Comparison of the Ocular Hypotensive Efficacy of Adjunctive Brimonidine 0.15% or Brinzolamide 1% in Combination with Travoprost 0.004%
Presented in part at: American Glaucoma Society Annual Meeting, March 2006, Charleston, South Carolina, and Association for Research and Vision in Ophthalmology Annual Meeting, April 2006, Fort Lauderdale, Florida.
Received 12 September 2006; accepted 7 March 2007. published online 16 May 2007.
Purpose
To compare efficacies of adjunctive therapy with brimonidine 0.15% and adjunctive therapy with brinzolamide 1% in combination with travoprost 0.004%.
Patients with primary open-angle glaucoma, exfoliation glaucoma, or ocular hypertension with intraocular pressure (IOP) > 18 mmHg on monotherapy with travoprost (N = 163).
Methods
Patients were randomized to receive adjunctive therapy with twice-daily brimonidine (N = 79) or twice-daily brinzolamide (N = 84). Treatment efficacy was assessed after 1 and 3 months of combination therapy. Intraocular pressure was measured at 8 am, noon, and 4 pm at baseline (on travoprost monotherapy) and after 3 months of combination therapy. Mean diurnal IOP was defined as the average of the IOP measurements at these 3 time points. Adverse events were recorded at each visit.
Main Outcome Measure
Difference between treatment groups in mean diurnal IOP at month 3, adjusted for difference in baseline IOP, using analysis of covariance.
Results
Mean diurnal IOPs (± standard error of the mean) at baseline were 21.7±0.33 mmHg in the brimonidine group and 21.1±0.29 mmHg in the brinzolamide group (P = 0.16). Mean diurnal IOPs at month 3 were 19.6±0.41 mmHg in the brimonidine group and 18.4±0.33 mm Hg in the brinzolamide group (P = 0.019). At month 3, mean diurnal IOPs, adjusted for difference in baseline IOP, were 19.3±0.27 in the brimonidine group and 18.6±0.25 in the brinzolamide group (P = 0.035).
Conclusions
The combination of travoprost and brinzolamide was statistically significantly more efficacious than the combination of travoprost and brimonidine in lowering IOP. The clinical significance of this difference is uncertain.
1Department of Ophthalmology and Visual Science, University of Texas Medical School, Houston, Texas.
3Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
4Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
5Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma.
Correspondence to Robert Feldman, MD, 6411 Fannin, 7th Floor Jones, Houston, TX 77030.
Manuscript no. 2006-1034.
Supported by an unrestricted grant from Alcon Laboratories, Ft. Worth, Texas (National Eye Institute core grant no. 10608), and grants from Research to Prevent Blindness, New York, New York, and the Hermann Eye Fund, Houston, Texas.
ABSTRACT