New bimatoprost concentration alters treatment paradigm

Barrie, Ontario-The impending availability of generic latanoprost is creating a lot of discussion about the potential impact on prescribing of IOP-lowering medication. However, the recent introduction of a reduced concentration formulation of another prostaglandin analogue, bimatoprost 0.01% (Lumigan, Allergan), may be a more important reason why eye-care professionals (ECPs) should be thinking about altering their paradigm for ocular hypotensive therapy, said Donald R. Nixon, MD.

Dr. Nixon is director, Trimed Eye Center, Barrie, Ontario. As a Canadian ECP, he has had access to bimatoprost 0.01% for almost 1 year. Based on his personal experience and clinical trial evidence, Dr. Nixon believes bimatoprost 0.01% provides the best of both worlds for IOP-lowering treatment in terms of activity and safety/tolerability.

"Introduction of the new 0.01% formulation of bimatoprost is almost like having access to a brand new drug because its tolerability profile is so different than bimatoprost 0.03%. Data from 12 months of follow-up in a prospective, randomized, double-masked, comparative clinical trial showed bimatoprost 0.01% was equivalent to bimatoprost 0.03% for lowering IOP, but the lower concentration formulation was associated with two-thirds lower rates of both moderate-to-severe hyperemia and hyperemia-related study discontinuation,"¹ he told Optometry Times.

"I now have well over 300 patients on bimatoprost 0.01% in my clinical practice," Dr. Nixon continued. "Based on its efficacy and tolerability, I am comfortable and confident prescribing bimatoprost 0.01% for my treatment-naïve patients, and it has offered an excellent option as an alternative for maintaining a monotherapy regimen in latanoprost-treated patients who are candidates for a switch."

Dr. Nixon pointed out there are "3 Ws" relevant to a discussion of switching prostaglandin analogue therapy-when, why, and what. "When" refers to early therapy or established treatment, and there are different "why" scenarios for both of those groups. As a more overarching principle, the "why," could refer to the basic reason to switch instead of add, and that is to maintain monotherapy for as long as possible.

"For patients started on latanoprost, treatment modification may be considered if IOP control is thought to be insufficient, either after an initial trial or over time. However, the goal in changing treatment is to keep it simple in order to optimize compliance," he said.