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Khopade AJ, Halder A, Patel V, Upadhyay S, Burade V, Pateliya B, Panchal S, Mandhane S, Awati C, Zope M. Preclinical Evaluation of a Novel Once-a-Day Brimonidine Ophthalmic Nanosuspension. J Ocul Pharmacol Ther 2023. [PMID: 37646731 DOI: 10.1089/jop.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Purpose: This article aims to describe a preclinical proof of concept for a novel once-a-day (OD) brimonidine ophthalmic nanosuspension. Methods: The preclinical proof of concept was established using New Zealand white rabbits as animal models. Dose-finding, multiple-dose efficacy, ocular pharmacokinetic, and hemodynamic studies were performed in normotensive rabbits. Steroid-induced ocular hypertension model in rabbits was used to study efficacy in glaucomatous pathophysiology. The test (0.35% OD suspension) and reference (0.15% three times a day [TID] solution) were compared. Results: The intraocular pressure (IOP) reduction was sustained for 0.35% and 0.5% strengths but not for other lower strengths tested or reference strengths. A 0.35% OD suspension reduced IOP >2 mmHg after 24 h of dosing, which was not seen with the reference. After multiple dosing, 0.35% OD suspension reduced IOP by 4-6 mmHg after 24 h, which was comparable to the 0.15% TID reference solution. An ocular pharmacokinetic study showed that the brimonidine was rapidly absorbed and distributed throughout the eye after topical administration. Concentration was higher in tissues with high α2 receptors, such as cornea-conjunctiva, iris/ciliary body, and choroid/retina. The steady-state concentrations in these organs were also significant after 24 h of the last dose. There was an indication of increased plasma levels, so a hemodynamic study was performed to assess any adverse effects. All hemodynamic parameters were normal and no new unusual safety findings were observed. Conclusions: The study demonstrated that the novel brimonidine 0.35% ophthalmic nanosuspension is both safe and effective when administered OD and is comparable to the marketed reference formulation administered TID.
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Affiliation(s)
- Ajay J Khopade
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Arindam Halder
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Vivek Patel
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Shivam Upadhyay
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Vinod Burade
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Bharat Pateliya
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Satish Panchal
- Department of Translational Development, Sun Pharma Advanced Research Company Ltd., Vadodara, India
| | - Sanjay Mandhane
- Department of Translational Development, Sun Pharma Advanced Research Company Ltd., Vadodara, India
| | - Chandan Awati
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Murlidhar Zope
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
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Hsueh HT, Chou RT, Rai U, Liyanage W, Kim YC, Appell MB, Pejavar J, Leo KT, Davison C, Kolodziejski P, Mozzer A, Kwon H, Sista M, Anders NM, Hemingway A, Rompicharla SVK, Edwards M, Pitha I, Hanes J, Cummings MP, Ensign LM. Machine learning-driven multifunctional peptide engineering for sustained ocular drug delivery. Nat Commun 2023; 14:2509. [PMID: 37130851 PMCID: PMC10154330 DOI: 10.1038/s41467-023-38056-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/12/2023] [Indexed: 05/04/2023] Open
Abstract
Sustained drug delivery strategies have many potential benefits for treating a range of diseases, particularly chronic diseases that require treatment for years. For many chronic ocular diseases, patient adherence to eye drop dosing regimens and the need for frequent intraocular injections are significant barriers to effective disease management. Here, we utilize peptide engineering to impart melanin binding properties to peptide-drug conjugates to act as a sustained-release depot in the eye. We develop a super learning-based methodology to engineer multifunctional peptides that efficiently enter cells, bind to melanin, and have low cytotoxicity. When the lead multifunctional peptide (HR97) is conjugated to brimonidine, an intraocular pressure lowering drug that is prescribed for three times per day topical dosing, intraocular pressure reduction is observed for up to 18 days after a single intracameral injection in rabbits. Further, the cumulative intraocular pressure lowering effect increases ~17-fold compared to free brimonidine injection. Engineered multifunctional peptide-drug conjugates are a promising approach for providing sustained therapeutic delivery in the eye and beyond.
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Affiliation(s)
- Henry T Hsueh
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Renee Ti Chou
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Usha Rai
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wathsala Liyanage
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yoo Chun Kim
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew B Appell
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Jahnavi Pejavar
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kirby T Leo
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Charlotte Davison
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Patricia Kolodziejski
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ann Mozzer
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - HyeYoung Kwon
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Maanasa Sista
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Nicole M Anders
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Avelina Hemingway
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Sri Vishnu Kiran Rompicharla
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Malia Edwards
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ian Pitha
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin Hanes
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Michael P Cummings
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA.
| | - Laura M Ensign
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA.
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA.
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Belamkar A, Harris A, Zukerman R, Siesky B, Oddone F, Verticchio Vercellin A, Ciulla TA. Sustained release glaucoma therapies: Novel modalities for overcoming key treatment barriers associated with topical medications. Ann Med 2022; 54:343-358. [PMID: 35076329 PMCID: PMC8794062 DOI: 10.1080/07853890.2021.1955146] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Glaucoma is a progressive optic neuropathy and a leading cause of irreversible blindness. The disease has conventionally been characterized by an elevated intraocular pressure (IOP); however, recent research has built the consensus that glaucoma is not only dependent on IOP but rather represents a multifactorial optic neuropathy. Although many risk factors have been identified ranging from demographics to co-morbidities to ocular structural predispositions, IOP is currently the only modifiable risk factor, most often treated by topical IOP-lowering medications. However, topical hypotensive regimens are prone to non-adherence and are largely inefficient, leading to disease progression in spite of treatment. As a result, several companies are developing sustained release (SR) drug delivery systems as alternatives to topical delivery to potentially overcome these barriers. Currently, Bimatoprost SR (DurystaTM) from Allergan plc is the only FDA-approved SR therapy for POAG. Other SR therapies under investigation include: bimatoprost ocular ring (Allergan) (ClinicalTrials.gov identifier: NCT01915940), iDose® (Glaukos Corporation) (NCT03519386), ENV515 (Envisia Therapeutics) (NCT02371746), OTX-TP (Ocular Therapeutix) (NCT02914509), OTX-TIC (Ocular Therapeutix) (NCT04060144), and latanoprost free acid SR (PolyActiva) (NCT04060758). Additionally, a wide variety of technologies for SR therapeutics are under investigation including ocular surface drug delivery systems such as contact lenses and nanotechnology. While challenges remain for SR drug delivery technology in POAG management, this technology may shift treatment paradigms and dramatically improve outcomes.
