Comparison of primary open-angle glaucoma treatment regimens for patients with disease progression characteristics. Part 2. The efficacy of initial hypotensive treatment regimens

PURPOSE: To evaluate the efficacy of initial hypotensive treatment strategies in patients with different stages of primary open-angle glaucoma in order to predict glaucoma progression or lack thereof.
METHODS: This combined analytical scientific and clinical multicenter study was conducted between January and April 2017. A total of 136 participants (237 eyes) from 30 academic referral centers from 6 (six) countries (Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Uzbekistan) — 52 (38.2%) males and 84 (61.8%) females — were included into the study. Glaucoma anamnesis and all treatment regimens were evaluated retrospectively. The study of treatment regimens included the assessment of the effectiveness of topical medication, laser and surgical treatment. Four (4) successive regimen changes were analyzed, each of them with no less than three (3) months duration.
RESULTS: The research team has established that the quantity of treatment regimens rises with each next regimen change: from 14 regimens at baseline to 30 regimens at the third adjustment. Prostaglandin analogues (PGA) and beta-blockers (BB) monotherapy were used as baseline first-choice therapy in 37.6% and 21.5% of cases respectively (66.2% in total). Fixed or unfixed combinations with PGA and BB were preferred in 16.5% of cases, BB and carbonic anhydrase inhibitors (CAI) combination — in 8.4% of cases.
The combination therapy with CAI at the start has achieved the most prominent reduction of intraocular pressure (IOP) (till 33.9%). The first choice monotherapy with BB or PGA led to a more effective IOP reduction compared to fixed or unfixed combinations of these drugs: BB reduced the IOP level by 20.0% from baseline, PGA — by 23.1%, their combination — by 19.2%. We have established an intensive use of combination therapy, starting with the 2nd regimen — 71.3%. The laser and surgical treatment was used as initial treatment in 0.8% and 2.1% respectively and achieved 26.7% and 46.0% prevalence respectively by the a final regimen.
We achieved the most prominent IOP reduction (by 37.1%) in regimens No 3 and No 4 that included trabeculectomy.
CONCLUSION: The results show that the tactics of managing patients with newly diagnosed glaucoma is changing in favor of prescribing first-choice monotherapy medicines — PGA. The choice of therapy tactics for patients with moderate and advanced glaucoma remains irrational: laser and surgical treatment becomes relevant only in regimens No 3 and No 4, 3-4 years after the diagnosis of the disease.

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