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Combination Of Latanoprost And Timolol Superior To Each Drug Individually: Presented at AAO
By Cameron Johnston
Special to DG News
NEW ORLEANS, LA -- November 16, 2001 -- Xalacom (latanoprost/timolol fixed combination, Pharmacia), recently approved in Europe for the treatment of open angle glaucoma (OAG), is more effective at lowering intra-ocular pressure than the same two drugs used separately.
In a presentation at the annual meeting of the American Academy of Ophthalmology, Dr Eve Higginbotham, of the University of Maryland, in Baltimore, Maryland, United States, said that almost half of the people with glaucoma in the US use combination therapies to treat the condition.
The most common combinations used are Xalatan (latanoprost) and timolol together, or Xalatan and Alphagan together.
In this study, 418 patients were randomized to two groups to take either latanoprost 0.005%, or timolol 0.5% together (Xalacom) or timolol twice daily, or latanopost once daily. There were 113 receiving the fixed combination.
After one year of treatment there was a mean reduction in diurnal IOP of -2.9 mmHg between the fixed combination group and the timolol alone group (p = 0.001) and a 1.0 mmHg decline in diurnal IOP between the study group and the latanoprost group
"Essentially there was a mean difference of 1.0 mmHg in IOP," Dr. Higginbotham, who is chair of the department of ophthalmology at U of Md said.
The actually mean diurnal pressure at weeks 26 and 52 changed by only 0.4 mmHg, indicating that the stability of intra-ocular pressure lasts up to 12 months.
A sub-group analysis showed that the reduction in IOP was even more favorable among subjects who had visual defects as a result of their elevated IOP. Subjects with visual defects had a reduction in 8:00AM IOP of 3.75 mmHg (mean) as compared with timolol, while for those who did not have visual defects, the mean reduction was only 2 mmHg at week two of the study. Mean IOP changed slightly over the course of the study. In those who had visual defects, IOP regressed to 3.5 mmHg by week 26, but improved to 3.0 mmHg in those without defects.
Comparing latanoprost alone with the combination therapy, it was found that there was a greater reduction in IOP favoring the fixed combination group at all time points among those who had defects as compared with those who did not have defects.
Apart from the superior efficacy in terms of reducing IOP, Dr. Higginbotham said combination therapy reduces the potential for errors in dosing that can influence patient responsiveness to these medications. This reduced risk of toxicity and potential cost must be considered an additional benefit to the fixed therapy regimen, she added.
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