Effectiveness and Tolerability of Netarsudil in Combination with Other Ocular Hypotensive Agents

To evaluate the effectiveness of netarsudil in combination with other ocular hypotensive agents in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT).Retrospective cohort study.All patients with OAG or OHT with netarsudil added to a regimen of at least 1 other ocular hypotensive agent between March 2018 and March 2019.Subjects with at least 2 baseline intraocular pressure (IOP) measurements on the same medication regimen before initiation of netarsudil were included. Subjects were excluded if they experienced other changes in their ocular hypotensive medication regimen.Change in IOP after initiation of netarsudil was assessed using linear mixed-effect models. Kaplan-Meier survival analysis was used to evaluate the time to discontinuation of netarsudil for any reason.Netarsudil was prescribed for 191 eyes of 138 patients. All of these subjects were included in the analysis of adverse effects. Twelve subjects discontinued netarsudil before the first follow-up visit because of adverse effects, leaving 175 eyes of 126 patients with at least 1 follow-up visit while using netarsudil included in the effectiveness analysis. The mean baseline IOP ± standard deviation was 17.1 ± 5.2 mmHg on a median of 2 ocular hypotensive medications. Including all observations on the same medication regimen after the addition of netarsudil, the mean IOP was 15.0 ± 4.5 mmHg, with a mean reduction of 2.2 mmHg (P0.001). A reduction in IOP was observed in eyes on 1 (2.0 mmHg, P0.001), 2 (1.0 mmHg, P = 0.12), 3 (3.0 mmHg, P0.001), and 4 (2.9 mmHg, P = 0.002) medications at baseline. A sustained ≥ 20% IOP reduction was observed in 16.2% of 123 eyes with at least 2 observations on treatment with netarsudil. Of the 138 subjects who were treated with netarsudil, 26.8% discontinued it because of adverse effects. The median time to discontinuation of netarsudil for any reason was 88 days.This study demonstrates a modest reduction in IOP is achievable with netarsudil in patients with OAG or OHT who are taking as many as 4 ocular hypotensive medications. The incidence of discontinuation due to adverse effects or inadequate efficacy was high.