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Affiliation(s)
- Aditya Belamkar
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alon Harris
- Department of Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Zukerman
- Department of Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Opthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brent Siesky
- Department of Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Thomas A Ciulla
- Indiana University School of Medicine, Indianapolis, IN, USA.,Vitreoretinal Medicine and Surgery, Midwest Eye Institute, Indianapolis, IN, USA
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4
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Khopade AJ, Halder A, Burade V, Pateliya B, Jani K, Patel V, Upadhyay S. Ophthalmic suspension of Brimonidine for sustained delivery using nano-resin/drug complex technique. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chan AHY, Foot H, Pearce CJ, Horne R, Foster JM, Harrison J. Effect of electronic adherence monitoring on adherence and outcomes in chronic conditions: A systematic review and meta-analysis. PLoS One 2022; 17:e0265715. [PMID: 35312704 PMCID: PMC8936478 DOI: 10.1371/journal.pone.0265715] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/07/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Electronic adherence monitoring (EAM) is increasingly used to improve adherence. However, there is limited evidence on the effect of EAM in across chronic conditions and on patient acceptability. We aimed to assess the effect of EAM on adherence and clinical outcomes, across all ages and all chronic conditions, and examine acceptability in this systematic review and meta-analysis. METHODS A systematic search of Ovid MEDLINE, EMBASE, Social Work Abstracts, PsycINFO, International Pharmaceutical Abstracts and CINAHL databases was performed from database inception to December 31, 2020. Randomised controlled trials (RCTs) that evaluated the effect of EAM on medication adherence as part of an adherence intervention in chronic conditions were included. Study characteristics, differences in adherence and clinical outcomes between intervention and control were extracted from each study. Estimates were pooled using random-effects meta-analysis, and presented as mean differences, standardised mean differences (SMD) or risk ratios depending on the data. Differences by study-level characteristics were estimated using subgroup meta-analysis to identify intervention characteristics associated with improved adherence. Effects on adherence and clinical outcomes which could not be meta-analysed, and patient acceptability, were synthesised narratively. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed, and Risk of bias (RoB) assessed using the Cochrane Collaboration's RoB tool for RCTs. The review is registered with PROSPERO CRD42017084231. FINDINGS Our search identified 365 studies, of which 47 studies involving 6194 patients were included. Data from 27 studies (n = 2584) were extracted for the adherence outcome. The intervention group (n = 1267) had significantly better adherence compared to control (n = 1317), (SMD = 0.93, CI:0.69 to 1.17, p<0.0001) with high heterogeneity across studies (I2 = 86%). There was a significant difference in effect according to intervention complexity (p = 0.01); EAM only improved adherence when used with a reminder and/or health provider support. Clinical outcomes were measured in 38/47 (81%) of studies; of these data from 14 studies were included in a meta-analysis of clinical outcomes for HIV, hypertension and asthma. In total, 13/47 (28%) studies assessed acceptability; patient perceptions were mixed. INTERPRETATION Patients receiving an EAM intervention had significantly better adherence than those who did not, but improved adherence did not consistently translate into clinical benefits. Acceptability data were mixed. Further research measuring effects on clinical outcomes and patient acceptability are needed.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Centre of Behavioural Medicine, School of Pharmacy, University College London, London, United Kingdom
| | - Holly Foot
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Christina Joanne Pearce
- Centre of Behavioural Medicine, School of Pharmacy, University College London, London, United Kingdom
| | - Rob Horne
- Centre of Behavioural Medicine, School of Pharmacy, University College London, London, United Kingdom
| | | | - Jeff Harrison
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Yang Y, Lockwood A. Topical ocular drug delivery systems: Innovations for an unmet need. Exp Eye Res 2022; 218:109006. [DOI: 10.1016/j.exer.2022.109006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/06/2022] [Accepted: 02/20/2022] [Indexed: 02/07/2023]
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Leshno A, Gaton D, Singer R, Eliasi E, Vorobichik-Berar O, Madgar S, Stern O, Jaber W, Kapelushnik N, Skaat A. A novel EyePhone© App for improving adherence to glaucoma therapy. Graefes Arch Clin Exp Ophthalmol 2021; 259:1253-1262. [PMID: 33528649 DOI: 10.1007/s00417-021-05091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Despite advances in glaucoma treatment options, patient adherence and compliance remain very low. The EyePhone© App is a free non-commercial reminder application designed specifically for the needs of glaucoma patients. In this study, we evaluated its usefulness in improving adherence to medical treatment among glaucoma patients. METHODS This is a prospective multicenter interventional study. Glaucoma patients were recruited from a tertiary center and a large community glaucoma service center. After a short explanation, the EyePhone© App was installed on their smartphone device, and the notifications for the current medical treatment were entered. After enrollment and at 1-month follow-up, subjects completed the Morisky Medication Adherence Scale (MMAS-8) and the Quality of Life and Glaucoma 17-item (GlauQOL-17) questionnaires for evaluation of adherence and QOL, respectively. RESULTS In the study, 133 patients (71 men and 62 women) aged 62±15.5 years and using 2.0±0.9 IOP-lowering drugs participated. The proportion of highly adherent subjects improved from 29.3% (39/133) at baseline to 42.1% (56/133) at follow-up (P < 0.001), and the proportion of poorly adherent subjects decreased from 29.3 (39/133) to 20.3% (27/133) at follow-up (P = 0.012). QOL also improved, as evidenced by a significant increase in the GlauQOL-17 score (P < 0.05). In a subgroup of patients for whom IOP measurements were available, IOP reduced by 0.92 mmHg (P = 0.069). CONCLUSIONS Significant improvements in glaucoma adherence and QOL were achieved among poorly adherent glaucoma patients after 1 month of using the EyePhone© App.
