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Editors Selection IGR 7-3

Medical Therapy: Bimatoprost once daily vs every other day

Comment by Louis Cantor on:

46843 Comparison of intraocular pressure-lowering effect of every night versus every other night dosing of bimatoprost 0.03%, Shazly TA; Latina MA, Journal of Ocular Pharmacology and Therapeutics, 2011; 27: 369-371

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Shazly et al. (1502) present a retrospective review of 68 eyes from 45 consecutive patients who were switched from once daily (QD) to every other day (QOD) night time administration of bimatoprost for intolerable conjunctival hyperemia. The IOP on day 1 and 2 on QOD administration was compared with the previous documented IOP while the patient was on QD therapy. In this population the authors noted no significant loss of IOP control on day 2 compared to daily dosing. The authors do not comment what effect QOD dosing had on conjunctival hyperemia. Optimal dosing of any medication is determined by careful dose response studies during drug development based on groups of patients, not individuals.

While (QOD dosing) may be appropriate in a limited number of patients, for most patients this dosing regimen is probably not ideal

While some patients may achieve a good response with less than the recommended dosing frequency, the converse may also be true. While most adverse effects appear to be dose related, idiosyncratic non dose related side effects may also occur. Being a retrospective review in a select group of patients who presumably had proven to be good responders to bimatoprost, may bias this study. Utilizing both eyes from some patients instead of one randomly selected eye from patients on bilateral therapy may also bias the results, as one would expect both eyes to respond in a similar fashion in an individual. In clinical practice it may also prove more difficult for patients to remember their medication QOD, as the day of dosing will change from week to week. Other studies have suggested that QOD dosing with a prostaglandin analog can be effective in some patients. While this approach may be appropriate in a limited number of patients, for most patients this dosing regimen is probably not ideal. If hyperemia or other adverse effects are problematic, alternative medications or other therapeutic approaches may provide a better course of action.

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