advertisement
Editors Selection IGR 26-1
Medical Treatment: Which glaucoma drug combinations work best together?
Comment by Miriam Kolko on:
128009 Efficacy and Drug Interactions of Glaucoma Medications: A Systematic Review and Component Network Meta-analysis, Hsia Y; Wang C; Su CC et al., Ophthalmology, 2025; 132: 1304-1316
This study presents a systematic review and network meta-analysis evaluating the efficacy of monotherapies and combination therapies for glaucoma. It included 166 studies with over 36,000 patients, covering 18 medication categories plus placebo. Using direct and indirect comparisons, treatments were ranked based on intraocular pressure reduction while assessing risk of bias, heterogeneity, and potential drug–drug interactions. The authors found prostaglandin F2α analog-based combinations, particularly prostaglandin F2α analog plus carbonic anhydrase inhibitor, and non-prostaglandin F2α analog triple combinations to be the most effective, with prostaglandin F2α analog plus carbonic anhydrase inhibitor highlighted as a promising avenue for new combination therapies. E-prostanoid receptor 2 agonists outperformed other non-prostaglandin F2α analog treatments but were less effective than prostaglandin F2α analog and nitric oxide-donating prostaglandin F2α analog, while antagonistic interactions were observed between prostaglandin F2α analog and beta-adrenergic blockers or Rho-associated protein kinase inhibitors. By comparing both monotherapies and combinations, this study provides guidance for clinical decision-making and future research.
Key considerations include few randomized controlled trials for certain combinations, low certainty of evidence for some comparisons, and variability within medication classes. In practice, the potential benefit of prostaglandin F2α analog plus carbonic anhydrase inhibitor may be constrained by pharmacological factors. Prostaglandin F2α analog is optimally administered once daily, as multiple doses can cause receptor desensitization, while carbonic anhydrase inhibitors have a short intraocular half-life and typically require two to three daily doses to maintain intraocular pressure reduction. Therefore, once-daily dosing for both agents may not fully exploit the carbonic anhydrase inhibitor effect, despite the synergy observed in study. This underscores the importance of considering pharmacokinetics and dosing schedules when interpreting efficacy and optimizing glaucoma treatment for patients.
Comments
The comment section on the IGR website is restricted to WGA#One members only. Please log-in through your WGA#One account to continue.Log-in through WGA#One