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Affiliation(s)
- Ari Leshno
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Gaton
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Glaucoma Institute, "Clalit" Healthcare Services, Century Tower, Tel Aviv, Israel
| | - Reut Singer
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elior Eliasi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofri Vorobichik-Berar
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Shiran Madgar
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ori Stern
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wasim Jaber
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Kapelushnik
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Skaat
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tapply I, Broadway DC. Improving Adherence to Topical Medication in Patients with Glaucoma. Patient Prefer Adherence 2021; 15:1477-1489. [PMID: 34239297 PMCID: PMC8259615 DOI: 10.2147/ppa.s264926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
The glaucomas form a heterogenous group of conditions, which collectively account for one of the most common irreversible causes of blindness worldwide. The only treatment, for which there is evidence, to stop or slow glaucomatous disease progression is to lower intraocular pressure (IOP); this is most often initially achieved with topical medication. Adherence to anti-glaucoma therapy is known to be low even when compared with adherence to therapy for other chronic conditions. We performed a PubMed search to review evidence as to how adherence to and persistence with anti-glaucoma medications might be improved. Approaches to improving adherence include technological (such as using smart drop bottles or automated reminders) use of instillation aids, improving communication with patient education and improving tolerability of eye drop formulations. There is limited short-term evidence that automated reminders can be effective and, unfortunately, instillation aids have not proved to be efficacious with respect to improving adherence. A range of factors have been identified which affect adherence and persistence, although only a multi-faceted approach has proven evidence of efficacy, compared to improved patient education alone. There is now a wider range of available preservative-free eye drops, which have been shown to be non-inferior in achieving IOP control, with fewer side effects and improved short-term adherence. Further studies relating to adherence are warranted, particularly given the projected increase in glaucoma prevalence worldwide.
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Affiliation(s)
- Ian Tapply
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
- Department of Ophthalmology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
- Correspondence: Ian Tapply Department of Ophthalmology, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UKTel +44 7810 583319 Email
| | - David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
- School of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, UK
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Marques RE, Sousa DC, Vandewalle E, Somers A, Melamed S, Nardi M, Figus M, Stalmans I, Abegao Pinto L. The effect of glaucoma treatment using high-intensity focused ultrasound on total and corneal astigmatism: a prospective multicentre study. Acta Ophthalmol 2020; 98:833-840. [PMID: 32421229 DOI: 10.1111/aos.14467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Ultrasound cycloplasty (UCP) acts through the selective coagulation of the ciliary body using high-intensity focused ultrasound (HIFU) technology. The aim of this study was to investigate whether the application of ultrasound beams targeting the ciliary body using an external probe influences astigmatism. METHODS Multicentre, prospective, single-arm, open-label study in adult patients with primary open-angle glaucoma and moderately uncontrolled intraocular pressure (IOP) under glaucoma medication. The primary outcome was induced corneal astigmatism, calculated from topography, and assessed statistically through vector analysis. Secondary outcomes included induced total astigmatism and mean changes from baseline in best-corrected visual acuity (logMAR) and IOP. Subgroup analysis was performed to assess the impact of device centring on corneal and total induced astigmatism. RESULTS Fifty eyes were enrolled. Mean age was 69.6 ± 11.3 years. At 1, 3 and 6 months postprocedure, HIFU-induced corneal astigmatism was 0.88 D × 93°, 0.87 D × 106° and 1.16 D × 97°, respectively, while induced total astigmatism was 0.62 D × 103°, 0.42 × 106° and 0.39 × 107°. By the last follow-up, the percentage of patients with <0.50, <1.00, <1.50 and <2.00 D of induced corneal versus total astigmatism was 8.3% versus 46%, 29% versus 66%, 62.5% versus 88% and 79% versus 94%. Visual acuity was statistically significantly impaired at 1 month, but no difference remained by 3 and 6 months postprocedure. CONCLUSION Ultrasound cycloplasty procedure is associated with increased corneal astigmatism. However, its impact on total refractive astigmatism is less pronounced.
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Affiliation(s)
- Raquel Esteves Marques
- Department of Ophthalmology Hospital de Santa Maria Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Vision Sciences Study Centre CECV Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
| | - David Cordeiro Sousa
- Department of Ophthalmology Hospital de Santa Maria Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Vision Sciences Study Centre CECV Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
| | - Evelien Vandewalle
- Department of Neurosciences Research Group of Ophthalmology KU Leuven Leuven Belgium
- Department of Ophthalmology University Hospitals UZ Leuven Leuven Belgium
| | - Alix Somers
- Department of Neurosciences Research Group of Ophthalmology KU Leuven Leuven Belgium
- Department of Ophthalmology University Hospitals UZ Leuven Leuven Belgium
| | - Shlomo Melamed
- The Sam Rothberg Glaucoma Centre Goldschleger Eye Institute Sheba Medical Centre Tel‐Aviv University Tel‐Hashomer Israel
| | - Marco Nardi
- Department of Surgical Medical, Molecular Pathology and of Critical Area University of Pisa Pisa Italy
| | - Michele Figus
- Department of Surgical Medical, Molecular Pathology and of Critical Area University of Pisa Pisa Italy
| | - Ingeborg Stalmans
- Department of Neurosciences Research Group of Ophthalmology KU Leuven Leuven Belgium
- Department of Ophthalmology University Hospitals UZ Leuven Leuven Belgium
| | - Luis Abegao Pinto
- Department of Ophthalmology Hospital de Santa Maria Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Vision Sciences Study Centre CECV Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
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Gelling hypotonic polymer solution for extended topical drug delivery to the eye. Nat Biomed Eng 2020; 4:1053-1062. [PMID: 32895514 PMCID: PMC7655548 DOI: 10.1038/s41551-020-00606-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/28/2020] [Indexed: 01/19/2023]
Abstract
Eye-drop formulations should hold as high a concentration of soluble drug in contact with ocular epithelium for as long as possible. However, eye tears and frequent blinking limit drug retention on the ocular surface, and gelling drops typically form clumps that blur vision. Here, we describe a gelling hypotonic solution containing a low concentration of a thermosensitive triblock copolymer, for extended ocular drug delivery. On topical application, the hypotonic formulation forms a highly uniform and clear thin layer that conforms to the ocular surface and resists clearance from blinking, significantly increasing the intraocular absorption of hydrophilic and hydrophobic drugs and extending the drug–ocular-epithelium contact time with respect to conventional thermosensitive gelling formulations and commercial eye drops. We also show that the conformal gel layer allows for therapeutically relevant drug delivery to the eyeball’s posterior segment in pigs. Our findings highlight the importance of formulations that conform to the ocular surface prior to viscosity enhancement, for increased and prolonged ocular-surface contact and drug absorption.
