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Using diurnal intraocular pressure fluctuation to assess the efficacy of fixed-combination latanoprost/timolol versus lantanoprost or timolol monotherapy
  1. Rohit Varma, MD, MPH1,
  2. Lie-Ju Hwang, PhD2,
  3. John W Grunden, PharmD2,
  4. Gerald W Bean, BS3
  1. 1 Keck School of Medicine, University of Southern California, United States;
  2. 2 Pfizer Inc, United States;
  3. 3 Independent Consultant, United States
  1. * Corresponding author; email: rvarma{at}usc.edu

Abstract

Aim: To evaluate differences in diurnal intraocular pressure (IOP) fluctuation in glaucoma/ocular hypertension patients treated with once-daily fixed-combination latanoprost/timolol, once-daily latanoprost, or twice-daily timolol.

Methods: In two 6-month, double-masked, parallel-group studies, patients received run-in timolol (2-4 weeks) and randomised (1:1:1) to therapy. IOP was measured three times/day at baseline and weeks 2, 13, 26. In post-hoc analyses, diurnal IOP fluctuation=highest daily IOP¡§Clowest daily IOP at baseline and week 26. Fluctuation also was dichotomised: high (>6mmHg), low (¡Ü6 mmHg).

Results: 854 patients were randomised (fixed combination=278; latanoprost=287; timolol=289). Diurnal fluctuation was significantly reduced from baseline to week 26 with the fixed combination (p=0.002) but not with latanoprost or timolol monotherapy (p=0.601; p=0.097). Relative to baseline, the percentage with high diurnal IOP fluctuation at week 26 was reduced by 48% with fixed combination but increased 13% with latanoprost and 48% with timolol. Changes in IOP fluctuation and in mean IOP were significantly correlated for the monotherapies but not the fixed combination.

Conclusions: Fixed-combination latanoprost/timolol results in lower diurnal IOP fluctuation and significantly fewer patients with high fluctuation than treatment with latanoprost or timolol monotherapy. The fixed combination may have an independent effect on reducing IOP fluctuation in addition to lowering IOP.

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