GLAUCOMA PIPELINE

Clinicians should avoid become overly obsessed with intraocular pressure (IOP) reduction and pay greater attention to broader glaucoma treatment strategies that positively affect patients’ quality of life, according to Norbert Pfeiffer MD. “There is a growing trend in glaucoma care to concentrate on the patients’ quality of life and I think this is a positive development because ultimately our patients are more interested in their overall quality of life than their target IOP,” Dr Pfeiffer, Medical Director, Mainz University Medical Centre, Mainz, Germany, told delegates attending the 2015 Congress of the European Society of Ophthalmology (SOE) in Vienna, Austria.

In a broad overview of current and future trends in glaucoma treatments, Dr Pfeiffer said that ongoing advances in delivery methods and medications are improving standards of care for glaucoma patients.

“Individualised target IOP is becoming more the norm as per the European Glaucoma Society guidelines. We also know today that patients are far less compliant than we assume in taking their medications, so I think we will continue to see a trend towards fixed combinations and probably long-term medication where compliance does not play such a key role,” he said.

New delivery methods for glaucoma drugs may play a major part in transforming the clinical management of the disease, said Dr Pfeiffer. “We will probably soon see something that I thought was impossible ten years ago – an injectable glaucoma medication into the vitreous cavity which will perhaps require twice-yearly injections. Certainly for some patients this may be preferable to the daily burden of using eye drops,” he said.

ENV 515 (Envisia Therapeutics Inc.), an implantable, ophthalmic, sustained-release formulation of the prostaglandin travoprost, has shown effective IOP reduction for up to six months in early trials, said Dr Pfeiffer.

There are also other promising new medications in the pipeline such as Rho-kinase (ROCK) inhibitors and TGF-beta antagonists. ROCK inhibitors such as AR-13324 (Aerie Pharmaceuticals) alter the cell shape and extracellular matrix of the trabecular meshwork to improve outflow of aqueous humour and reduce fibrosis.

“There are three identified IOP-lowering mechanisms with AR-13324: ROCK inhibition relaxes the trabecular meshwork and increases outflow, reduces fluid production and also lowers episcleral venous pressure,” said Dr Pfeiffer.

Another drug currently under development, PG324 (Aerie Pharmaceuticals), adds latanoprost into a fixed combination therapy. This may potentially add another IOP-lowering mechanism to the mix by increasing fluid outflow through the uveoscleral pathway in addition to the same mechanisms identified with AR-13324, he said.

Another compound, DE-117 (Santen Pharmaceutical Co. Ltd.), a non-prostanoid selective EP2 receptor agonist, is currently in trials.

Norbert Pfeiffer: pfeiffer@augen.klinik.uni-mainz.de