism has an effect on Schlemm’s canal that enables it to regulate the volume within the canal. “Those two mechanisms can help to in- crease the outflow of the aqueous humor,” she said. “By increasing nitric oxide, it has an effect that can increase how much aqueous humor goes out of the outflow channels.” Pressure lowering with Vy- zulta is about 7 to 9 mmHg from baseline, Dr. Okeke noted. This may give practitioners even more reason to consider it as a first-line medication, she thinks. Dr. Radcliffe said that the new agent could be particularly appealing for a younger glaucoma patient in whom practitioners would like to keep fluid going through the pathway with the ni- tric oxide mechanism; this could help from the standpoint of try- ing to maintain the normal level of physiologic outflow. Dr. Radcliffe thinks that some practitioners may want to use this for the next several years until the patient has a stent placed or undergoes some other trabecular outflow procedure. Various mechanisms of action for common ocular hypotensive agents used in the treatment of glaucoma and the classes of medication associated with those actions Source: Constance Okeke, MD continued on page 70