Fixed Triple-Combination Bimatoprost/Brimonidine/Timolol Versus Separate Administration in Glaucoma: Randomized...

Area of Science:

• Ophthalmology
• Clinical Pharmacology

Background:

• Glaucoma management often requires multiple topical hypotensive agents.
• Fixed triple combination (FTC) therapies aim to simplify treatment regimens.
• Assessing the comparative efficacy and tolerability of FTC versus separate agents is crucial for optimizing patient care.

Purpose of the Study:

• To compare the efficacy, tolerability, and persistence of a fixed triple combination (FTC) of bimatoprost/brimonidine/timolol with separate administration of these agents.
• To evaluate secondary outcomes including adverse effects, quality of life (QoL), and adherence in glaucoma patients.

Main Methods:

• A randomized clinical trial involving 46 patients with open-angle or angle-closure glaucoma requiring multiple hypotensive agents.
• Patients were randomized to receive either FTC or separate agents twice daily after a washout period.
• Evaluations included intraocular pressure measurement, hyperemia grading, tear break-up time, corneal staining, and validated questionnaires for QoL, ocular surface, and adherence at 1, 4, and 6 months.

Main Results:

• Both FTC and separate agent regimens significantly reduced intraocular pressure without a significant difference between groups.
• Worsening conjunctival hyperemia and declining quality of life were observed in both groups.
• Treatment discontinuation rates were high (63%), primarily due to disease progression and intolerance, with a 69.6% probability of treatment maintenance at 6 months.

Conclusions:

• Fixed triple combination and separate agent regimens demonstrate comparable efficacy in lowering intraocular pressure for advanced glaucoma.
• Both treatment approaches are associated with progressive hyperemia, reduced quality of life, and low treatment persistence.
• The findings underscore the limitations of multiple topical therapies in long-term glaucoma management.