Replacing maximum-tolerated medications with latanoprost versus adding latanoprost to maximum-tolerated medications: a two-center randomized prospective trial.
OBJECTIVE
To compare the replacement of every drug with latanoprost 0.005% once a day in glaucomatous eyes with poorly controlled intraocular pressure upon combination therapy, versus addition of latanoprost to the pre-existing treatment.


METHODS



METHODS
prospective, investigator-masked, two-center, randomized clinical trial lasting 3 months.


METHODS
open-angle glaucoma; IOP > or = 21 mm Hg upon the combination of a non-selective beta-blocker with pilocarpine or dorzolamide or both; no previous bulbar surgery; and prior glaucoma therapy lasting at least 2 years. Two treatment arms: (1) addition of latanoprost 0.005% QD to the pre-existing therapy [group A]; (2) substitution with latanoprost alone [group B].


RESULTS
One hundred thirty-six eyes (68 eyes/treatment group) were randomized according to intraocular pressure level and the number of adjunctive medications to beta blocker. Both treatments provided a significant IOP decrease over baseline (from 23.5 +/- 1.4 to 19.7 +/- 1.9 mm Hg in group A, (P < 0.001); from 23.2 +/- 1.3 to 20.1 +/- 2.2 mm Hg in group B (P < 0.001), paired Student t test). At the end of the follow-up period, group A showed a higher number of intraocular readings less than or equal to 18 mm Hg than group B (42.6% vs. 30.8%; Fisher exact test: P = 0.018).


CONCLUSIONS
In eyes showing an intraocular pressure greater than 21 mm Hg upon combination therapy, the substitution of the pre-existing treatment with latanoprost can provide a significant IOP decrease. However, adding latanoprost to the pre-existing therapy is more likely to achieve a target intraocular pressure less than or equal to 18 mm Hg.
Gandolfi
Stefano A
SA
Glaucoma Research and Care Center, University of Parma, Milan, Italy. s.gandolfi@rsadvnet.it
Rossetti
Luca
L
Cimino
Luca
L
Mora
Paolo
P
Tardini
Mariagrazia
M
Orzalesi
Nicola
N
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D000077338:Latanoprost; D008875:Middle Aged; D010862:Pilocarpine / Q000008:administration & dosage*; D011461:Prostaglandins F, Synthetic / Q000627:therapeutic use*; D019233:Retreatment; D016037:Single-Blind Method; D013449:Sulfonamides / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D011461:Prostaglandins F, Synthetic; D013449:Sulfonamides; D013876:Thiophenes; D010862:Pilocarpine; D000077338:Latanoprost; C062765:dorzolamide