Archive for the ‘Eye drugs’ Category

Glaucoma medications costs

Friday, December 28th, 2007

Eye surgeryIn the United States, the management of glaucoma costs about $2.5 billion per year. Of the $1.9 billion in direct costs, glaucoma medications account for an estimated 38% to 52% of the total. In an article published in the January 2008 issue of the American Journal of Ophthalmology, researchers from The Texas A&M University System Health Science Center College of Medicine, Temple, Texas; analyzed the economics of medically managing glaucoma. The yearly costs to patients of various topical glaucoma medications were calculated and significant price differences and increases in cost over time were found.

The researchers looked at four classes of pharmaceuticals; ?-blockers, prostaglandins, ?2-agonists and carbonic anhydrase inhibitors. They compared both brand-name and generic formulations, evaluated how accurately the bottles were filled and how accurately the medications could be dispensed by patients. Using results from earlier studies, the increases in Average Wholesale Prices (AWP) were also evaluated from 1999 through 2006.

Nonselective ?-blockers remain the most inexpensive class of glaucoma medications. For all categories of drugs, calculated yearly cost ranged from $150.81 for generic timolol maleate 0.5% (?-blocker), to $697.42 for Cosopt (combination formulation), to as high as $873.98 for a three-times-daily dose of Alphagan P 0.15% (?2-agonist). Among brand name ?-blockers, yearly cost ranged between $203.47 for Timoptic 0.5% and $657.24 for Betoptic S. Generic ?-blockers consistently were more economical than their brand-name counterparts. Yearly cost of prostaglandin analogs ranged from $427.69 for Travatan to $577.62 for Lumigan. The two carbonic anhydrase inhibitors, Azopt and Trusopt, yielded similar economic profiles. The generic selective ?2-agonist brimonidine tartrate 0.2% costs approximately $352.89 and $529.34 per year for the respective two and three drops daily per eye regimens.

AWP trends through two periods, 1999 to 2006 and 2002 to 2006, showed significant increases, even within a category. For example, in the ?-blockers, Betoptic S increased nearly 100 % from 1999 to 2006, while Timoptic, increased only 11.7 %. In the period 2002 to 2006, the AWP of Timoptic remained constant.

Writing in the article, Steven D. Vold states, “Physicians consider many factors when treating patients with glaucoma. Ultimately, the goal of eye care providers is to give the best, most cost-effective care to their patients. Our study addresses the calculated cost per year passed on to the patient for single medication treatment plans…As newer medications and treatment schemes are introduced, future studies will be needed to update the rapidly changing economic information pertaining to the medical management of glaucoma.”

Glaucoma treatment cannot cure the condition, but it can dramatically slow or temporarily halt its progress. Glaucoma can be treated with either medication or surgery. Both of these treatments are aimed at lowering intraocular pressure (IOP), or pressure within the eye. In the United States, medications are usually the first-line of glaucoma treatment. If this fails, then glaucoma surgery is the next treatment considered.

Glaucoma Medications

Glaucoma medications are either oral or topical. Topical medications such as eye drops, eye ointments, or inserts (strips of medication inserted in the corner of the eye) work to reduce IOP either by increasing the outflow of fluid from the eye or by reducing the amount of fluid produced by the eye. To learn more about the condition, examine the risk factors and symptoms of glaucoma. It is important to tell all of your doctors about any glaucoma medications that you are using. In order for these medications to work, you must take them regularly and continuously as they were prescribed.

Topical Glaucoma Medications

There are five types of topical glaucoma medications, each achieving different purposes:

  • Miotics increase the outflow of fluid. These include Isopto® Carpine, Ocusert®, Pilocar®, and Pilopine®.
  • Epinephrines increase the outflow of fluid. These include Epifrin® and Propine®.
  • Beta-blockers reduce the amount of fluid. These include Betagan®, Betimol®, Betoptic®, Ocupress®, Optipranalol®, and Timoptic®.
  • Carbonic-anhydrase inhibitors and alpha-adrenergic agonists reduce the amount of fluid present. These include Alphagan®, Iopidine®, and Trusopt®.
  • Prostaglandin analogs increase the outflow of fluid through a secondary drainage route. These include Lumigan®, Rescula®, Travatan®, and Xalatan®.

