Transcript
Speaker 1:Glaucoma is a group of conditions that lead to deterioration of the peripheral visual field and irreversible vision loss. Although it is the leading cause of irreversible blindness, the only modifiable risk factor currently supported by clinical trials is IOP control. As a result, timely treatment to lower IOP is [00:00:30] imperative to slow the rate of vision loss from glaucoma with common methods including topical medication, sustained release drug delivery, laser treatment, and surgery.
As the landscape of glaucoma treatment evolves and minimally invasive options are integrated into clinical practice, early stage disease management represents a pivotal therapeutic window through which timely intervention may prevent lifelong visual disability. In recent years, advancements in [00:01:00] both procedural and pharmacologic modalities have transformed clinicians' approach to managing this phase of the disease.
The Early Stage Glaucoma Consensus Group reflects the perspectives of experienced glaucoma specialists and comprehensive ophthalmologists uncovering a harmonized view of how selective laser trabeculoplasty and sustained release drug delivery systems may function as a complementary tool in the early stage glaucoma [00:01:30] treatment algorithm. The consensus group participated in an online survey and follow-up interviews to address prevailing practice gaps and establish current practice patterns and attempt to advance the care of patients with early stage glaucoma.
[00:02:00] Patient preference and adherence concerns and ability to reduce or eliminate daily medication burden are the top two considerations by the Early Stage Glaucoma Expert Consensus Group when integrating sustained release therapy into early glaucoma management. Additionally, the consensus group indicates they consider incorporating sustained release [00:02:30] drug delivery devices into their treatment algorithms in many situations, including when patient adherence to drops is a concern, 83%, when side effects from drops are problematic, 83%, and when patients are hesitant to start drops 83%.
Half of the consensus group also offer it when they feel consistent prolonged drug release outweigh the need for more frequent monitoring. Other indications include cost of drops and if [00:03:00] a patient fails first-line SLT or is not at target.
Zarmeena Vendal...:Intracameral drug delivery is what I have really found to be the most beneficial in my hands in our practice, and not just from the point of view of efficacy, but from the point of view of patient adoption. So [00:03:30] we are in a world of really trying to knock it out of the park with issues with compliance, adherence, quality of life, and everything related to topical therapy.
Intracameral has been a really relatively easy thing for patients to adopt. I also see some of our industry partners really dedicating a lot of their work in that intracameral space. So much so, so that's really where my mindset is.
[00:04:00] That is 100% the way we employ drug delivery in my practice. In any one of those instances, and even others, if we feel that a patient is going to have issues with topical therapy, we are right away suggesting drug delivery. I think it is the, along with laser, the answer to finding the [00:04:30] issues of this chronic disease that the GAAP study has uncovered for us. 90% non-compliance over a glaucoma patient's lifetime, a chance of 50% of discontinuation of medication over a patient's lifetime. So I would say all of the above.
A lot of it is just purely data-driven. When I know that there's an 80% chance that my patient will respond to laser and it'll last from a year to three years, [00:05:00] I just have a longer length of time that I have bought them glaucoma control, if you will, from my toolbox. So I find laser to be the first line, knock it out of the park therapy, and then to combine it with sustained drug delivery if needed.
For me, the ability to lower their medication burden and the clinical outcomes are the [00:05:30] main deciding factors on offering drug delivery. The issue of cost-effectiveness has already been proven, and so the math has already been done on that. We actually know the fact that drug delivery is less costly to our medical system than drugs that pay topical medications over a patient's lifetime. So that's not really a deciding factor for me at all.
Inder Paul Sing...:[00:06:00] There is some duration effect, which we see it with the MORPHEUS data from DURISTA. We see with the eye dose and its two-year phase 2B data, the three-year trials. We do see these patients who have drug delivery tend to have a longer duration even if the drug is potentially worn off.
So there's a lot of benefits to it from a patient satisfaction, from a compliance perspective, from the office compliance and office efficiency and flow. Then our trust in that we're doing something to actually stabilize the disease, and then we do have more faith than [00:06:30] we do with topical drops. I think we're seeing exactly what the studies show us.
