Examining the Long-Term Efficacy and Tolerability of Netarsudil as an Adjunctive Glaucoma Medical Therapy

Abstract

Background and Hypothesis:
Glaucoma is a group of progressive optic nerve neuropathies that commonly cause vision loss or blindness. The most prevalent of these neuropathies is known as primary open-angle glaucoma. POAG is caused by increased intraocular pressure (IOP) in the anterior chamber of the eye, due to increased resistance to outflow of aqueous humor. Netarsudil is a recently developed novel medication for lowering intraocular pressure. The aim of this study is to assess the long-term efficacy and tolerability of netarsudil as an adjunctive therapy in patients with POAG.

Methods:
In this study data was collected through a retrospective chart review of patients being treated for POAG. Efficacy was measured by using the difference in intraocular pressure over the course of treatment. Tolerability was assessed using a Kaplan-Meier estimator, measuring the time to failure of treatment. Failure in this case is defined as either a termination in treatment due to adverse effects, or termination in treatment from lack of efficacy in lowering IOP. Data was separated into groups of either 2nd, 3rd, or 4th line treatments. In patients where both eyes were treated, one eye was randomly selected to be followed for measurements.

Results:
Probability of failure curves, based on the tolerability and efficacy of netarsudil treatment, were constructed for each group. IOP reduction (mmHg) was found to be: 3.00 (3.09 95% CI) for 2nd line, 7.05 (4.65 95% CI) for 3rd line, and 5.31 (1.38 95% CI) for 4th line.

Conclusion and Impact:
These results give context to netarsudil as a therapy in terms of its long-term implications. As the drug was only approved for use in late 2018, there is limited data on its long-term efficacy and tolerability, and this information helps to give clinicians a better idea of whether it will be a helpful treatment for patients.