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    Glaucoma

    This study evaluates the efficacy of netarsudil 0.02% ophthalmic solution in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT).

    Study design

    This double-masked, randomized, multicenter, parallel-group, noninferiority study compared the novel Rho kinase inhibitor netarsudil 0.02% once and twice a day with timolol 0.5% dosed twice a day. The study included 756 patients with OAG or OHT who were randomized to each of the groups after medication washout and followed for 12 months. Diurnal pressure was monitored for 3 months followed by morning IOP in month 6, 9 and 12.

    Outcomes

    At 12 months, IOP was reduced from approximately 22.5 mm Hg at baseline to 18.8 mm Hg with once-daily netarsudil, 18.0 mm Hg for twice-daily netarsudil and 17.6 mm Hg for twice-daily timolol.

    Adverse events were mild for all 3 arms and consisted of conjunctival hyperemia (61%, 66% and 14%), corneal verticillata (26, 25, 1%) and conjunctival petechial hemorrhage (20, 19, 1%), respectively.

    Limitations

    This study was funded by Aerie, the manufacturer of netarsudil. While netarsudil does show noninferiority to timolol, this study does not compare netarsudil with prostaglandin analogues, the current first-line glaucoma therapy. This study population was in their mid-60s, on average, predominantly female and white, and had fairly mild disease that required 1 to 2 medications at baseline.

    Clinical significance

    Netarsudil dosed daily is an option for adjunctive IOP lowering. This novel compound can increase trabecular outflow facility, decrease aqueous production and decrease episcleral venous pressure. It is a nice expansion to the glaucoma armamentarium.