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Shahid S, Rizvi SWA, Khan AA, Ashraf H, Akhter A. Comparison of safety and efficacy of Netarsudil 0.02% and Bimatoprost 0.01% monotherapy and combination therapy in primary open-angle glaucoma and ocular hypertension. Indian J Ophthalmol 2024; 72:427-431. [PMID: 38146971 PMCID: PMC11001237 DOI: 10.4103/ijo.ijo_1340_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE To study and compare the efficacy and safety profile of Rho-kinase inhibitor (netarsudil 0.02%) and prostaglandin analog (bimatoprost 0.01%) both as monotherapy and in combination. DESIGN Prospective, randomized, monocentric, open-label clinical trial. METHODS Patients ≥20 years of age with primary open-angle glaucoma or ocular hypertension (IOP >21 mmHg) were recruited and randomized to receive either netarsudil 0.02%, netarsudil 0.02% + bimatoprost 0.01%, or bimatoprost 0.01% once daily for a period of 12 weeks. IOP and side effects were documented at 4, 8, and 12 weeks. RESULTS The mean treated IOP ranged 17.51-18.57 mmHg for netarsudil, 15.80-16.46 mmHg for bimatoprost, and 14.00-14.87 mmHg for the combination therapy group. The mean IOP reduction from baseline at 4, 8, and 12 weeks was found to be statistically significant ( P < 0.001) in all three groups. The safety profile of netarsudil/bimatoprost combination was consistent with each constituent individually. The only frequently observed ocular adverse event was conjunctival hyperemia, which was seen mostly in netarsudil and netarsudil + bimatoprost groups ( P < 0.001). CONCLUSION The IOP-lowering effect of netarsudil 0.02% once daily is non-inferior to bimatoprost 0.01% in patients with POAG and ocular hypertension with acceptable ocular safety, and the combination therapy achieved a higher IOP-lowering effect. This group of medications can be a useful adjunct in patients on maximal therapy.
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Affiliation(s)
- Saima Shahid
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Syed Wajahat A Rizvi
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Adeeb A Khan
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Humayoun Ashraf
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Afeefa Akhter
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
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Mathur MC, Ratnam PV, Saikumar S, John M, Ravishankar S, Dinesh M, Chandil P, Pahuja K, Cherlikar V, Wadhwani S, Bendale P, Hazari A, Mishra R, Deshmukh S, Achlerkar RR, Shah DT, Hingorani C, Shah K, Topiwala P, Jani S, Rana VG, Majumdar NK, Chakrabarti D, Dey R, Halder D, Choudhury S, Kumar A, Das S, Nanda AK, Kumar VB, Dubey R, Kamdar GA, Pandey A, Kishanpuria S, Srivastava RM, Singh P, Verma SK, Sharma N, Gupta R. Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety. Indian J Ophthalmol 2023; 71:2500-2503. [PMID: 37322670 PMCID: PMC10418014 DOI: 10.4103/ijo.ijo_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40-80. The best way to manage primary open-angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods An open-label, real-world, multicentric, observation-based 3-month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first-line therapy. Diurnal IOP measurements, best-corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day-1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results Four hundred and sixty-nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once-daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion We found that netarsudil 0.02% w/v solution monotherapy when used as the first-line treatment in primary open-angle glaucoma and ocular hypertension was both safe and effective.
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Affiliation(s)
| | | | | | - Manuel John
- Holy Ghost Mission Hospital, Kottayam, Kerala, India
| | | | - M.B Dinesh
- Uma Eye Clinic, Chennai, Tamil Nadu, India
| | | | - Kishore Pahuja
- Natasha Eye Care and Research Centre, Pune, Maharashtra, India
| | | | | | - Pankaj Bendale
- Dr. Bendale’s Eye Care, Pimpri-Chinchwad, Maharashtra, India
| | - Ajit Hazari
- Hazari Nursing Home, Aurangabad, Maharashtra, India
| | - Rajesh Mishra
- Advanced Eye Hospital, A Unit of Dr Agarwals Eye Hospital, Vashi, Navi Mumbai, Maharashtra, India
| | - Susheel Deshmukh
- Sudrishti Eye Care and Goregaon Glaucoma Centre, Mumbai, Maharashtra, India
| | | | | | | | - Kaivan Shah
- Bhavna Super Speciality Eye Care, Surat, Gujarat, India
| | | | - Sheetal Jani
- Netralaya Superspecialty Eye Hospital, Ahmedabad, Gujarat, India
| | - Viral G. Rana
- Shree Bidada Survoday Trust- Laxmi Jyot Eye Hospital, Bidada, Gujarat, India
| | | | | | - Rituparna Dey
- Citizen’s Eye and Healthcare, Hooghly, West Bengal, India
| | | | | | - Ajeet Kumar
- Sharda Eye and Dental Hospital, Patna, Bihar, India
| | - Sasmita Das
- Kar Vision Eye Hospital, Bhubaneshwar, Odisha, India
| | | | | | - Rama Dubey
- Rama Eye Hospital, Jaipur, Rajasthan, India
| | | | | | | | | | - Parul Singh
- GSVM Medical College, Kanpur,Uttar Pradesh, India
| | | | - Neha Sharma
- P.C. Sharma Eye Hospital, Ambala, Haryana, India
