Defining a niche for tafluprost

For optometrists, the newest prostaglandin drop for glaucoma could be a case of addition by subtraction-of preservatives.

Tafluprost may prove beneficial to patients sensitive to benzalkonium chloride, or BAK, or who cannot tolerate other prostaglandin drugs. Other prostaglandins-latanoprost (Xalatan, Pfizer) and bimatoprost (Lumigan, Allergan)-are preserved with BAK. Alcon also markets Travatan Z, a travaprost drop preserved with SofZia.

Like other prostaglandins, tafluprost has been associated with ocular surface disease (OSD) in some patients. But the extent to which those complications are a function of the drug or preservative really isn't known, according to J. James Thimons, OD, FAAO, of Ophthalmic Consultants of Connecticut.

Tafluprost and OSD

Dr. Thimons is participating in a post-release clinical trial to assess the implications of tafluprost for OSD. In an interview with Optometry Times, Dr. Thimons said using a prostaglandin without preservatives offers the opportunity to gather data and better understand the extent to which the drug or the preservative is responsible for ocular surface complications.

Among glaucoma patients who have been treated with other prostaglandin drops, 40% to 50% had ocular surface complaints in some studies, according to Dr. Thimons. They become potential candidates for tafluprost if other interventions fail in resolving symptoms. Dr. Thimons has already started prescribing tafluprost to some patients who have had ocular surface reactions to other prostaglandins.

"In an attempt to keep those patients in prostaglandin therapy, I could see up to 15% to 20% of my patients converting," he said.

Danica Marrelli, OD, clinical professor at University of Houston College of Optometry, agreed that patients who cannot tolerate existing prostaglandins may prove a good niche for tafluprost.

Cost considerations

She noted that the new drop comes in unit-dose containers like other preservative-free drugs. Such packaging tends to increase a drug's cost, Dr. Marelli noted, which could be a factor in considering tafluprost for patients who tolerate other drugs well.

Like other prostaglandins, tafluprost has been shown to increase pigmentation in eyelids and eyelashes in some patients, as well as cause changes in the length, color, thickness and shape of the lashes, according to the manufacturer. The long-term effect of these changes is not known in the newly approved drug. Studies with the earlier approved prostaglandins-latanoprost was cleared for glaucoma in 1996-have suggested the pigmentation changes may be permanent.

"I see tafluprost as another option in our glaucoma arsenal," Dr. Marrelli said. "Especially for people who are sensitive to BAK, there is now one more option."