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11
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The Effect of Patient Education and Telemedicine Reminders on Adherence to Eye Drops for Glaucoma. Ophthalmol Glaucoma 2020; 3:369-376. [PMID: 32980041 DOI: 10.1016/j.ogla.2020.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine the improvement in patient adherence to topical ocular hypotensive therapy by introducing a personalized illustrated medication reference chart and telereminder. DESIGN Prospective randomized controlled clinical trial. PARTICIPANTS Fifty-nine patients with glaucoma who were using at least 3 or more eye drops were recruited from the ophthalmology clinic at the National University Hospital of Singapore. METHODS Participants were randomized into 3 groups: control, reference chart only, and reference chart with telereminder. They completed a survey on demographics, barriers to glaucoma medication adherence, and self-adherence (measured by the Morisky adherence scale) before and 6 weeks after intervention. Logistic regression analysis was performed on the barriers that contribute to nonadherence and paired t tests were conducted for the preimplementation and postimplementation effects of intervention on adherence score. MAIN OUTCOME MEASURES Changes in mean adherence score based on the Morisky adherence scale before and after intervention in participants from all 3 groups. RESULTS In our study, 71% of participants who were nonadherent to medications had multiple barriers to adherence, with lack of self-efficacy and forgetfulness being the most common factors. Only the reference chart with telereminder group showed a statistically significant increase in mean adherence score, from 7.18 to 7.69 (P = 0.047). CONCLUSIONS Adherence to medication in chronic diseases like glaucoma is an important healthcare issue to address. Most of these patients have poor adherence because of multiple factors, and hence interventions aimed at improving adherence should be multifaceted to target these barriers.
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Lambert WS, Pasini S, Collyer JW, Formichella CR, Ghose P, Carlson BJ, Calkins DJ. Of Mice and Monkeys: Neuroprotective Efficacy of the p38 Inhibitor BIRB 796 Depends on Model Duration in Experimental Glaucoma. Sci Rep 2020; 10:8535. [PMID: 32444682 PMCID: PMC7244559 DOI: 10.1038/s41598-020-65374-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/04/2020] [Indexed: 01/23/2023] Open
Abstract
Glaucoma is a group of optic neuropathies associated with aging and sensitivity to intraocular pressure (IOP). Early progression involves retinal ganglion cell (RGC) axon dysfunction that precedes frank degeneration. Previously we demonstrated that p38 MAPK inhibition abates axonal dysfunction and slows degeneration in the inducible microbead occlusion model of glaucoma in rat. Here, we assessed the neuroprotective effect of topical eye delivery of the p38 MAPK inhibitor BIRB 796 in three models of glaucoma (microbead occlusion in rat and squirrel monkey and the genetic DBA/2 J mouse model) with distinct durations of IOP elevation. While BIRB 796 did not influence IOP, treatment over four weeks in rats prevented degradation of anterograde axonal transport to the superior colliculus and degeneration in the optic nerve. Treatment over months in the chronic DBA/2 J model and in the squirrel monkey model reduced expression and activation of p38 downstream targets in the retina and brain but did not rescue RGC axon transport or degeneration, suggesting the efficacy of BIRB 796 in preventing associated degeneration of the RGC projection depends on the duration of the experimental model. These results emphasize the importance of evaluating potential therapeutic compounds for neuroprotection in multiple models using elongated treatment paradigms for an accurate assessment of efficacy.
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Affiliation(s)
- Wendi S Lambert
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37232-2337, USA
| | - Silvia Pasini
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37232-2337, USA
| | - John W Collyer
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37232-2337, USA
| | - Cathryn R Formichella
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37232-2337, USA
| | - Purnima Ghose
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37232-2337, USA
| | - Brian J Carlson
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37232-2337, USA
| | - David J Calkins
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37232-2337, USA.
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13
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Cimolai N. A review of neuropsychiatric adverse events from topical ophthalmic brimonidine. Hum Exp Toxicol 2020; 39:1279-1290. [DOI: 10.1177/0960327120918307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Brimonidine is a first-line topical medication for increased intraocular pressure and glaucoma which may be used alone or in conjunction with other topical therapies. Its structural and pharmacological comparabilities to clonidine give way to the hypothesis that it may cause neuropsychiatric side effects. The majority of case reports citing brimonidine toxicity, either for topical or peripheral exposure, include pediatric age groups but especially infants. Among the latter, a dose-response phenomenon is evident. Dose-response correlates have also been shown among adults. Case series and prospective double-blind treatment studies also give evidence for the occurrence of several central nervous system adverse reactions. Topical ophthalmic brimonidine use should be followed for the occurrence of neuropsychiatric disturbances generally, and enhanced vigilance should be maintained for at-risk populations.
