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Abstract #10097 Published in IGR 6-1
Is addition of a third or fourth antiglaucoma medication effective?
Neelakantan A; Vaishnav HD; Iyer SA; Sherwood MBJournal of Glaucoma 2004; 13: 130-136
PURPOSE: To study the intraocular pressure (IOP)-lowering effect of adding a third or a fourth antiglaucoma medication to preexisting antiglaucoma medical therapy, for a follow-up period of one year. PATIENTS AND METHODS: The authors performed a retrospective, nonrandomized, noncomparative, interventional study including all patients seen by a single glaucoma specialist at the University of Florida Eye Clinic between January 1st, 2000 and December 31st, 2000, who had a third or a fourth antiglaucoma medication added to their existing regimen of two or three antiglaucoma medications, respectively. The main outcome measured was IOP at two, six, nine, and 12 months after addition of an antiglaucoma medication. 'Efficacy' success was defined as a decrease in IOP of greater than or equal to 20% from baseline, without a change in the antiglaucoma medical therapy. Also, 'safety outcome' was analyzed based on the need for surgical intervention and/or the occurrence of intolerable side effects to the antiglaucoma medications leading to discontinuation of their use. RESULTS: Sixty-seven patients had a third, and 29 a fourth antiglaucoma medication added to their existing regimen. Analysis for a specific time point showed a success rate of 48% at two months (n = 65), 47% at six months (n = 47), and 41% at one year (n = 39) after addition of a third antiglaucoma medication and 59% at two months (n = 29), 45% at six months (n = 22), and 55% at one year (n = 20) after addition of a fourth antiglaucoma medication. By Kaplan-Meier analysis the cumulative probability of achieving efficacy success (≥ 20% IOP decrease from baseline) was 33% at six months and 23% at one year after adding a third medication (Group A), and 43% at six months and 18% at one year after adding a fourth medication (Group B). Combining both efficacy and safety outcomes decreased the cumulative probability of success to 27 and 14% in Group A, and 31 and 14% in Group B, at six months and one year, respectively. CONCLUSIONS: Addition of a third and fourth antiglaucoma medication produces a clinically significant reduction in IOP in about 40-60% of patients at any single time point. However, the cumulative probability of success including safety outcomes is relatively poor at six months and one year. This suggests that adding another antiglaucoma medication to a regimen of two or three medications frequently does not achieve a significant (≥ 20%) fall in IOP.
Dr. A. Neelakantan, Department of Ophthalmology, University of Florida, Gainesville, FL 32610-0284, USA
Classification:
11.1 General management, indication (Part of: 11 Medical treatment)
