In the last couple years, the Food and Drug Administration has approved several new ophthalmic topical medications. Some of them are novel drugs, while others are new formulations of familiar favorites.
Now that we've had the opportunity to use them in clinical practice, what place do these drugs have in our armamentarium? Are these drugs living up to their expected potential? Are providers incorporating them into their daily practice?
We went to some leaders in eye care to help answer these questions.
New Glaucoma Drops
* Simbrinza (brinzolamide/bri-monidine tartrate 1%/0.2%, Alcon) is the first beta blocker-free, fixed-combination suspension indicated for the reduction of elevated intraocular pressure in patients with primary open-angle glaucoma or ocular hypertension.
In Phase III studies, after six months of treatment, Simbrinza showed it lowered 10P by a mean of 1mm Hg to 3mm Hg more than the administration of either brimonidine tartate 0.2% or brinzolamide 1.0% individually, and a 21% to 35% sustained reduction in baseline IOP. (1), (2)
Although data showing two drugs combined is more effective than either drug administered individually is not exactly groundbreaking, there does still appear to be a useful therapeutic application. The general consensus among those consulted is to use Simbrinza not as first-line therapy but as adjunct therapy, especially for those patients in whom beta blockers are contraindicated and/or have crossed the threshold into multiple medications. The main reason cited was to simplify the instillation regimen: one bottle of Simbrinza TID vs. two bottles of brimonidine tartrate 0.2% and brinzolamide 1.0%. Simbrinza is an expensive combination of two very inexpensive generic drugs, so keep this in mind if cost is more of a concern than convenience. Also, it must be refrigerated under long-term storage, which has drastically limited sampling and is another detriment to its widespread use.
Remember that Simbrinza has not yet been studied in patients with kidney disease, so use it with caution as you would use each of the component medications separately. Paul Ajamian, OD, of Atlanta, says, "I have found a nice niche for patients who cannot use a beta blocker for pulmonary or heart reasons. Brinzolamide and brimonidine in one bottle works nicely, and with the Alcon Openings Patient Support Program, you may be able to save your patients some money. It is showing up on more and more formularies as well."
Paul Karpecki, OD, of Lexington, Ky., agrees, stating that it is surprising how many patients with glaucoma also have pulmonary or heart disease, so the option of a non-beta blocker combination agent seems to fill that role. "I've found that in patients with breathing problems, it is a better additional medication to prostaglandin analogs for lowering IOP," he says. "Patients don't tend to tolerate more than two bottles total, so I've found myself going to combination agents much more often when needing additional IOP reduction."
* Zioptan (tafluprost 0.0015%, Merck) is the first preservative-free prostaglandin analog (PGA) indicated to decrease IOP in patients with primary open-angle glaucoma or ocular hypertension. In a randomized clinical...