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Affiliation(s)
- N Cimolai
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Children’s and Women’s Health Centre of British Columbia, Vancouver, BC, Canada
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14
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Varadaraj V, Kahook MY, Ramulu PY, Pitha IF. Patient Acceptance of Sustained Glaucoma Treatment Strategies. J Glaucoma 2019; 27:328-335. [PMID: 29462013 DOI: 10.1097/ijg.0000000000000913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess patient acceptance of different methods for delivering sustained-release, intraocular pressure (IOP)-lowering medications. METHODS Electronic surveys were administered to 150 patients at 2 glaucoma clinics. Participants were questioned on their willingness to accept: (1) drug-eluting contact lenses, (2) ring inserts (3) punctal plugs, and (4) subconjunctival injections as alternatives to IOP-lowering eye drops based on various success levels. Multivariable logistic regression models determined the association between device type and treatment acceptance adjusting for age, sex, study site, cost burden of drops, and previous contact lens use. RESULTS The majority (69%) of participants were 55 to 74 years of age, and white (65%), and half were female. The majority of participants would accept contacts (59%), rings (51%), plugs (57%), and subconjunctival injections (52%) if they obviated glaucoma surgery; fewer would accept these devices if they reduced (23% to 35%) or eliminated (27% to 42%) drops. Most participants would also accept contacts (56%), plugs (55%), and subconjunctival injections (53%) if they were more effective than eye drops, whereas only 47% would accept a ring; fewer would accept any device if it were equally or less effective than drops. Participants were also 36% (95% confidence interval=0.44-0.92; P=0.02) less likely to accept rings and 32% (95% confidence interval=0.47-0.98; P=0.04) less likely to accept subconjunctival injections as compared with contacts. CONCLUSION Most glaucoma patients considered sustained drug-delivery modalities acceptable alternatives to IOP-lowering eye drops, but only when they were said to obviate surgery or demonstrate greater efficacy than eye drops.
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Affiliation(s)
| | - Malik Y Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | | | - Ian F Pitha
- Glaucoma Center of Excellence.,Center for Nanomedicine, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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15
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Hasebe Y, Kashiwagi K, Tsumura T, Suzuki Y, Yoshikawa K, Suzumura H, Maeda T, Takeda R, Saito H, Araie M. Changes in adherence and associated factors among patients on newly introduced prostaglandin analog and timolol fixed-combination therapy. Patient Prefer Adherence 2018; 12:1567-1577. [PMID: 30214159 PMCID: PMC6118338 DOI: 10.2147/ppa.s168921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We investigated patient adherence and factors related to a newly introduced prostaglandin analog and timolol fixed-combination eye drops (PGTFC). PATIENTS AND METHODS The Glaucoma Research on Adherence to fixed-Combination Eye drops in Japan (GRACE) study group performed a nationwide prospective questionnaire survey. Participants in this study were patients with glaucoma who were scheduled to receive any type of PGTFC for the first time. The participants answered a questionnaire on the day of PGTFC introduction and again at a return visit 4-6 weeks after PGTFC introduction. The physicians in charge were asked to complete a separate questionnaire on the day of PGTFC introduction. One of two leaflets was randomly delivered to each participant before the description of the PGTFC. One leaflet explained how to correctly instill the eye drops, and the other explained the clinical meaning of intraocular pressure reduction in addition to explaining how to correctly instill the eye drops. Nonadherence was defined as forgetting to instill the eye drops one or more times during the week before the return visit. RESULTS In total, 3,597 patients (age, 68.4±12.2 years) met the study protocol requirements. PGTFC introduction significantly reduced the number of antiglaucoma eye drops from 1.93±0.78 to 1.34±0.54 (P<0.0001) and significantly improved adherence (P<0.00001). Factors significantly associated with nonadherence at the return visit included a history of nonadherence as reported by either the patient or their physician before introduction, acceptable instillation times as reported by the patient, and burdensome eye drop instillation as reported by the patient. No significant difference was observed between the two leaflets in terms of their effects on adherence. CONCLUSION PGTFC significantly improved adherence and some of the factors that were significantly associated with adherence. REGISTRATION NUMBER UMIN000013696.
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Affiliation(s)
- Yuka Hasebe
- Department of Ophthalmology, University of Yamanashi, Yamanashi, Japan,
| | - Kenji Kashiwagi
- Department of Ophthalmology, University of Yamanashi, Yamanashi, Japan,
| | | | - Yasuyuki Suzuki
- Department of Ophthalmology, Tokai University, Kanagawa, Japan
| | | | | | | | - Ryuji Takeda
- Faculty of Agriculture, Kinki University, Nara, Japan
| | - Hitomi Saito
- Department of Ophthalmology, Kanto Central Hospital of the Mutual Aid Association of Public School, Tokyo, Japan
| | - Makoto Araie
- Department of Ophthalmology, Kanto Central Hospital of the Mutual Aid Association of Public School, Tokyo, Japan
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16
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Fedorchak MV, Conner IP, Schuman JS, Cugini A, Little SR. Long Term Glaucoma Drug Delivery Using a Topically Retained Gel/Microsphere Eye Drop. Sci Rep 2017; 7:8639. [PMID: 28819134 PMCID: PMC5561248 DOI: 10.1038/s41598-017-09379-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to characterize and determine the efficacy of a long-term, non-invasive gel/microsphere (GMS) eye drop for glaucoma. This novel drug delivery system is comprised of a thermoresponsive hydrogel carrier and drug-loaded polymer microspheres. In vitro release of brimonidine from the GMS drops and gel properties were quantified. A single brimonidine-loaded GMS drop was administered to 5 normotensive rabbits and intraocular pressure (IOP) was monitored for 28 days. Here we report that IOP reduction in rabbits receiving a single brimonidine GMS drop was comparable to that of rabbits receiving twice daily, standard brimonidine drops. GMS drops were retained in the inferior fornix in all animals for the length of the study. Our results suggest in vivo efficacy over 28 days from a single GMS drop and a potential decrease in systemic absorption, based on a lack of substantial IOP effects on the fellow untreated eye, compared to brimonidine twice-daily eye drops. To our knowledge, this represents the first long-term, drug-releasing depot that can be administered as a traditional eye drop.
