Timolol versus brinzolamide added to travoprost in glaucoma or ocular hypertension.

Author(s): Pfeiffer N

Affiliation(s): Department of Ophthalmology, Mainz University, Langenbeckstr. 1, 55131, Mainz, Germany. pfeiffer@augen.klinik.uni-mainz.de

Publication date & source: 2011-07, Graefes Arch Clin Exp Ophthalmol., 249(7):1065-71. Epub 2011 Apr 16.

Publication type: Comparative Study; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

BACKGROUND: To compare the efficacy and safety of timolol 0.5% versus brinzolamide 1.0% when added to travoprost monotherapy in patients with primary open-angle glaucoma or ocular hypertension. METHODS: Patients meeting selection criteria (IOP one eye 19 mmHg and </=32 mmHg and IOP both eyes </=32 mmHg at 8:00 h) were switched to travoprost monotherapy for 4 weeks. Patients then insufficiently controlled on travoprost (IOP at 8:00 h >/=19 mmHg) at baseline were randomized to receive either travoprost and brinzolamide or travoprost and timolol in a double-masked fashion for 12 weeks. RESULTS: Two hundred and fifty-three patients underwent the 4-week run-in period. Switching to travoprost resulted in adequate IOP control (<19 mmHg) for 21.7% of patients. After 3 months of treatment, both drug combinations statistically significantly reduced the mean IOP at each time point (8:00, 12:00 and 16:00 h) and the mean diurnal IOP, which was 17.9 +/- 2.6 mmHg for the brinzolamide group and 17.0 +/- 3.2 mmHg for the timolol group. Both combinations were well-tolerated. However, a statistically significant difference occurred at 16:00 h, with pressures of 16.4 +/- 3.2 mmHg and 17.3 +/- 2.8 mmHg for the timolol and brinzolamide groups, respectively (p = 0.038). Fifty percent of patients reported one adverse event, whereas in 13.2% three or more adverse effects were named. Hyperemia was found most often (6.3% of the patients). CONCLUSION: Both adjunctive combinations moderately reduced IOP in patients inadequately controlled with travoprost monotherapy, with timolol being slightly stronger 8 hours after instillation. Adjunctive treatment with brinzolamide and travoprost may be an alternative for patients not tolerant or not responsive to treatment with timolol and travoprost.