title: Comparison of the ocular hypotensive efficacy of adjunctive brimonidine 0.15% or brinzolamide 1% in combination with travoprost 0.004%.
abstract: OBJECTIVE
  To compare efficacies of adjunctive therapy with brimonidine 0.15% and adjunctive therapy with brinzolamide 1% in combination with travoprost 0.004%.
  
  
  METHODS
  Three-month randomized, parallel-group, double-masked, multicenter clinical trial.
  
  
  METHODS
  Patients with primary open-angle glaucoma, exfoliation glaucoma, or ocular hypertension with intraocular pressure (IOP) > 18 mmHg on monotherapy with travoprost (N = 163).
  
  
  METHODS
  Patients were randomized to receive adjunctive therapy with twice-daily brimonidine (N = 79) or twice-daily brinzolamide (N = 84). Treatment efficacy was assessed after 1 and 3 months of combination therapy. Intraocular pressure was measured at 8 am, noon, and 4 pm at baseline (on travoprost monotherapy) and after 3 months of combination therapy. Mean diurnal IOP was defined as the average of the IOP measurements at these 3 time points. Adverse events were recorded at each visit.
  
  
  METHODS
  Difference between treatment groups in mean diurnal IOP at month 3, adjusted for difference in baseline IOP, using analysis of covariance.
  
  
  RESULTS
  Mean diurnal IOPs (+/- standard error of the mean) at baseline were 21.7+/-0.33 mmHg in the brimonidine group and 21.1+/-0.29 mmHg in the brinzolamide group (P = 0.16). Mean diurnal IOPs at month 3 were 19.6+/-0.41 mmHg in the brimonidine group and 18.4+/-0.33 mm Hg in the brinzolamide group (P = 0.019). At month 3, mean diurnal IOPs, adjusted for difference in baseline IOP, were 19.3+/-0.27 in the brimonidine group and 18.6+/-0.25 in the brinzolamide group (P = 0.035).
  
  
  CONCLUSIONS
  The combination of travoprost and brinzolamide was statistically significantly more efficacious than the combination of travoprost and brimonidine in lowering IOP. The clinical significance of this difference is uncertain.
authors.affiliation: Department of Ophthalmology and Visual Science, University of Texas Medical School, Houston, Texas, USA. rmfeldman@swbell.net
authors.forename: Robert M
authors.initials: RM
authors.lastname: Feldman
authors.forename: Angelo P
authors.initials: AP
authors.lastname: Tanna
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Gross
authors.forename: Alice Z
authors.initials: AZ
authors.lastname: Chuang
authors.forename: Laura
authors.initials: L
authors.lastname: Baker
authors.forename: Adam
authors.initials: A
authors.lastname: Reynolds
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Prager
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000068438:Brimonidine Tartrate; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D002940:Circadian Rhythm; D003008:Cloprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D017889:Exfoliation Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D011810:Quinoxalines / Q000008:administration & dosage / Q000627:therapeutic use*; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use*; D013843:Thiazines / Q000008:administration & dosage / Q000627:therapeutic use*; D000069557:Travoprost; D016896:Treatment Outcome
chemical_list: D000316:Adrenergic alpha-Agonists; D002257:Carbonic Anhydrase Inhibitors; D011810:Quinoxalines; D013449:Sulfonamides; D013843:Thiazines; D003008:Cloprostenol; D000068438:Brimonidine Tartrate; C111827:brinzolamide; D000069557:Travoprost