Omidenepag isopropil
O omidenepag isopropil (um pró-fármaco do metabólito biologicamente ativo omidenepag) é um agonista do receptor EP2 da prostaglandina relativamente seletivo com um mecanismo de ação inovador. Ele reduz a pressão intraocular (PIO) elevada, aumentando a drenagem do humor aquoso através das vias de saída trabecular e uveoscleral. A eficácia clínica foi confirmada em vários estudos.[88]Kuo HT, Yeh CY, Hsu AY, et al. Clinical efficacy of omidenepag isopropyl for primary open-angle glaucoma, normal tension glaucoma, or ocular hypertension: a meta-analysis. J Ocul Pharmacol Ther. 2023 Aug 9.
https://www.liebertpub.com/doi/10.1089/jop.2023.0058
http://www.ncbi.nlm.nih.gov/pubmed/37579061?tool=bestpractice.com
A aprovação foi concedida nos EUA para a redução da PIO elevada ou aumentada em pacientes com glaucoma de ângulo aberto ou hipertensão ocular. Os efeitos adversos observáveis incluem hiperemia conjuntival, espessamento da córnea, edema macular/edema macular cistoide e inflamação ocular.[89]Bae BJ, Kang EM, Lee SY. Cystoid macular edema associated with omidenepag isopropyl in a phakic eye with an implantable collamer lens: a case report. BMC Ophthalmol. 2023 Jul 26;23(1):334.
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-023-03091-0
http://www.ncbi.nlm.nih.gov/pubmed/37495978?tool=bestpractice.com
Deve ser usado com precaução em pacientes com olhos afácicos ou pseudofácicos.[90]Matsuo M, Matsuoka Y, Tanito M. Efficacy and patient tolerability of omidenepag isopropyl in the treatment of glaucoma and ocular hypertension. Clin Ophthalmol. 2022;16:1261-79.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9058248
http://www.ncbi.nlm.nih.gov/pubmed/35510270?tool=bestpractice.com
Ripasudil
Ripasudil é um inibidor de Rho quinase. A eficácia de ripasudil foi demonstrada em conjunto com timolol ou latanoprosta.[61]Clement Freiberg J, von Spreckelsen A, Kolko M, et al. Rho kinase inhibitor for primary open-angle glaucoma and ocular hypertension. Cochrane Database Syst Rev. 2022 Jun 10;6(6):CD013817.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9185806
http://www.ncbi.nlm.nih.gov/pubmed/35686679?tool=bestpractice.com
[62]Nana Wandji B, Bacq N, Ehongo A. Efficacy and safety of rho kinase inhibitors vs. beta-blockers in primary open-angle glaucoma: a systematic review with meta-analysis. J Clin Med. 2024 Mar 18;13(6):1747.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10971175
http://www.ncbi.nlm.nih.gov/pubmed/38541970?tool=bestpractice.com
Ripasudil associado a timolol reduziu consideravelmente a PIO, em comparação com a monoterapia com timolol; a terapia combinada foi associada ao aumento de efeitos adversos oculares.[61]Clement Freiberg J, von Spreckelsen A, Kolko M, et al. Rho kinase inhibitor for primary open-angle glaucoma and ocular hypertension. Cochrane Database Syst Rev. 2022 Jun 10;6(6):CD013817.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9185806
http://www.ncbi.nlm.nih.gov/pubmed/35686679?tool=bestpractice.com
[62]Nana Wandji B, Bacq N, Ehongo A. Efficacy and safety of rho kinase inhibitors vs. beta-blockers in primary open-angle glaucoma: a systematic review with meta-analysis. J Clin Med. 2024 Mar 18;13(6):1747.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10971175
http://www.ncbi.nlm.nih.gov/pubmed/38541970?tool=bestpractice.com
Nenhum estudo comparou a eficácia da monoterapia com ripasudil com a da monoterapia com betabloqueador.[62]Nana Wandji B, Bacq N, Ehongo A. Efficacy and safety of rho kinase inhibitors vs. beta-blockers in primary open-angle glaucoma: a systematic review with meta-analysis. J Clin Med. 2024 Mar 18;13(6):1747.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10971175
http://www.ncbi.nlm.nih.gov/pubmed/38541970?tool=bestpractice.com
Ripasudil não está disponível atualmente nos EUA ou na Europa.