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Affiliation(s)
- Morgan V Fedorchak
- UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, USA. .,The Louis J. Fox Center for Vision Restoration, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA. .,The McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Ian P Conner
- UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, USA.,The Louis J. Fox Center for Vision Restoration, University of Pittsburgh, Pittsburgh, PA, USA.,The McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel S Schuman
- UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, USA.,The Louis J. Fox Center for Vision Restoration, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,The McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Ophthalmology, Langone Eye Center, NYU School of Medicine, New York, NY, USA.,Department of Neuroscience, NYU School of Medicine, New York, NY, USA.,Department of Physiology, NYU School of Medicine, New York, NY, USA.,Depatment of Electrical and Computer Engineering, NYU Tandon School of Engineering, New York, NY, USA
| | - Anthony Cugini
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven R Little
- UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, USA. .,Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA. .,The McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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17
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Cairns EA, Szczesniak AM, Straiker AJ, Kulkarni PM, Pertwee RG, Thakur GA, Baldridge WH, Kelly MEM. The In Vivo Effects of the CB 1-Positive Allosteric Modulator GAT229 on Intraocular Pressure in Ocular Normotensive and Hypertensive Mice. J Ocul Pharmacol Ther 2017; 33:582-590. [PMID: 28719234 DOI: 10.1089/jop.2017.0037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Orthosteric cannabinoid receptor 1 (CB1) activation leads to decreases in intraocular pressure (IOP). However, use of orthosteric CB1 agonists chronically has several disadvantages, limiting their usefulness as clinically relevant drugs. Allosteric modulators interact with topographically distinct sites to orthosteric ligands and may be useful to circumvent some of these disadvantages. The purpose of this study was to investigate the effects of the novel CB1-positive allosteric modulator (PAM) GAT229 on IOP. METHODS IOP was measured using rebound tonometry in anesthetized normotensive C57Bl/6 mice and in a genetic model of ocular hypertension [nose, eyes, ears (nee) mice] before drug administration, and at 1, 6, and 12 h thereafter. RESULTS In normotensive mice, topical administration of 5 μL GAT229 alone at either 0.2% or 2% did not reduce IOP. However, a subthreshold dose (0.25%) of the nonselective orthosteric CB1 agonist WIN 55,212-2, when combined with 0.2% GAT229, significantly reduced IOP compared with vehicle at 6 and 12 h. Similarly, combination of subthreshold Δ9-tetrahydrocannabinol (a nonselective orthosteric CB1 agonist; 1 mg/kg) with topical 0.2% GAT229 produced IOP lowering at 6 h. In nee mice, administration of topical 0.2% GAT229 or 10 mg/kg GAT229 alone was sufficient to lower IOP at 6 and 12 h, and 12 h, respectively. CONCLUSIONS The CB1 PAM GAT229 reduces IOP in ocular hypertensive mice and enhanced CB1-mediated IOP reduction when combined with subthreshold CB1 orthosteric ligands in normotensive mice. Administration of CB1 PAMs may provide a novel approach to reduce IOP with fewer of the disadvantages associated with orthosteric CB1 activation.
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Affiliation(s)
- Elizabeth A Cairns
- 1 Department of Pharmacology, Dalhousie University , Halifax, Nova Scotia, Canada
| | | | - Alex J Straiker
- 2 Department of Psychological and Brain Sciences, Indiana University , Bloomington, Indiana
| | - Pushkar M Kulkarni
- 3 Department of Pharmaceutical Sciences School of Pharmacy, Bouvé College of Health Sciences, Northeastern University , Boston, Massachusetts
| | - Roger G Pertwee
- 4 School of Medicine, Medical Sciences, and Nutrition, Institute of Medical Sciences, University of Aberdeen , Aberdeen, Scotland
| | - Ganesh A Thakur
- 3 Department of Pharmaceutical Sciences School of Pharmacy, Bouvé College of Health Sciences, Northeastern University , Boston, Massachusetts
| | - William H Baldridge
- 5 Department of Medical Neuroscience, Dalhousie University , Halifax, Nova Scotia, Canada .,6 Department of Ophthalmology and Visual Sciences, Dalhousie University , Halifax, Nova Scotia, Canada
| | - Melanie E M Kelly
- 1 Department of Pharmacology, Dalhousie University , Halifax, Nova Scotia, Canada .,6 Department of Ophthalmology and Visual Sciences, Dalhousie University , Halifax, Nova Scotia, Canada
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18
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Fu J, Sun F, Liu W, Liu Y, Gedam M, Hu Q, Fridley C, Quigley HA, Hanes J, Pitha I. Subconjunctival Delivery of Dorzolamide-Loaded Poly(ether-anhydride) Microparticles Produces Sustained Lowering of Intraocular Pressure in Rabbits. Mol Pharm 2016; 13:2987-95. [PMID: 27336794 DOI: 10.1021/acs.molpharmaceut.6b00343] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Topical medications that inhibit the enzyme carbonic anhydrase (CAI) are widely used to lower intraocular pressure in glaucoma; however, their clinical efficacy is limited by the requirement for multiple-daily dosing, as well as side effects such as blurred vision and discomfort on drop instillation. We developed a biodegradable polymer microparticle formulation of the CAI dorzolamide that produces sustained lowering of intraocular pressure after subconjunctival injection. Dorzolamide was ion paired with sodium dodecyl sulfate (SDS) and sodium oleate (SO) with 0.8% and 1.5% drug loading in poly(lactic-co-glycolic acid) (PLGA), respectively. Encapsulating dorzolamide into poly(ethylene glycol)-co-poly(sebacic acid) (PEG3-PSA) microparticles in the presence of triethylamine (TEA) resulted in 14.9% drug loading and drug release that occurred over 12 days in vitro. Subconjunctival injection of dorzolamide-PEG3-PSA microparticles (DPP) in Dutch belted rabbits reduced IOP as much as 4.0 ± 1.5 mmHg compared to untreated fellow eyes for 35 days. IOP reduction after injection of DPP microparticles was significant when compared to baseline untreated IOPs (P < 0.001); however, injection of blank microparticles (PEG3-PSA) did not affect IOP (P = 0.9). Microparticle injection was associated with transient clinical vascularity and inflammatory cell infiltration in conjunctiva on histological examination. Fluorescently labeled PEG3-PSA microparticles were detected for at least 42 days after injection, indicating that in vivo particle degradation is several-fold longer than in vitro degradation. Subconjunctival DPP microparticle delivery is a promising new platform for sustained intraocular pressure lowering in glaucoma.
