Switching from a preserved to a preservative-free prostaglandin preparation in topical glaucoma medication.
OBJECTIVE
The purpose of this study was to investigate the tolerability and intraocular pressure (IOP) reducing effect of the first preservative-free prostaglandin tafluprost (Taflotan) in patients exhibiting ocular surface side-effects during latanoprost (Xalatan) treatment.


METHODS
A total of 158 patients were enrolled in this open-label multicentre study. Eligible patients had to have at least two ocular symptoms, or one sign and one symptom, during treatment with latanoprost. At baseline, the patients were directly switched from latanoprost to preservative-free tafluprost for 12 weeks. The patients were queried for ocular symptoms, and ocular signs were assessed by using tear break-up time, Schirmer's test, fluorescein staining and evaluation of conjunctival hyperaemia and blepharitis. In addition, HLA-DR and MUC5AC in conjunctival impression cytology specimens were analyzed, and a drop discomfort/quality of life (QoL) questionnaire was employed. IOP was measured at all visits.


RESULTS
Preservative-free tafluprost maintained IOP at the same level after 12- weeks treatment (16.4 +/- 2.7 mmHg) as latanoprost at baseline (16.8 +/- 2.5 mmHg). During treatment with preservative-free tafluprost, the number of patients having irritation/burning/stinging (56.3%), itching (46.8%), foreign body sensation (49.4%), tearing (55.1%) and dry eye sensation (64.6%) decreased to 28.4%, 26.5%, 27.1%, 27.1% and 39.4% correspondingly. The number of the patients with abnormal fluorescein staining of cornea (81.6%) and conjunctiva (84.2%), blepharitis (60.1%), conjunctival hyperaemia (84.2%) and abnormal Schirmer's test (71.5%) was also reduced significantly to 40.6%, 43.2%, 40.6%, 60.0% and 59.4% correspondingly. The tear break-up time improved significantly from 4.5 +/- 2.5 seconds to 7.8 +/- 4.9 seconds. A reduction in the number of patients with abnormal conjunctival cells based on HLA-DR and MUC5AC was also detected.


CONCLUSIONS
Preservative-free tafluprost maintained IOP at the same level as latanoprost, but was better tolerated in patients having signs or symptoms while on preserved latanoprost. Preservative-free tafluprost treatment resulted in improved QoL, increased patient satisfaction and drop comfort.
Uusitalo
Hannu
H
University of Tampere and Tampere University Hospital, Finland. hannu.uusitalo@uta.fi <hannu.uusitalo@uta.fi>
Chen
Enping
E
Pfeiffer
Norbert
N
Brignole-Baudouin
Françoise
F
Kaarniranta
Kai
K
Leino
Markku
M
Puska
Päivi
P
Palmgren
Elina
E
Hamacher
Thomas
T
Hofmann
Günter
G
Petzold
Gernot
G
Richter
Ulrich
U
Riedel
Tobias
T
Winter
Martin
M
Ropo
Auli
A
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001548:Benzalkonium Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D001762:Blepharitis / Q000139:chemically induced / Q000378:metabolism / Q000517:prevention & control; D003229:Conjunctival Diseases / Q000139:chemically induced / Q000378:metabolism / Q000517:prevention & control; D017889:Exfoliation Syndrome / Q000188:drug therapy*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D006068:Gonioscopy; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced / Q000378:metabolism / Q000517:prevention & control; D007429:Intraocular Pressure / Q000187:drug effects*; D000077338:Latanoprost; D008297:Male; D008875:Middle Aged; D055271:Mucin 5AC / Q000378:metabolism; D009798:Ocular Hypertension / Q000188:drug therapy; D009887:Ophthalmoscopy; D017060:Patient Satisfaction; D011310:Preservatives, Pharmaceutical / Q000008:administration & dosage* / Q000009:adverse effects; D011460:Prostaglandins F / Q000008:administration & dosage*; D011461:Prostaglandins F, Synthetic / Q000008:administration & dosage / Q000009:adverse effects; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014065:Tonometry, Ocular
D000959:Antihypertensive Agents; D001548:Benzalkonium Compounds; D006684:HLA-DR Antigens; C524678:MUC5AC protein, human; D055271:Mucin 5AC; D011310:Preservatives, Pharmaceutical; D011460:Prostaglandins F; D011461:Prostaglandins F, Synthetic; C485333:tafluprost; D000077338:Latanoprost