We’ve got another glaucoma med to prescribe.

The FDA just approved Bausch + Lomb’s new glaucoma drop, Vyzulta.
How does it work?
According to B&L, it is “a nitric oxide-donating prostaglandin F2-alpha analog”.
I can feel your attention fading so let me say that a different way.
Vyzulta is a drop that has two mechanisms of action to reduce IOP.
  1. It’s a prostaglandin analogue that increases aqueous outflow via the uveoscleral pathway (similar to Lumigan, Travatan etc).
  2. It also acts as a nitric oxide donor. That’s your talking point. The nitric oxide donation gives it an extra kick by increasing outflow throughout the trabecular meshwork and Schlemm’s canal.
What is the dosing?
One drop once a day.
What are the side effects?
The most common are conjunctival hyperemia, eye irritation, eye pain, and instillation site pain. As with other prostaglandins, increased pigmentation of the iris and periorbital tissue and growth of eyelashes can occur.
What about the clinical trials?
There were many. Four Phase 3 studies (APOLLO, LUNAR, JUPITER, and CONSTELLATION) and one Phase 2 study (VOYAGER) with over 1000 participants in total. They compared Vyzulta to Timolol 0.5% and Xalatan and found a greater IOP reduction with Vyzulta.
How much IOP reduction are we talking?
In the APOLLO and LUNAR studies, there was an average of 32% IOP reduction.
When can we prescribe it?
The company hopes to make Vyzulta available by the end of the year. (via)

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