title: Fixed-combination brimonidine/timolol as adjunctive therapy to a prostaglandin analog: a 3-month, open-label, replacement study in glaucoma patients.
abstract: OBJECTIVE
  To evaluate intraocular pressure (IOP) and ocular allergy after replacement of 1 of 2 adjunctive therapy regimens (fixed-combination dorzolamide/timolol or dorzolamide/timolol plus brimonidine) with fixed-combination brimonidine/timolol in glaucoma patients treated with ongoing prostaglandin analog (PGA) therapy.
  
  
  METHODS
  This prospective, nonrandomized, open-label study involved patients on dorzolamide 2%/timolol 0.5% and a PGA who needed lower IOP and patients on brimonidine, dorzolamide 2%/timolol 0.5%, and a PGA who wanted to simplify their treatment regimens. After the baseline evaluation, patients were continued on the PGA and their other IOP-lowering medications were replaced with brimonidine 0.2%/timolol 0.5%. IOP was measured at baseline and months 1 and 3.
  
  
  RESULTS
  In patients who replaced dorzolamide/timolol with brimonidine/timolol (n = 45), the mean (SD) IOP was 15.9 (1.4) mm Hg at baseline, 13.3 (0.9) mm Hg after 1 month (P < 0.001 vs. baseline), and 13.3 (1.0) mm Hg after 3 months (P < 0.001 vs. baseline). In patients who replaced both brimonidine and dorzolamide/timolol with brimonidine/timolol (n = 15), the mean (SD) IOP was 15.9 (5.2) mm Hg at baseline, 13.8 (1.8) mm Hg after 1 month (P = 0.053 vs. baseline), and 13.8 (1.4) mm Hg after 3 months (P = 0.079 vs. baseline). Allergy was reported in 5 patients previously treated with dorzolamide/timolol and 1 patient previously treated with brimonidine plus dorzolamide/timolol.
  
  
  CONCLUSIONS
  For patients on multiple-drug therapy including a PGA, replacement of dorzolamide/timolol with brimonidine/timolol may help achieve a lower IOP, while replacement of brimonidine plus dorzolamide/timolol with brimonidine/timolol may help achieve as low an IOP with fewer medications.
authors.affiliation: Division of Ophthalmology, Scripps Clinic and Scripps Research Foundation, La Jolla, California 92037, USA. Nguyen.Quang@scrippshealth.org
authors.forename: Quang H
authors.initials: QH
authors.lastname: Nguyen
authors.forename: Melissa
authors.initials: M
authors.lastname: Earl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068438:Brimonidine Tartrate; D004338:Drug Combinations; D004342:Drug Hypersensitivity / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011461:Prostaglandins F, Synthetic / Q000627:therapeutic use; D011810:Quinoxalines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D013999:Timolol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D011461:Prostaglandins F, Synthetic; D011810:Quinoxalines; D013449:Sulfonamides; D013876:Thiophenes; D000068438:Brimonidine Tartrate; D013999:Timolol; C062765:dorzolamide