EyeWorld India March 2020 Issue

PHARMACEUTICALS EWAP MARCH 2020 51 by Maxine Lipner EyeWorld Senior Contributing Writer Bringing Rocklatan into the glaucoma fold Contact information Brubaker: jacobbrubaker@me.com Huang: lindayh@gmail.com Trubnik: valerietrubnik@yahoo.com Zhang: amydzhang@gmail.com T he new fixed- dose combination agent Rocklatan (netarsudil/ latanoprost, Aerie Pharmaceuticals), which gained FDA approval in March 2019, is garnering traction in many glaucoma practices. “I think that it’s really exciting to have the opportunity to have this medication available, especially as a once-daily formulation,” Amy Zhang, MD, said. For Dr. Zhang, this fixed-dose combination agent brings with it the potential for increased patient compliance. “By having combinations, it allows for less chance of someone not using the drop,” she said, adding that the dosing is easier since it requires instilling just one drop instead of two. Another benefit of the fixed-dose combination is that fewer preservatives and other additives are placed on the ocular surface where damage/ toxicity can result, according to Linda Huang, MD. “Additionally, you’re increasing the likelihood that patients are getting the drop in,” Dr. Huang said, adding that they’re not putting one drop and then having to wait 5–10 minutes to instill another. This article originally appeared in the January-February 2020 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. You don’t risk someone falling asleep before instilling all of their drops, she said. Valerie Trubnik, MD, pointed out that Rocklatan increased pressure lowering compared to either single agent in the combination, as seen in the FDA trials. “Over 60% of patients achieved greater than 30% reduction and more patients achieved lower IOPs than with just latanoprost (Xalatan, Pfizer) or [netarsudil] (Rhopressa, Aerie Pharmaceuticals) alone,” Dr. Trubnik said. This may allow some to attain pressures under 14 mmHg, something that may be even more important in patients with normal tension glaucoma, Dr. Trubnik noted. Jacob Brubaker, MD, described a low-tension glaucoma patient who had a pressure of 16 mmHg on a prostaglandin and Cosopt (dorzolamide hydrochloride 2% timolol maleate 0.5% ophthalmic solution, Akorn Pharmaceuticals) who needed better pressure control. One month after switching to Rocklatan, the patient came in with a pressure of 10 mmHg. “The beauty of this combination is that while the patient is on four medications, he is still only using two bottles,” Dr. Brubaker said. Making the switch Deciding when to use Rocklatan can vary. Dr. Huang views Rocklatan as a good switch for those who are already on prostaglandin monotherapy. “If they need additional therapy, it’s easy to switch them to Rocklatan so that they have two medications on board,” Dr. Huang said, adding that those with compliance issues, as well as those with low- tension glaucoma, can get a real boost from the addition of the netarsudil component in the combination. Dr. Zhang usually still prescribes a prostaglandin as the Source: Aerie Pharmaceuticals