Maximal therapy with netarsudil lowers IOP for patients

Reviewed by Dr Bella J. Wolf.

Instillation of netarsudil (Rhopressa, Aerie Pharmaceuticals) can have an additional, modest beneficial effect in patients who are already on the maximally tolerated medical therapy for glaucoma, according to Dr Bella J. Wolf and Dr Edmund P. Farris Jr, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States.

However, the IOP-lowering drug, which the FDA approved to treat glaucoma in 2017, is associated with some adverse effects that affect patient adherence.

Retrospective analysis of netarsudil effect

The study included all patients in a large glaucoma clinic treated with netarsudil from 2018 to 2020. In this study, the investigators compared the IOPs measured during 3 consecutive examinations over a time frame of at least 1 month before and after initiation of treatment with netarsudil in order to assess the drug’s effect.

A search of the medical records identified 516 patients for whom netarsudil had been prescribed during the study period; 43 eyes of 29 patients (mean age, 75 years) met the inclusion criteria. All were receiving the maximally tolerated medical therapy at the time of inclusion in the study.

Patients were excluded from the analysis if they had had a recent change in their IOP therapy, had been treated with laser or surgery during the time of the study, or were poorly adherent to their therapy. Primary open-angle glaucoma was the most common diagnosis in 45% of patients, followed by mixed-mechanism glaucoma in 24%.

Before investigators added netarsudil to the patients’ drug regimens, 24 patients were taking 4-plus medications to lower IOP, 4 were taking 3 drugs, and 1 was taking 2 drugs. Seventeen patients had also undergone previous laser treatments and 15 had undergone a glaucoma surgery.

Wolf and Farris noted that the mean baseline IOP was 16.74 ± 4.8 mm Hg, and the mean IOP after netarsudil was 14.43 ± 3.89 mm Hg. The mean reduction was 2.31 mm Hg (P < .000006).

A limitation of this treatment was that an adverse effect of netarsudil, conjunctival hyperaemia, as well as cost, resulted in a significant decrease in patient adherence to the medication.

Netarsudil was prescribed as an adjunctive therapy for patients who were on maximally tolerated medical therapy for glaucoma. In most cases, those patients had an IOP that was not controlled well or there was a concern that the glaucoma would progress.

The investigators concluded that netarsudil can result in a modest IOP decrease in patients who are already taking maximally tolerated medical therapy.

Bella J. Wolf, MD

E: (212) 241-6500

This article was adapted from Wolf’s presentation at the 2021 American Academy of Ophthalmology annual meeting in New Orleans, Louisiana. She has no financial interest in this subject matter.