Stellenwert der Kombinationstherapie in der medikamentösen Glaukombehandlung

Zusammenfassung

Eine Kombinationstherapie des Glaukoms ist immer dann indiziert, wenn der angestrebte Zieldruckwert mit einer Monotherapie nicht erreicht wird, und/oder die Glaukomerkrankung fortschreitet oder eine Konversion von einer okulären Hypertension zu einem Glaukom auftritt. Seit einiger Zeit stehen für eine Kombinationstherapie auch zahlreiche Fixkombinationen aus zwei unterschiedlichen Wirkstoffen zur Verfügung, die die Anwendung für die Patienten im Vergleich zu nicht fixen Präparatekombinationen bedeutend erleichtern: Fixkombinationen reduzieren die tägliche Tropffrequenz. Dies kann die Adhärenz verbessern. Fixkombinationen enthalten ferner normalerweise weniger toxische Konservierungsstoffe im Vergleich zu nicht fixen Präparatekombinationen. Ferner entfällt bei Fixkombinationen auch die potenzielle Gefahr eines „Auswaschens“ des zuerst getropften Glaukompräparats durch eine zu kurze Wartezeit zwischen den einzelnen Tropfenapplikationen. In dieser Übersichtsarbeit werden die wichtigsten Aspekte einer fixen und nicht fixen Kombinationstherapie des Glaukoms diskutiert, wobei der Schwerpunkt auf den fixen Präparatekombinationen liegt. In Deutschland sind derzeit Fixkombinationen mit den Zusammensetzungen Dorzolamid/Timolol (FCDT), Brinzolamid/Timolol (FCBRINT), Latanoprost/Timolol (FCLT), Travoprost/Timolol (FCTT), Bimatoprost/Timolol (FCBIMT), Brimonidin/Timolol (FCBT), Pilocarpin/Timolol (FCPT) und Pilocarpin/Metipranolol (FCPM) zur Behandlung von Patienten mit Glaukom oder okulärer Hypertension zugelassen. Die Ergebnisse klinischer Studien, in denen diese Fixkombinationen mit den Einzelwirkstoffen, mit den entsprechenden nicht fixen Kombinationen, sowie untereinander verglichen werden, werden, soweit verfügbar, in dieser Übersichtsarbeit zusammenfassend dargestellt.

Abstract

A combination of antiglaucoma medications is indicated if monotherapy is not sufficient to achieve the predefined target pressure and/or in case of a progression of glaucomatous damage or conversion from ocular hypertension to glaucomatous optic neuropathy. Most recently many fixed combinations with two active compounds have become available for the medical treatment of glaucoma. Compared to non-fixed combinations, these drugs offer a much easier use for the patients. Fixed combinations have to be applied less frequently which may improve adherence. Furthermore, they most likely contain a lower amount of toxic preservatives compared to non-fixed combinations. And finally, fixed combinations may eliminate the risk of a “washout” of the first medication by using the second product of a non-fixed combination too soon after the first drop has been installed. This review aims to examine the most important aspects of IOP-lowering fixed and non-fixed combinations in glaucoma management with a clear focus on the results obtained with fixed combinations. In Germany, fixed combinations with the compositions dorzolamide/timolol (FCDT), brinzolamide/timolol (FCBRINT), latanoprost/timolol (FCLT), travoprost/timolol (FCTT), bimatoprost/timolol (FCBIMT), brimonidine/timolol (FCBT), pilocarpine/timolol (FCPT) and metipranolol/timolol (FCMT) are approved for the medical management of glaucoma and ocular hypertension. The results of clinical studies comparing fixed combinations with their active ingredients and with the corresponding non-fixed combinations will be discussed. Furthermore – if available – the results of direct comparisons of the efficacy and safety of different IOP-lowering fixed combinations are summarised.

Schlüsselwörter

intraokularer Druck - Kombinationstherapie - Fixkombinationen - Glaukom

Key words

intraocular pressure - combination therapy - fixed combinations - glaucoma

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