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Kitaoka Y, Sase K, Tsukahara C, Fujita N, Arizono I, Kogo J, Tokuda N, Takagi H. Axonal Protection by Netarsudil, a ROCK Inhibitor, Is Linked to an AMPK-Autophagy Pathway in TNF-Induced Optic Nerve Degeneration. Invest Ophthalmol Vis Sci 2022; 63:4. [PMID: 34982146 PMCID: PMC8742515 DOI: 10.1167/iovs.63.1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Netarsudil, a Rho kinase inhibitor with norepinephrine transport inhibitory effect, lowers intraocular pressure, however, its effect on axon damage remains to be elucidated. The aim of the current study was to investigate the effect of netarsudil on TNF-induced axon loss and to examine whether it affects phosphorylated-AMP-activated kinase (p-AMPK) and autophagy in the optic nerve. Methods Intravitreal administration of TNF or TNF with netarsudil was carried out on rats and quantification of axon number was determined. Electron microscopy determined autophagosome numbers. Localization of p-AMPK expression was examined by immunohistochemistry. The changes in p62, LC3-II, and p-AMPK levels were estimated in the optic nerve by immunoblot analysis. The effect of an AMPK activator A769662 or an AMPK inhibitor dorsomorphin on axon number was evaluated. Results Morphometric analysis revealed apparent protection by netarsudil against TNF-induced axon degeneration. Netarsudil increased autophagosome numbers inside axons. Netarsudil treatment significantly upregulated optic nerve LC3-II levels in both the TNF-treated eyes and the control eyes. Increased p62 protein level induced by TNF was significantly ameliorated by netarsudil. The netarsudil administration alone lessened p62 levels. Netarsudil significantly upregulated the optic nerve p-AMPK levels. A769662 exhibited obvious axonal protection against TNF-induced damage. A769662 treatment upregulated LC3-II levels and the increment of p62 level induced by TNF was significantly ameliorated by A769662. Immunohistochemical analysis revealed that p-AMPK is present in axons. Netarsudil-mediated axonal protection was significantly suppressed by dorsomorphin administration. Conclusions Netarsudil upregulated p-AMPK and autophagy. Netarsudil-mediated axonal protection may be associated with upregulated p-AMPK.
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Affiliation(s)
- Yasushi Kitaoka
- Department of Molecular Neuroscience, St. Marianna University Graduate School of Medicine, Kanagawa, Japan
| | - Kana Sase
- Department of Ophthalmology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Chihiro Tsukahara
- Department of Molecular Neuroscience, St. Marianna University Graduate School of Medicine, Kanagawa, Japan.,Department of Ophthalmology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Naoki Fujita
- Department of Molecular Neuroscience, St. Marianna University Graduate School of Medicine, Kanagawa, Japan.,Department of Ophthalmology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ibuki Arizono
- Department of Molecular Neuroscience, St. Marianna University Graduate School of Medicine, Kanagawa, Japan.,Department of Ophthalmology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Jiro Kogo
- Department of Ophthalmology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Naoto Tokuda
- Department of Ophthalmology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hitoshi Takagi
- Department of Ophthalmology, St. Marianna University School of Medicine, Kanagawa, Japan
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Liu P, Wang F, Song Y, Wang M, Zhang X. Current situation and progress of drugs for reducing intraocular pressure. Ther Adv Chronic Dis 2022; 13:20406223221140392. [PMID: 36479139 PMCID: PMC9720821 DOI: 10.1177/20406223221140392] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022] Open
Abstract
Glaucoma, the most common cause of irreversible blindness worldwide, usually causes characteristic optic nerve damage. Pathological intraocular pressure (IOP) elevation is a major risk factor. Drug reduction of IOP is the preferred treatment for clinicians because it can delay the progression of disease. However, the traditional IOP-lowering drugs currently used by patients may be poorly tolerated. Therefore, in recent years, some new drugs have been put into clinical application or in clinical phase I–III studies. They have a better IOP-lowering effect and fewer adverse reactions. Because glaucoma is a chronic disease, drugs need to be administered continuously for a long time. For patients, good compliance and high drug bioavailability have a positive effect on the prognosis of the disease. Therefore, clinicians and scientists have developed drug delivery systems to solve this complex problem. In addition, natural compounds and dietary supplements have a good effect of reducing IOP, and they can also protect the optic nerve through antioxidant action. We summarize the current traditional drugs, new drugs, sustained-release drug delivery systems, and complementary drugs and outline the mechanism of action and clinical effects of these drugs on glaucoma and their recent advances.
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Affiliation(s)
- Peiyu Liu
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Feifei Wang
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Yuning Song
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Menghui Wang
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Xu Zhang
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, 463 Bayi Road, Nanchang 330006, China
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