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    Innovation in glaucoma thriving

    New drugs, devices, diagnostics ‘nicely’ fueling growth


    The biggest pipeline news is AR-13324, a combination ROCKi and norepinephrine transport inhibitor (NETi) from Aerie Pharmaceuticals. The ROCKi facilitates outflow while the NETi decreases aqueous production.

    Phase IIb data for a full cohort of 221 eyes with once-daily dosing showed IOP lowering that is about <1 mm Hg than latanoprost. But a subgroup analysis of patients with a baseline IOP of between 22 mm Hg to 26 mm Hg showed clinically and statistically equivalent lowering of IOP, compared to latanoprost at 14 days and 28 days.

    “That is an important finding because most glaucoma patients fall into that 22 mm Hg to 26 mm Hg range before treatment,” Dr. Cunningham said. “At the same time, the phase I pharmacokinetics study showed a 30% reduction in IOP for normotensive eyes, which is better than the IOP reduction seen with prostaglandins. The results suggest a novel mechanism of action.”

    ROCKi agents act through the trabecular meshwork to facilitate outflow, but the precise mechanism is not entirely clear. It is known that outflow resistance is a major determinant of IOP. Outflow resistance is determined in large part by the episcleral venous pressure (EVP). EVP sets an effective floor for IOP, Dr. Cunningham explained, which suggests that Aerie’s ROCKi agent may act by reducing EVP.

    “ROCKi agents hold major promise,” he said. “They offer significant IOP reduction through the range of pressures we see in practice, not just at the high end.”

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