Speaker 1:Let's review some of the latest clinical trial results on sustained release drug delivery in early stage glaucoma. With the Bimatoprost intracameral implant DURISTA, the mean IOP reduction was between five and eight millimeters of mercury through the first 15 weeks, from a baseline of 24.5 millimeters of mercury. Impressively, a single administration helps 77% of patients maintain [00:07:00] reduced pressure for up to 18 months without needing additional therapy.
With the Travoprost intracameral implant eye dose TR, the results are equally compelling. 12 months after receiving the implant, 81% of patients were completely free of topical IOP lowering medication. Drug levels in the aqueous humor remained high enough to sustain maximum pressure lowering effects for at least 24 months. [00:07:30] Both the fast and slow eluding versions provide clinically and statistically significant IOP reduction for up to 36 months when compared with twice daily Timolol.
In terms of magnitude, the mean IOP reduction ranged from 7.6 to 8.8 millimeters of mercury for the fast eluding group and from 7.3 to 8 for the slow eluding group. Most importantly, patients saw a substantial and durable [00:08:00] reduction in their medication burden lasting as long as three years in some cases. Together, these results show that sustained release therapy isn't just about convenience, it's delivering long-term efficacy, safety, and a better quality of life for patients with glaucoma.
Emily M. Schehl...:I do think that [00:08:30] sustained release where the drug is anchored somewhere in the anterior chamber is absolutely the way of the future. I think that further studies of visual fields are going to show similar to SLT that there's actually disease modification for those drops where you're being provided constant elusion of prostaglandin analogs or whatever it is. So it's absolutely my preference, but I also [00:09:00] think that being very interventional, we want to suggest things to patients that are really going to be safe and helpful for them.
Manjool Shah, M...:I think sustained drug delivery is a powerful kind of one, two punch. Right now, the issue with drug delivery is a limited set of options, unfortunately, and access continues to be a challenge. So it's just not as ubiquitously available to all patients and all providers to offer [00:09:30] as SLT is in my opinion, but that is also a very rapidly changing and growing space. I think as we develop more and more comfort with standalone surgery as well as drug delivery, now we're starting to create a little bit more of an all encompassing package of procedures that can indeed deliver some duration to care [00:10:00] and pressure control.
Swarup S. Swami...:I think intracameral, I think, is going to be what we're going to see. So we have two things in the market right now as you probably know and heard of. So DURISTA and iDose both are prostaglandin related medications that you can inject into the eye, one in the operating room, one doesn't have to be in the operating room. Various [00:10:30] advantages and disadvantages of both.
I think the idea of safe administration of something that elutes medicine over a long period of time, I think is something that we're going to see a lot of pharma companies developing further. I think trying to get them to get those medications to release for a longer period of time, [00:11:00] I think is going to be at another new evolution. Then also, I think the idea of being able to replace them or repeat, administer them, I think that's slowly going to become a thing that we see more.
I think it is something that is coming in the future. I think intracameral delivery is going to be, I think, a focus because it moves away. I think this is a concept in glaucoma [00:11:30] that early glaucoma patients sometimes struggle with is, one, your disease isn't going to disappear. Using these medications isn't going to undo your change. This is a long, long game. This is not a short-term thing because I think a lot of people are used to just using drops for a little bit of time and it solves the issue and they're fine. So they say, "Oh, let me just use the drops."
They don't maybe fully understand that these medications are for life. So when you talk about that, talk them through that, especially when they're younger, because then they might be on meds for 30, 40 [00:12:00] years, then they get like, "Maybe you should think about some of these other things to prevent me from having to be on this for 50 years." So I think that's been conversation that I usually have with my early disease patients.
Lorraine M. Pro...:I tell patients when they come in, one of my goals is to try to keep you off drops for as long as possible. I say sometimes [00:12:30] we still have to use them as a bridge therapy, or if we're not quite ready to take the next step, we can reach for drops, but I personally wouldn't want drops on my eyes for the rest of my life, and I'm going to try to do that for you too. So that's where we're looking for SLT. We're looking at drug delivery, usually bringing up cataract MIGS as a future option.
Speaker 1:To read the consensus statement in its entirety and complete the related CME activity, scan the QR code on this screen.
