title: Comparison of 24-hour intraocular pressure reduction obtained with brinzolamide/timolol or brimonidine/timolol fixed-combination adjunctive to travoprost therapy.
abstract: BACKGROUND
  To determine the adjunctive 24-h efficacy obtained with brinzolamide/timolol, or brimonidine/timolol fixed combinations (FCs) in open-angle glaucoma patients insufficiently controlled on travoprost monotherapy.
  
  
  METHODS
  Prospective, observer-masked, active controlled, crossover, comparison. Qualified primary open-angle or exfoliative glaucoma patients with a baseline intraocular pressure (IOP) >18 mm Hg at 10:00 on travoprost monotherapy were randomized for 3 months to either brinzolamide/timolol, or brimonidine/timolol FC therapy adjunct to travoprost. Patients were then crossed-over to the opposite therapy for another 3 months. At baseline and at the end of each treatment period, the patients underwent 24-h IOP monitoring.
  
  
  RESULTS
  Fifty patients completed the study. The mean 24-h baseline IOP on travoprost monotherapy was 20.1 mm Hg [95% confidence interval (CI): 19.6, 20.7 mm Hg]. Both adjunctive FC therapies significantly reduced the IOP at each time point and for the mean 24-h IOP (P<0.001) compared with travoprost monotherapy. Brinzolamide/timolol FC provided a significantly lower mean 24-h IOP (17.2 mm Hg, 95% CI: 16.4, 17.9 mm Hg) than brimonidine/timolol FC (18.0 mm Hg, 95% CI: 17.3, 18.8 mm Hg) (P<0.001). For all the 3 timepoints between 18:00 and 02:00, the brinzolamide/timolol FC provided a significantly lower IOP than the brimonidine/timolol FC (P≤0.036). For the other 3 timepoints, no significant differences were detected.
  
  
  CONCLUSIONS
  This study demonstrated that both FCs provide statistically and clinically significant incremental 24-h IOP lowering to travoprost monotherapy. The brinzolamide/timolol FC however achieves a better mean 24-h IOP control owing to the greater efficacy in late afternoon and during the night.
authors.affiliation: Glaucoma Unit, 1st University Department of Ophthalmology, AHEPA Hospital, Thessaloniki, Greece. konstas@med.auth.gr
authors.forename: Anastasios G P
authors.initials: AG
authors.lastname: Konstas
authors.forename: Gábor
authors.initials: G
authors.lastname: Holló
authors.forename: Anna-Bettina
authors.initials: AB
authors.lastname: Haidich
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Mikropoulos
authors.forename: Theodoros
authors.initials: T
authors.lastname: Giannopoulos
authors.forename: Irini C
authors.initials: IC
authors.lastname: Voudouragkaki
authors.forename: Eleni
authors.initials: E
authors.lastname: Paschalinou
authors.forename: Vassilios
authors.initials: V
authors.lastname: Konidaris
authors.forename: John R
authors.initials: JR
authors.lastname: Samples
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000068438:Brimonidine Tartrate; D003008:Cloprostenol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018592:Cross-Over Studies; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011810:Quinoxalines / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*; D013997:Time Factors; D013999:Timolol / Q000627:therapeutic use*; D000069557:Travoprost
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D011810:Quinoxalines; D013449:Sulfonamides; D013876:Thiophenes; C479140:dorzolamide-timolol combination; D003008:Cloprostenol; D000068438:Brimonidine Tartrate; D013999:Timolol; D000069557:Travoprost