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Affiliation(s)
- Jie Fu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Fengying Sun
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Wenhua Liu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Yanfei Liu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Manasee Gedam
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Qi Hu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Colleen Fridley
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Harry A Quigley
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Justin Hanes
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Ian Pitha
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
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19
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Lusthaus JA, Goldberg I. Emerging drugs to treat glaucoma: targeting prostaglandin F and E receptors. Expert Opin Emerg Drugs 2016; 21:117-28. [DOI: 10.1517/14728214.2016.1151001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Characterization of Glaucoma Medication Adherence in Kaiser Permanente Southern California. J Glaucoma 2016; 25:22-6. [DOI: 10.1097/ijg.0000000000000205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lambert WS, Carlson BJ, van der Ende AE, Shih G, Dobish JN, Calkins DJ, Harth E. Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure. Transl Vis Sci Technol 2015; 4:1. [PMID: 25599009 DOI: 10.1167/tvst.4.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
PURPOSE We examined the efficacy of an extended-release drug delivery system, nanosponge (NS) encapsulated compounds, administered intravitreally to lower intraocular pressure (IOP) in mice. METHODS Bilateral ocular hypertension was induced in mice by injecting microbeads into the anterior chamber. Hypertensive mice received NS loaded with ocular hypotensive drugs via intravitreal injection and IOP was monitored. Retinal deposition and retinal ganglion cell (RGC) uptake of Neuro-DiO were examined following intravitreal injection of Neuro-DiO-NS using confocal microscopy. RESULTS Brimonidine-loaded NS lowered IOP 12% to 30% for up to 6 days (P < 0.02), whereas travoprost-NS lowered IOP 19% to 29% for up to 4 days (P < 0.02) compared to saline injection. Three bimatoprost NS were tested: a 400-nm NS and two 700-nm NS with amorphous (A-NS) or amorphous/crystalline (AC-NS) crosslinkers. A single injection of 400 nm NS lowered IOP 24% to 33% for up to 17 days compared to saline, while A-NS and AC-NS lowered IOP 22% to 32% and 18% to 26%, respectively, for up to 32 days (P < 0.046). Over time retinal deposition of Neuro-DiO increased from 19% to 71%; Neuro-DiO released from NS was internalized by RGCs. CONCLUSIONS A single injection of NS can effectively deliver ocular hypotensive drugs in a linear and continuous manner for up to 32 days. Also, NS may be effective at targeting RGCs, the neurons that degenerate in glaucoma. TRANSLATIONAL RELEVANCE Patient compliance is a major issue in glaucoma. The use of NS to deliver a controlled, sustained release of therapeutics could drastically reduce the number of patients that progress to vision loss in this disease.
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Affiliation(s)
- Wendi S Lambert
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian J Carlson
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Grace Shih
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julia N Dobish
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David J Calkins
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA ; Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eva Harth
- Department of Chemistry, Vanderbilt University, Nashville, TN, USA
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22
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28-day intraocular pressure reduction with a single dose of brimonidine tartrate-loaded microspheres. Exp Eye Res 2014; 125:210-6. [DOI: 10.1016/j.exer.2014.06.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 11/18/2022]
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Beckers HJM, Webers CAB, Busch MJWM, Brink HMA, Colen TP, Schouten JSAG. Adherence improvement in Dutch glaucoma patients: a randomized controlled trial. Acta Ophthalmol 2013; 91:610-8. [PMID: 23025424 DOI: 10.1111/j.1755-3768.2012.02571.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the effect of patient education and the TravAlert(®) -Eyot(®) drop guider on intraocular pressure (IOP) and adherence in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT) monitored with the TravAlert(®) dosing aid. METHODS Multicentre, randomized, controlled clinical trial among 18 Dutch hospitals. Patients were randomized to one of the four study arms: (1) use of the dosing aid, (2) use of the dosing aid with the drop guider, (3) use of the dosing aid together with patient education or (4) use of the dosing aid and drop guider together with patient education. IOP was recorded at baseline and after 3 and 6 months. Data on adherence generated by the dosing aid were collected and studied at the end of the study. RESULTS Mean IOP dropped from 20.3 ± 5.7 mmHg at baseline to 16.3 ± 4.0 mmHg (right eye) after 6 months and from 20.2 ± 5.9 mmHg to 16.4 ± 4.1 mmHg (left eye). The mean adherence rate was 0.91 ± 0.1. IOP and adherence rate were not statistically different between the study arms. Patients with 'drug holidays' had a significantly higher mean IOP after 6 months. Patients who used the drop guider were less adherent. A lower adherence level was also associated with new patients with glaucoma and patients with a lower level of knowledge on glaucoma. CONCLUSION Patient education is especially useful for new patients with glaucoma. The use of a drop guider does not improve adherence. Especially patients with 'drug holidays' are at risk for developing uncontrolled IOP levels.