Oral Glaucoma Medications

Your ophthalmologist can also prescribe oral medications to treat glaucoma. Carbonic anhydrase anhibitors are the oral medications most commonly used in the treatment of glaucoma. These include Daranide®, Diamox®, and Neptazane®.

Patients will be started on one medication or a combination of drugs. If a patient does not respond to one type of drug, he or she can be switched to another until all possibilities have been exhausted. Once this happens, the ophthalmologist may recommend glaucoma surgery.
Glaucoma Surgery

For patients who still have an elevated IOP after attempting glaucoma treatment through medication, an ophthalmologist may recommend either laser or conventional surgery.

Glaucoma Laser Surgery

There are three types of glaucoma laser surgery that can be performed in the doctor’s office:

Trabeculoplasty

Trabeculoplasty uses a laser to burn tissue from the trabecular meshwork, a structure within the eye that controls the flow of fluid. This procedure increases the aqueous outflow in the area surrounding the laser spot, relieving pressure within the eye. Pressure is reduced in 60 to 70 percent of the patients in whom a laser trabeculoplasty is performed. This type of glaucoma laser surgery is used to treat patients with open-angle glaucoma.

Iridotomy

Closed-angle glaucoma occurs when the angle between the iris and the cornea in the eye is too small. This causes the iris to block fluid drainage, increasing inner eye pressure. Iridotomy glaucoma laser surgery makes a small hole in the iris, allowing it to fall back from the fluid channel so fluid can drain.

Cyclophotocoagulation

Cyclophotocoagulation uses a laser to burn ciliary tissue, which decreases the production of fluid in the eye. The procedure, performed under local anesthesia, has only recently become available to glaucoma patients to reduce the intraocular pressure. This type of glaucoma laser surgery is used to treat patients who have failed to respond to other types of glaucoma surgery. Many patients will require more than a single treatment. The procedure appears to have significant success and relatively low risk.

Conventional Glaucoma Surgery

If laser surgery fails to lower IOP, the surgeon may recommend conventional glaucoma surgery, known as trabeculectomy or filtering surgery. This is an outpatient procedure involving the removal of a tiny piece of the eye under the eyelid. This conventional glaucoma surgery creates a new drainage path that increases the outflow of fluid from the eye.

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Xalatan is more effective than Alphagan

Friday, December 28th, 2007

XalatanStudy Compares Two Common Glaucoma Medications

A multinational study group including ophthalmologists from Finland, Germany, Ireland, Spain, and the United Kingdom recently reported the results of their study comparing Xalatan (latanoprost) and Alphagan (brimonidine) at the European Glaucoma Society meeting. The study group sought to determine both effectiveness and safety of the two commonly used glaucoma drops. Hannu Uusitalo, MD, ophthalmologist at the University Hospital, Tampere, Finland, presented the results.

The Study Protocol

A total of 379 patients with glaucoma or ocular hypertension (high eye pressure) were enrolled in the study and randomly assigned to receive one of the two drugs. The ophthalmologists were masked as to which agent individual patients were receiving to prevent observer bias. Baseline eye pressure measurements were taken prior to using the drops. The measurements were repeated at 2 weeks, 3 months, and 6 months after the patients had used the medication. Pressure readings were taken at 10:00 a.m. and 5:00 p.m. on examination days.

Adverse Events

Six months after the initiation of treatment, only 5 patients in the Xalatan group had withdrawn due to either side effects or uncontrolled eye pressure versus 53 patients in the Alphagan group. In the Alphagan group, 14 had ocular allergies to the medicine, 12 had uncontrolled eye pressure, and the remainder withdrew due to side effects or compliance related issues.

Effectiveness Controlling Eye Pressure

Patients in the Xalatan and Alphagan study groups had substantial decreases in eye pressure during the study; however, the group taking Xalatan had statistically significantly lower eye pressures than the Alphagan group. Those in the Xalatan group had a 28% reduction of eye pressure compared with a 21% reduction in the Alphagan group.

