Netarsudil v/s Ripasudil: The battle of supremacy between two ROCKS-I (rho kinase inhibitors)

To compare the intraocular pressure (IOP) lowering effect and safety of topical netarsudil 0.02% once daily with topical ripasudil 0.4% twice daily in primary open angle glaucoma (POAG) patients.

A prospective, comparative, randomized study conducted on 140 eyes of patients diagnosed to have POAG, in a tertiary care hospital of Northern India. Patients divided into groups, A and B in a 1:1 ratio and were treated with ripasudil 0.4% or netarsudil 0.02% respectively and followed up. The mean diurnal IOP noted at 3rd week and 3rd month comparing it from baseline values, with their side effects.

At 3rd month, meandiurnal IOP for ripasudil 0.4% group ranged from 19.22 to 20.69 mmHg whereas for netarsudil group it was 17.11-18.47 mmHg, an intergroup statistically significant difference in IOP of 2.3 mmHg (p < 0.0001) noted. At 3^rd month the difference from baseline was 2.77 mmHg (p = 0.048) for ripasudil and 4.64 mmHg (p = 0.001) for netarsudil. At the end of 3 months the adverse events were seen less in group B than group A (59.8% and 66.7% respectively. Eye irritation followed by conjunctival hyperemia was seen. Overall incidence of adverse events was 32.9% and 44.3% for topical netarsudil and ripasudil respectively.

Topical netarsudil 0.02% once daily was well tolerated with fewer side effects and in reducing IOP than topical ripasudil 0.4% twice daily dosing in POAG patients. Netarsudil 0.02% once daily may be considered an important option for the IOP control in POAG.