FIXED COMBINATION

Fixed-combination drugs provide an enhanced quality of life for glaucoma patients by offering simplified daily administration and better adherence, according to Gábor Holló MD, PhD, DSC.

“Fixed-combination intraocular pressure (IOP)-lowering drops, combining two or more hypotensive agents in a single bottle, provide several advantages over unfixed combinations in clinical practice,” Prof Holló told delegates attending the 2015 Congress of the European Society of Ophthalmology (SOE) in Vienna, Austria. 
“The benefits are much greater than the limitations in terms of convenience, adherence and tolerability, although personalised decision-making is essential when introduction of a fixed combination into the treatment regimen is made,” he said.

Prof Holló, Professor and Head of the Glaucoma and Perimetry Unit in the Department of Ophthalmology at Semmelweis University in Budapest, Hungary, noted that the European Glaucoma Society (EGS) guidelines on the treatment of primary open-angle glaucoma recommend an individualised approach to management, setting a target IOP on the basis of risk factors such as family history, IOP at presentation, visual field defects or the presence of pseudoexfoliation, with the goal of preventing significant visual disability in the patient’s lifetime. 

EGS GUIDELINES

For patients with advanced glaucoma, a high risk of progression and a reasonable life expectancy, early and aggressive initial IOP-lowering may offer the best chance of preventing visual impairment, said Prof Holló.

Although the EGS guidelines recommend that initial therapy for glaucoma is usually with a single agent, many patients may require additional agents to reach their target IOP and this is where a fixed-combination medication needs to be considered by the treating clinician, added Prof Holló.
By definition, fixed-combination therapies generally offer equivalent efficacy to concomitant use of the individual components, with equivalent or superior tolerability, he said. 

A broad spectrum of anti-glaucoma drugs is currently available for the treatment of open-angle glaucoma. Typical fixed combinations usually consist of a beta blocker combined with either a prostaglandin analogue, an alpha-adrenergic agonist or a carbonic anhydrase inhibitor. One of the main advantages of a fixed-combination regimen is that it avoids the poor adherence associated with complex therapeutic regimens, said Prof Holló. Using one drop daily from a single bottle also means fewer instillations and reduced opportunity for patient error. “Studies have shown that 75 per cent of patients do not respect the minimum separation time in unfixed combination treatments. Using fixed combinations avoids this problem and is much more convenient for the patient,” he said. 

Gábor Holló: hollo.gabor@med.semmelweis-univ.hu