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Affiliation(s)
- Henny J M Beckers
- University Eye Clinic, Maastricht University Medical Centre, Maastricht, The NetherlandsDepartment of Ophthalmology, Catharina Hospital, Eindhoven, The NetherlandsDepartment of Ophthalmology, Jeroen Bosch Hospital, 's Hertogenbosch, The NetherlandsDepartment of Ophthalmology, Amphia Hospital Langendijk, Breda, The Netherlands
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Biodegradable nanoparticles for controlled subconjunctival delivery of latanoprost acid: In vitro and in vivo evaluation. Preliminary results. Exp Eye Res 2013; 112:29-36. [DOI: 10.1016/j.exer.2013.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 11/21/2022]
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25
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Konstas AGP, Mocan MC, Katsanos A, Voudouragkaki IC, Irkec M. Latanoprost/timolol fixed combination for the treatment of glaucoma. Expert Opin Pharmacother 2013; 14:1815-27. [DOI: 10.1517/14656566.2013.813482] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Waterman H, Evans JR, Gray TA, Henson D, Harper R. Interventions for improving adherence to ocular hypotensive therapy. Cochrane Database Syst Rev 2013:CD006132. [PMID: 23633333 DOI: 10.1002/14651858.cd006132.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Poor adherence to therapy is a significant healthcare issue, particularly in patients with chronic disease such as open-angle glaucoma. Treatment failure may necessitate unwarranted changes of medications, increased healthcare expenditure and risk to the patient if surgical intervention is required. Simplifying eye drop regimes, providing adequate information, teaching drop instillation technique and ongoing support according to the patient need may have a positive effect on improving adherence. OBJECTIVES To summarise the effects of interventions for improving adherence to ocular hypotensive therapy in people with ocular hypertension (OHT) or glaucoma. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 6), MEDLINE (June 1946 to June 2012), EMBASE (June 1980 to June 2012), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (June 1937 to June 2012), PsycINFO (1806 to June 2012), PsycEXTRA (1908 to June 2012), Web of Science (1970 to June 2012), ZETOC (1993 to June 2012), OpenGrey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 26 June 2012. We did not search the National Research Register (NNR) as this resource has now been now archived. We contacted pharmaceutical manufacturers to request unpublished data and searched conference proceedings for the Association for Research in Vision and Ophthalmology (ARVO), and the Annual Congress for the Royal College of Ophthalmologists (RCO). SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that compared interventions to improve adherence to ocular hypotensive therapy for patients with OHT or glaucoma. DATA COLLECTION AND ANALYSIS At least two authors independently assessed the search results for eligibility and extracted data for included trials onto specifically designed forms. We did not pool data due to clinical and methodological heterogeneity. MAIN RESULTS Sixteen trials (1565 participants) met the inclusion criteria. Seven studies investigated some form of patient education. In six of these studies this education was combined with other behavioural change interventions including tailoring daily routines to promote adherence to eye drops. Eight studies compared different drug regimens (one of these trials also compared open and masked monitoring) and one study investigated a reminder device. The studies were of variable quality and some were at considerable risk of bias; in general, the length of follow-up was short at less than six months with only two studies following up to 12 months. Different interventions and outcomes were reported and so it was not possible to produce an overall estimate of effect. There was some evidence from three studies that education combined with personalised interventions, that is, more complex interventions, improved adherence to ocular hypotensive therapy. There was less information on other outcomes such as persistence and intraocular pressure, and no information on visual field defects, quality of life and cost. There was weak evidence as to whether people on simpler drug regimens were more likely to adhere and persist with their ocular hypotensive therapy. A particular problem was the interpretation of cross-over studies, which in general were not reported correctly. One study investigated a reminder device and monitoring but the study was small and inconclusive. AUTHORS' CONCLUSIONS Although complex interventions consisting of patient education combined with personalised behavioural change interventions, including tailoring daily routines to promote adherence to eye drops, may improve adherence to glaucoma medication, overall there is insufficient evidence to recommend a particular intervention. The interventions varied between studies and none of the included studies reported on the cost of the intervention. Simplified drug regimens also could be of benefit but again the current published studies do not provide conclusive evidence. Future studies should follow up for at least one year, and could benefit from standardised outcomes.
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Affiliation(s)
- Heather Waterman
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Deokule SP, Baffi JZ, Guo H, Nazzaro M, Kaneko H. Evaluation of extended release brimonidine intravitreal device in normotensive rabbit eyes. Acta Ophthalmol 2012; 90:e344-8. [PMID: 22676067 DOI: 10.1111/j.1755-3768.2012.02418.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the safety profile of a brimonidine extended release intravitreal implant, in normotensive rabbit eyes. METHODS Devices were made from hollow poly-l-lactic acid (PLA) tubes and contained hundred micrograms of brimonidine pamoate. Device was injected intravitreally in one eye of 12 New Zealand pigmented rabbits, whereas other eye was injected with a sham implant in masked fashion. Ocular examination was conducted at baseline and months 1, 3 and 6 including dilated fundus examination and electro-retinogram (ERG). Four rabbits were sacrificed at each time-point for retinal histology. ERG data were compared between groups and time-points using anova. RESULTS No complications were reported from either eye of any rabbits over a 6-month period. Photopic A wave was reduced in the control eye at 1 month compared with baseline (p < 0.01). There was no significant difference in other ERG parameters between the groups at different time-points. Gross retinal histology was normal at all time-points. CONCLUSION Extended release intravitreal brimonidine device was found to be safe and in normotensive rabbit eyes.
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Affiliation(s)
- Sunil P Deokule
- Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, KY, USA.
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Reardon G, Kotak S, Schwartz GF. Objective assessment of compliance and persistence among patients treated for glaucoma and ocular hypertension: a systematic review. Patient Prefer Adherence 2011; 5:441-63. [PMID: 22003282 PMCID: PMC3191921 DOI: 10.2147/ppa.s23780] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE This study summarizes findings from objective assessments of compliance (or adherence) and persistence with ocular hypotensive agents in patients with glaucoma and ocular hypertension. DESIGN Systematic literature review. METHODS A PubMed and reference list search was conducted across publication years 1970-2010, using these terms and variants: "compliance," the equivalent term "adherence," and "persistence" in patients with these conditions and therapies. Summaries of selected studies were stratified by measurement method (electronic monitor, prescription fills review, medical chart review). Measures of central tendency across studies were calculated for commonly-reported compliance or persistence measures. RESULTS Fifty-eight articles met all inclusion/exclusion criteria: measurement of compliance-electronic monitoring (seven studies reported in 14 articles), measurement of compliance/ persistence-prescription records (36 studies in 38 articles), and measurement of persistence- medical chart review (six studies in six articles). From electronic monitoring, most therapy-experienced patients took medication consistently, but ≥20% met criteria for poor compliance. From prescription records, only 56% (range 37%-92%) of the days in the first therapy year could be dosed with the medication supply dispensed over this period. At 12 months from therapy start, only 31% (range 10%-68%) of new therapy users had not discontinued, and 40% (range 14%-67%) had not discontinued or changed the initial therapy. From medical chart review, only 67% (range 62%-78%) of patients remained persistent 12 months after starting therapy. CONCLUSIONS Evidence provided by this review suggests that poor compliance and persistence has been and remains a common problem for many glaucoma patients, and is especially problematic for patients new to therapy. The direction of empirical research should shift toward a greater emphasis on understanding of root causes and identification and testing of solutions for this problem.
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Affiliation(s)
- Gregory Reardon
- Informagenics, LLC, Worthington, OH, USA; The Ohio State University College of Pharmacy, Columbus, OH, USA
- Correspondence: Gregory Reardon, Informagenics, LLC, 450 W. Wilson, Bridge Rd, Suite 340, Worthington, OH 43085, USA, Tel +1 614 847 1900, Fax +1 614 573 7129, Email
| | | | - Gail F Schwartz
- Glaucoma Consultants, Greater Baltimore Medical Center; Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
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