The impact of timolol maleate on the ocular tolerability of fixed-combination glaucoma therapies

Abstract

Glaucomatous optic atrophy is the second most common cause of blindness worldwide, and lowering intraocular pressure (IOP) is the only proven method to slow or stop the progression of the disease. Approximately 40% of patients with elevated IOP will require more than one medication to obtain a modest 20% reduction in IOP, and as a result, some patients may require two medications, provided in either two separate bottles or in one bottle with the use of fixed-combination therapies. Each therapy has its own unique safety and efficacy profile. Topical beta-blockers have a particularly favorable ocular-tolerability profile, and several studies of fixed-combination medications containing the beta-blocker timolol maleate have shown a lower prevalence of some ocular adverse events for the fixed-combination therapy compared to the non-beta-blocker individual component. In this review, we examined clinical data pertaining to the ocular surface tolerability of fixed-combination medications containing timolol maleate in comparison to the individual components. In particular, preference was given to prospective, randomized, multicenter trials of 3 months in duration or longer that compared a fixed-combination therapy to monotherapy with the individual components. A review of the literature revealed that some fixed-combination therapies can provide a reduced risk of common side effects compared to their individual components, with conjunctival hyperemia and ocular allergy being less frequent in some timolol-containing fixed-combination therapies. This effect appears to be most significant for latanoprost 0.005%, bimatoprost 0.03%, and brimonidine 0.2%.

Topical Treatment of Elevated Intraocular Pressure in Patients with Graves’ Ophthalmopathy

“…Topical ocular hypotensive therapy was well-tolerated by the patients, both on the check-up appointment and the final visit. Our results were in agreement with the results of other previously published studies that showed good ocular-tolerability profile of both types of eye drops [24][25][26]. Although, the study by Katz et al showed fixed-combination brimonidine-timolol was as effective as latanoprost in reducing IOP in patients with glaucoma or ocular hypertension [26], the results of the present study showed better efficacy in lowering IOP of latanoprost versus fix-combination brimonidine-timolol in patients with TAO.…”

The signs of ocular-surface disorders after switching from latanoprost to tafluprost/timolol fixed combination: a prospective study

“…In a study using quantitative hyperemia analysis software, tafluprost, among the prostaglandin analogs tested, was reported to cause the lowest level of hyperemia 24. Data from a meta analysis25 indicate that receiving treatment with prostaglandin/timolol fixed combinations results in a lower risk of hyperemia than treatment with prostaglandins alone, although the mechanism of this effect is unknown 26. In this study, a reduction in hyperemia was expected after switching from latanoprost to TTFC, however, no significant differences in hyperemia scores were detected.…”

IOP-lowering therapy and ocular surface in glaucoma. Part 2. The effect of preservatives on ocular surface

“…Аллергический конъюнктивит и дерматит в ответ на терапию АПг и ингибиторами карбоангидразы развиваются довольно редко: к примеру, лишь у 1,5% пациентов, использовавших латанопрост, и у 3-4% получавших дорзоламид. Весьма часто (9-11,5%) аллергические реакции развиваются на альфа-агонист бримонидин, однако в составе фиксированных комбинаций с тимололом частота этого осложнения снижается [37].…”