Furthermore, a target eye pressure of less than 18 mm Hg was achieved in 57% of the Xalatan patients versus 33% of the Alphagan patients. A pressure reduction of 30% or more was achieved in 42% of the Xalatan patients versus 22% of the Alphagan patients. Only 12% of the patients in the Xalatan group had a pressure reduction from baseline of less than 15%, compared to 32% of patients in the Alphagan group.

Conclusions

This study clearly shows Xalatan lowered intraocular pressure more effectively than Alphagan and had fewer side effects. Furthermore, since Xalatan only needs to be instilled once each day, patients may find it easier to use instead of Alphagan, which is used twice each day.

Despite the study results, patients should realize that glaucoma medications are tailored to the individual and the physician considers many factors when selecting the appropriate medication. This relatively short-term study did not assess the effect of treatment on the optic nerve or the peripheral vision with visual field testing, both key parameters when assessing treatment effect. Finally, as one can see from the above study results, the effect of glaucoma medication varies significantly from one individual to another, both in lowering pressure and side-effects. Therefore, it is certainly possible that Xalatan may be less effective than Alphagan in a given individual. This is why many ophthalmologists treat one eye initially, monitoring the effectiveness of the medication against the patient’s untreated eye.

What is Xalatan?

Xalatan reduces pressure in the eye by increasing the amount of fluid that drains from the eye.
Xalatan is used to treat certain types of glaucoma and other causes of high pressure inside the eye.

Xalatan may also be used for other purposes not listed in this medication guide.

Important information about Xalatan

Do not use Xalatan while you are wearing contact lenses. This medication may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using Xalatan before putting your contact lenses in.

Xalatan may cause a gradual change in the color of your eyes or eyelids and lashes, as well as increased growth or thickness of your eyelashes. These color changes, usually an increase in brown pigment, occur slowly and you may not notice them for months or years. Color changes may be permanent even after your treatment ends, and may occur only in the eye being treated. This could result in a cosmetic difference in eye or eyelash color from one eye to the other.
Do not allow the dropper to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.

After using Xalatan, wait at least 5 minutes before using any other eye drops that your doctor has prescribed.

Before using Xalatan

Do not use Xalatan if you are allergic to latanoprost.

Before using Xalatan, tell your doctor if you are allergic to any drugs, or if you have swelling or infection of your eye.

Xalatan may cause a gradual change in the color of your eyes or eyelids and lashes, as well as increased growth or thickness of your eyelashes. These color changes, usually an increase in brown pigment, occur slowly and you may not notice them for months or years. Color changes may be permanent even after your treatment ends, and may occur only in the eye being treated. This could result in a cosmetic difference in eye or eyelash color from one eye to the other.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Xalatan passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use Xalatan?
Do not use Xalatan while you are wearing contact lenses. This medication may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using Xalatan before putting your contact lenses in.

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

What is Alphagan?

Alphagan reduces the amount of fluid in the eye, which decreases pressure inside the eye.
Alphagan is used to treat open-angle glaucoma or ocular hypertension (high pressure inside the eye).

Alphagan may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Alphagan?
Do not use Alphagan if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

Before using Alphagan, tell your doctor if you have kidney or liver disease, heart disease, high blood pressure, circulation problems such as Raynaud’s or Buerger’s disease, or a history of fainting or low blood pressure.

Do not use Alphagan while you are wearing contact lenses. This medication may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using Alphagan before putting your contact lenses in.

Do not allow the dropper tip to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.
What should I discuss with my healthcare provider before using Alphagan?

You should not use Alphagan if you are allergic to brimonidine.
Do not use Alphagan if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

Before using Alphagan, tell your doctor if you have:

  • kidney disease;
  • liver disease;
  • heart disease or high blood pressure;
  • circulation problems, such as Raynaud’s syndrome or Buerger’s disease; or
  • a history of fainting or low blood pressure.

If you have any of these conditions, you may need a dose adjustment or special tests to safely use Alphagan.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Alphagan passes into breast milk or if it could harm a nursing baby. Do not use Alphagan without telling your doctor if you are breast-feeding a baby.

How should I use Alphagan?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Wash your hands before using the eye drops. Do not use Alphagan while you are wearing contact lenses. This medication may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using Alphagan before putting your contact lenses in.

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