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Editors Selection IGR 12-3

Medical Treatment: New Drugs

Comment by Robert Feldman on:

Latanoprostene bunod (LBN) is a nitric oxide-donating prostaglandin F2α receptor antagonist that has been shown to lower intraocular pressure (IOP) in open-angle glaucoma and ocular hypertension. The purpose of this study was to evaluate LBN 0.024% in reducing IOP over a 24-hour period in normal eyes with normal IOP.

In this single-center, single-arm study, 24 Japanese males (mean age 26.8 ± 6.3 years) used LBN QD at 8 p.m. for 14 days. IOP measurements were taken at 8 p.m., 10 p.m., 12 a.m., 2 a.m., 4 a.m., 8 a.m., 10 a.m., 12 p.m., and 4 p.m. at baseline and 14 days after start of treatment. The authors found a significant reduction in IOP over the entire 24-hour period and at each time point.

However, there are several problems with this study. IOP measurements were taken at time points throughout the night, but the authors used a Goldmann applanation tonometer, meaning measurements were not taken in a habitual position without waking subjects during the night (which can alter the pressure, inducing significant study artifacts). Additionally, this study lacks a control group, and we do not know what effect the protocol would have on untreated eyes. Overall it is helpful to see that the medication lowers IOP over 24 hours while upright and awake, but it would be more useful to see that effect in the habitual state of supine and low light low activity unstimulated conditions.

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