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Ophthalmology Volume 115, Number 1, January 2008

Discussion results of latanoprost and the DTFC. The 6-month results
should have accounted for, however, short-term changes in
The purpose of this study was to evaluate the 24-hour drug effect, such as tachyphylaxis, or at least a portion of
short-term (month 2) versus midterm (month 6) efficacy and the long-term drift with timolol as described by Boger and
safety of evening-dosed latanoprost versus the DTFC dosed the slightly greater effect seen with latanoprost over the first
twice daily in patients with POAG or ocular hypertension in 6 months of treatment. 1–3,22 However, a longer study may
a sample larger than those studied previously. have further differentiated these 2 treatments. In addition,
The midterm (month 6) results in this study showed that this study did not look at long-term visual outcomes to
both latanoprost and the DTFC effectively reduced the IOP determine if one of the medicines has an advantage over the
from untreated baseline for the 24-hour pressure curve after other on visual results. Future research may further clarify
6 months of treatment. In addition, when both treatments the appropriate use of these medicines in stepwise therapy
were compared 24-hour mean pressures did not differ sig- of glaucoma.
nificantly between treatment groups.
The short-term (month 2) results were similar to midterm
(month 6) results, except that with the DTFC there was a References
significantly lower 24-hour pressure as well as lower max-
imum and minimum pressures. When each treatment was 1. Alm A, Stjernschantz J, Scandinavian Latanoprost Study
compared between months 2 and 6, the fixed combination Group. Effects on intraocular pressure and side effects of
remained stable. 0.005% latanoprost applied once daily, evening or morning: a
In contrast, latanoprost showed a 0.3-mmHg further re- comparison with timolol. Ophthalmology 1995;102:1743–52.
duction between months 2 and 6. This efficacy improve- 2. Camras CB, United States Latanoprost Study Group. Compar-
ment has been shown previously by Camras, Watson, et al ison of latanoprost and timolol in patients with ocular hyper-
in the regulatory trials but has not been discussed exten- tension and glaucoma: a six-month masked, multicenter trial
sively. 2,3 Although the previous studies and the current in the United States. Ophthalmology 1996;103:138–47.
study suggest that latanoprost essentially reaches its maxi- 3. Watson P, Stjernschantz J, Latanoprost Study Group. A six-
month, randomized, double-masked study comparing latano-
mum efficacy within 2 weeks, it may have a slight further prost with timolol in open-angle glaucoma and ocular hyper-
increase in efficacy by month 6. The reason for the contin- tension. Ophthalmology 1996;103:126–37.
ued increase in therapy is not known precisely but might be 4. Smith SL, Pruitt CA, Sine CS, et al. The use of latanoprost
a further maturing of the intraciliary body channels, which 0.005% once daily to simplify medical therapy in patients with
might allow for a further slight increase of aqueous flow primary open-angle glaucoma or ocular hypertension. Acta
over time. 19 Nonetheless, a change of 0.3 mm Hg has not Ophthalmol Scand 1999;77:189–92.
been shown previously to have value clinically in helping 5. Clineschmidt CM, Williams RD, Snyder E, Adamsons IA. A
preserve vision of patients in the long term. 20,21 randomized trial in patients inadequately controlled on timolol
In contrast, the apparent reason for the stable pressure alone comparing the dorzolamide-timolol combination to
with the fixed combination at month 6 compared with monotherapy with timolol or dorzolamide. Ophthalmology
1999;106(suppl):17–24.
month 2 is not completely clear. This finding may indicate 6. Hutzelmann J, Owens S, Shedden A, et al. Comparison of the
that the fixed combination demonstrates less long-term drift safety and efficacy of the fixed combination of dorzolamide/
than that observed previously with timolol alone. 22 How- timolol and the concomitant administration of dorzolamide
ever, it should be noted that 6 months is not a sufficient time and timolol: a clinical equivalence study. Br J Ophthalmol
to evaluate the long-term drift for timolol completely. 22 1998;82:1249–53.
Nonetheless, this current study extends the knowledge of 7. Boyle JE, Ghosh K, Gieser DK, Adamsons IA. A randomized
the efficacy of the dorzolamide/timolol fixed combination trial comparing the dorzolamide-timolol combination given
compared with latanoprost over 24-hour testing to the mid- twice daily to monotherapy with timolol or dorzolamide.
term follow-up level (6 months) and provides the physician Ophthalmology 1999;106:10–6.
greater confidence in how these products’ efficacies might 8. Fechtner RD, Airaksinen PJ, Getson AJ, et al. Efficacy and
contrast with each other with long-term treatment. tolerability of the dorzolamide 2%/timolol 0.5% combination
(COSOPT) versus 0.005% (XALATAN) in the treatment of
The adverse events noted in the present 24-hour study ocular hypertension or glaucoma: results from two random-
mostly were typical of latanoprost and the dorzolamide/ ized clinical trials. Acta Ophthalmol Scand 2004;82:42–8.
timolol maleate fixed combination, as seen previously. 1–3,7 9. Konstas AG, Papapanos P, Tersis I, et al. Twenty-four–hour
The dorzolamide/timolol fixed combination group had more diurnal curve comparison of commercially available latano-
burning/stinging and bitter taste, whereas the latanoprost prost 0.005% versus the timolol and dorzolamide fixed com-
group had more hypertrichosis and ocular itching. The sig- bination. Ophthalmology 2003;110:1357–60.
nificantly greater incidence of headache with latanoprost 10. Orzalesi N, Rossetti L, Bottoli A, et al. The effect of latano-
was an unusual finding. Headache has been reported previ- prost, brimonidine, and a fixed combination of timolol and
ously with both timolol and latanoprost. 23,24 The greater dorzolamide on circadian intraocular pressure in patients with
glaucoma or ocular hypertension. Arch Ophthalmol 2003;
incidence in this study should be confirmed in a future trial. 121:453–7.
This study suggests that, after 6 months of therapy, the 11. Konstas AG, Mantziris DA, Stewart WC. Diurnal intraocular
DTFC and latanoprost have clinically similar 24-hour IOP- pressure in untreated exfoliation and primary open-angle glau-
lowering efficacies. coma. Arch Ophthalmol 1997;115:182–5.
This study did not evaluate the long-term (1–5 years) 12. Konstas AG, Mantziris DA, Cate EA, Stewart WC. Effect of

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