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Editors Selection IGR 19-4
Medical treatment: Bunazocin
Comment by Makoto Aihara on:
15116 Addition of or switch to topical bunazosin hydrochloride in elderly patients with normal-tension glaucoma: A one-year follow-up study, Yoshikawa K; Katsushima H; Kimura T et al., Japanese Journal of Ophthalmology, 2006; 50: 443-448
The Tajimi study, conducted for Japanese who have a higher morbid risk to develop NTG, recently revealed that higher IOP and aging are risk factors. Special care should be taken to treat elderly glaucoma patients, because of higher potential of systemic diseases. Bunazosin hydrochrolide is a selective alpha-1 adrenergic antagonist in both mechanisms of IOP-lowering action and less side effects. Thus, bunazosin may be a favorable topical drug in elderly patients. Yoshikawa et al. (1228) investigated long-term IOP lowering effect and safety of bunazosin, in Japanese elderly NTG patients aged over 65 years old in multi-center study. Ninety-eight patients were enrolled and 58 and 40 patients were added or switched to bunazosin from one of other therapies, respectively. Finally, 86 NTG patients were followed 52 weeks. Seven patients were dropped because of inadequate IOP control or side effect. The IOP after 4 weeks of treatment was significantly lower than that that before addition or switching to bunazosin (i.e., 13.4 &plm; 2.4 mmHg at week 0, 15.0 &plm; 2.5 mmHg at week 52, p < 0.0001). Through the period, visual field was stable and no systemic adverse events occurred. A local side effect, mainly hyperemia, was observed in 7 of 86 patients. This study suggests that in general, bunazosin was a tolerable local IOP-lowering drug in both IOP reduction by adding or switching therapy and less adverse events in elderly NTG patients. However, more additional information is needed and expected. Firstly, it should be noted that two types of patients were enrolled: those where existing treatment had not reached the target IOP and those where existing treatment was difficult to continue because of adverse reactions or for other reasons. It was not revealed whether these initial reasons were improved by Bunazosin treatment. Secondly, the patients enrolled by the former criteria will have more IOP reduction than those by the latter, who may have sufficient IOP reduction in spite of adverse events. Thus the distribution of these two types of patients will affect the data. Third, whether the additive or switching effect is dependent on the types of pretreatment or not should be clarified in future.
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