Brinzolamide plus brimonidine for the treatment of glaucoma: an update

Abstract

Introduction: Glaucoma is a common sight-threatening condition that is primarily treated by lowering intraocular pressure (IOP). Today the mainstay of treatment is topical ocular hypotensive medications; many patients require more than one agent to achieve target IOP. For such patients, fixed combination formulations have several advantages including simplicity of treatment regimen, adherence to the treatment regimen, efficacy, improved ocular surface comfort and reduced cost. All currently available fixed combinations contain a β-blocker, which is contraindicated in some patients. Hence there is a clinical need for fixed-combination preparations without a β-blocker. This paper reviews the current literature on a new fixed-combination drug containing brinzolamide 1% and brimonidine 0.2% (BBFC).

Areas covered: A PubMed, Embase and ClinicalTrials.gov registry search was performed to identify all relevant studies. Four published clinical papers pertaining to three randomized controlled trials were identified for review. All studies demonstrated a significant reduction (p < 0.01) in mean IOP in patients administered with BBFC compared with its individual components, brinzolamide 1% or brimonidine 0.2%. Adverse effects from BBFC were no different from each of the individual components, the most common being blurred vision, eye irritation and dysgeusia (abnormal taste sensation). Although BBFC use was associated with more adverse effects compared with the individual components used as monotherapy (p < 0.001), the cumulative adverse effect profile from BBFC did not appear greater than one would expect from the simultaneous use of the two components.

Expert opinion: BBFC is a potential alternative to other fixed-combination medications and is especially useful when topical β-blockers are contraindicated. Longer-term experience will determine if additional adverse effects occur or if efficacy is maintained over longer periods.

Keywords: brimonidine; brinzolamide; carbonic anhydrase inhibitor; glaucoma; ocular hypertension; α2-adrenoceptor agonist.