Purpose: To compare the peak IOP efficacy of brimonidine and latanoprost as adjunctive therapy in patients with ocular hypertension or glaucoma.
Design: A prospective, multicenter, double-masked, parallel design clinical trial.
Participants: One hundred fifteen patients with IOP inadequately controlled on topical beta-blocker monotherapy.
Methods: Patients were randomized to receive brimonidine 0.2% BID or latanoprost 0.005% QD as adjunctive therapy for 3 months. After 1 month of adjunctive treatment, patients who failed to meet a target 15% reduction in IOP at peak drug effect were crossed over to the other study medication.
Results: After 1 month of adjunctive therapy, brimonidine and latanoprost provided comparable IOP lowering [4.88 mm Hg (22.8%) with brimonidine and 5.01 mm Hg (23.5%) with latanoprost, P=.798]. Response rates were similar in both groups with 81.5% (44/54) of brimonidine patients and 81.1% (43/53) of latanoprost patients achieving the target 15% IOP reduction at month 1 (P=.963). After 3 months of adjunctive therapy, mean IOP reductions were 4.55 mm Hg with brimonidine and 5.49 mm Hg with latanoprost (P=.149). Patients in the latanoprost group reported more negative quality of life variables than patients in the brimonidine group. Significantly more latanoprost patients reported watery or teary eyes (34/53, 64.2% versus 23/54, 42.6% with brimonidine; P=.025) and hands or feet that became cold easily (24/53, 45.3% versus 12/54, 22.2% with brimonidine; P=.012).
Conclusions: As adjunct therapy with beta-blockers, brimonidine BID and latanoprost QD were comparable in lowering IOP while brimonidine-treated patients had fewer reports of adverse quality-of-life effects.