Agentes neuroprotetores
Uma revisão Cochrane que avaliou a efetividade dos agentes neuroprotetores para retardar a evolução do glaucoma de ângulo aberto não encontrou evidências de que eles previnam a morte das células ganglionares retinianas, assim preservando a visão, em pacientes com glaucoma de ângulo aberto.[91]Sena DF, Lindsley K. Neuroprotection for treatment of glaucoma in adults. Cochrane Database Syst Rev. 2017 Jan 25;(1):CD006539.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006539.pub4/full
http://www.ncbi.nlm.nih.gov/pubmed/28122126?tool=bestpractice.com
Outras pesquisas clínicas na forma de ensaios clínicos randomizados e controlados com acompanhamento em longo prazo são necessárias para determinar a eficácia.[91]Sena DF, Lindsley K. Neuroprotection for treatment of glaucoma in adults. Cochrane Database Syst Rev. 2017 Jan 25;(1):CD006539.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006539.pub4/full
http://www.ncbi.nlm.nih.gov/pubmed/28122126?tool=bestpractice.com
[92]Khatib TZ, Martin KR. Neuroprotection in glaucoma: towards clinical trials and precision medicine. Curr Eye Res. 2020 Mar;45(3):327-38.
http://www.ncbi.nlm.nih.gov/pubmed/31475591?tool=bestpractice.com
Novos sistemas de administração de medicamentos
Vários sistemas de administração de medicamentos estão disponíveis ou em desenvolvimento para abordar a adesão do paciente e os efeitos adversos associados à terapia medicamentosa para o glaucoma. Eles incluem tampões punctais, anéis colocados no fórnix, lentes de contato farmacológicas, injeções/dispositivos subconjuntivais, sistemas de administração intracameral (por exemplo, implante intracameral de bimatoprosta e travoprosta [aprovado nos EUA]) e dispositivos intraoculares farmacológicos.[93]Perera SA, Ting DS, Nongpiur ME, et al. Feasibility study of sustained-release travoprost punctum plug for intraocular pressure reduction in an Asian population. Clin Ophthalmol. 2016 Apr 26;10:757-64.
https://www.dovepress.com/feasibility-study-of-sustained-release-travoprost-punctum-plug-for-int-peer-reviewed-fulltext-article-OPTH
http://www.ncbi.nlm.nih.gov/pubmed/27175058?tool=bestpractice.com
[94]Brandt JD, DuBiner HB, Benza R, et al. Long-term safety and efficacy of a sustained-release bimatoprost ocular ring. Ophthalmology. 2017 Oct;124(10):1565-6.
https://www.aaojournal.org/article/S0161-6420(17)30388-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/28528010?tool=bestpractice.com
[95]Gote V, Sikder S, Sicotte J, et al. Ocular drug delivery: present innovations and future challenges. J Pharmacol Exp Ther. 2019 Sep;370(3):602-24.
https://jpet.aspetjournals.org/content/370/3/602
http://www.ncbi.nlm.nih.gov/pubmed/31072813?tool=bestpractice.com
[96]Wong TT, Novack GD, Natarajan JV, et al. Nanomedicine for glaucoma: sustained release latanoprost offers a new therapeutic option with substantial benefits over eyedrops. Drug Deliv Transl Res. 2014 Aug;4(4):303-9.
http://www.ncbi.nlm.nih.gov/pubmed/25787063?tool=bestpractice.com
[97]Gutiérrez-Hernández JC, Caffey S, Abdallah W, et al. One-year feasibility study of Replenish MicroPump for intravitreal drug delivery: a pilot study. Transl Vis Sci Technol. 2014 July;3(4):1.
https://tvst.arvojournals.org/article.aspx?articleid=2120943
http://www.ncbi.nlm.nih.gov/pubmed/25774328?tool=bestpractice.com
[98]Craven ER, Walters T, Christie WC, et al. 24-month phase I/II clinical trial of bimatoprost sustained-release implant (Bimatoprost SR) in glaucoma patients. Drugs. 2020 Feb;80(2):167-79.
https://link.springer.com/article/10.1007/s40265-019-01248-0
http://www.ncbi.nlm.nih.gov/pubmed/31884564?tool=bestpractice.com
[99]Dick HB, Schultz T, Gerste RD. Miniaturization in glaucoma monitoring and treatment: a review of new technologies that require a minimal surgical approach. Ophthalmol Ther. 2019 Mar;8(1):19-30.
https://link.springer.com/article/10.1007/s40123-019-0161-2
http://www.ncbi.nlm.nih.gov/pubmed/30725339?tool=bestpractice.com
[100]Berdahl JP, Sarkisian SR Jr, Ang RE, et al. Efficacy and safety of the travoprost intraocular implant in reducing topical IOP - lowering medication burden in patients with open-angle glaucoma or ocular hypertension. Drugs. 2024 Jan;84(1):83-97.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10789685
http://www.ncbi.nlm.nih.gov/pubmed/38060092?tool=bestpractice.com
[101]Sarkisian SR, Ang RE, Lee AM, et al. Travoprost intracameral implant for open-angle glaucoma or ocular hypertension: 12-month results of a randomized, double-masked trial. Ophthalmol Ther. 2024 Apr;13(4):995-1014.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10912401
http://www.ncbi.nlm.nih.gov/pubmed/38345710?tool=bestpractice.com