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CLINIC UPDATES

Stay informed with the latest updates on glaucoma medications, antivirals, and steroids explained by Dr. Coral Pucci from UMSL. Learn about FDA approvals, mechanisms, prescriptions, studies, and adverse effects of cutting-edge ocular pharmaceuticals.

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CLINIC UPDATES

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  1. CLINIC UPDATES Ocular Pharmaceutical Developments: Dr. Coral Pucci, UMSL

  2. Dr. Coral Pucci Dr. Coral Pucciattended the University of Missouri-St. Louis College of Optometry when she earned her Doctorate of Optometry. She then completed a residency in Primary Care with emphasis in Ocular Disease at the Marion Veterans Administration Hospital in Illinois. Following residency, she returned to UMSL as an Assistant Clinical Professor, where she precepts primary care clinics. Dr. Pucciis the course coordinator for the Pharmacology courses, and also teaches in the ocular disease and binocular vision labs. UMSL

  3. Financial Disclosures No financial interests or affiliations to disclose. All products are reported without bias for the purpose of education only.

  4. Glaucoma Medications FDA Approvals Vyzulta FDA approved November 2017 Rhopressa FDA approved December 2017 Xelpros FDA approved September 2018 Rocklatan FDA approved March 2019

  5. Glaucoma Medications Vyzulta (latanoprostenebunod 0.24%) What makes it different? Dual Mechanism of Action Latanoprostacid working on uveoscleraloutflow Butanediolmononitrate releasing nitric oxide to increase outflow through the trabecular meshwork How is it prescribed? 1 drop in affected eye every evening http://www.bausch.com/Portals/69/-/m/BL/United%20States/USFiles/Package%20Inserts/Pharma/vyzulta-prescribing-information.pdf

  6. Glaucoma Medications Studies to note: Voyager Apollo Lunar Vyzulta (latanoprostenebunod 0.24%) Ophthalmology. 2016 May;123(5):965-73. doi: 10.1016/j.ophtha.2016.01.019. Epub 2016 Feb 11 WeinrebRN,etal.Br J Ophthalmol2015;99:738–745. doi:10.1136/bjophthalmol-2014-305908

  7. Glaucoma Medications Xelpros (latanoprost 0.005%) Mechanism of action Work on F2αreceptors to reorganize collagen increasing uveosclearal outflow What makes it different? Not preserved with BAK How is it prescribed? 1 drop in affected eye every evening https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/206185s000lbl.pdf

  8. Glaucoma Medications Rhopressa (netarsudil 0.02%) What makes it different? Mechanism of Action Rho kinase (ROCK) inhibitors working to relax TM Possible decrease in episcleral venous pressure Norepinephrine transporter (NET) inhibition decreases aqueous production How is it prescribed? 1 drop in affected eye every evening https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208254lbl.pdf

  9. Glaucoma Medications Rhopressa (netarsudil 0.02%) Adverse Effects: Conjunctival hyperemia (54.4%) Conjunctival hemorrhage (17.2%) Whorl keratopathy (20.9%) Aka corneal verticillata No decreased VA, resolved with discontinued medication Pain at instillation site https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/Verticillata/index.htm https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208254lbl.pdf

  10. Glaucoma Medications Rocklatan (netarsudil0.02% and latanoprost 0.005%) What makes it different? First combination drop to include new glaucoma medications

  11. Glaucoma Medications Rocklatan (netarsudil0.02% and latanoprost 0.005%) Studies to note: Mercury 1 and 2 http://investors.aeriepharma.com/static-files/29defd23-b47b-4319-ba01-5a7ac53e2108

  12. Glaucoma Medications Rocklatan (netarsudil0.02% and latanoprost 0.005%) Adverse Effects: Conjunctival hyperemia (59%) Conjunctival hemorrhage (11%) Whorl keratopathy (15%) Pain at instillation site (20%) https://www.dovemed.com/diseases-conditions/subconjunctival-hemorrhage/ https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/208259s000lbl.pdf

  13. Antivirals FDA Approvals Avaclyr FDA approved March 2019 http://medilinks.blogspot.com/2012/01/photos-for-herpes-simplex-keratitis-hsk.html

  14. Antivirals Avaclyr (acyclovir ophthalmic ointment 3%) What makes it different? First topical ophthalmic acyclovir in the US Used for acute dendritic HSK 1 and 2 How is it prescribed? 5x/day until corneal ulceration heals, then 3x/day for 7 days 1cm ribbon in lower cul-de-sac Studies to note: 7 day resolution 83% vs 50% with Idoxuridineung https://www.wikihow.pet/Give-Idoxuridine-to-Cats-with-Herpes-Eye-Infections https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/0202408s000lbl.pdf

  15. Steroids FDA Approvals Inveltys FDA approved August 2018 Dextenza FDA approved December 2018 LotemaxSM FDA approved February 2019 Generic Loteprednol FDA approved April 2019

  16. Steroids Inveltys (loteprednoletabonate ophthalmic suspension 1%) What makes it different? 1st and only BID post-op steroid 1% suspension vs Lotemax 0.5% KPI-121 (AMPPLIFY Drug Delivery) How is it prescribed? 1-2 drops BID into affected eye for 2 weeks following surgery Use: Post-op inflammation https://www.eyeworld.org/article-cataract-surgery-90-something-style--saying-yes-to-cataract-surgery-for-nonagenarians https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210565s000lbl.pdf

  17. Steroids Inveltys (loteprednoletabonate ophthalmic suspension 1%) Studies to note: Safety and efficacy of KPI-121 1% Ocular Pharmacokinetics (MMP) • Kim et al. Safety and efficacy of KPI-121 1%.Clinical Ophthalmology 2019:13 https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210565s000lbl.pdf Schopf L. et al. OphthalmolTher (2014) 3:63–72

  18. Steroids Dextenza (dexamethasone ophthalmic insert 0.4 mg) What makes it different? Intracanalicular implant 30 days of medication distribution How is it prescribed? Inserted dry into lower punctum and the canaliculus Use: Post-operative ocular pain https://crstoday.com/articles/2015-jan/advances-in-drug-delivery/

  19. Steroids Lotemax SM (loteprednoletabonate ophthalmic suspension, 0.38%) What makes it different? Submicron particles 0.38% vs Lotemax 0.5% Increased penetration How is it prescribed? 1 drop TID into affected eye for 2 weeks following surgery Use: Post-operative inflammation and ocular pain https://www.lotemaxsm.com/sm-technology#ISI https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/208219s000lbl.pdf

  20. Steroids Generic loteprednol (loteprednoletabonate ophthalmic suspension, 0.5%) What makes it different? First approved generic How is it prescribed? 1 drop QID in affected eye Use: Post-operative inflammation and ocular pain Inflammation of conjunctiva and anterior segment Generic

  21. Dry Eye Medications FDA Approvals Cequa FDA approved August 2018 Lumify FDA approved December 2017

  22. Dry Eye Medications Cequa (cyclosporine ophthalmic solution 0.09%) What makes it different? Nanomicellar technology 0.09% vs Restasis 0.05% cyclosporine How is it prescribed? 1 drop BID into each eye 12 hours apart Use: To increase tear production https://www.nytimes.com/2017/07/31/well/no-crying-over-dry-eyes.html https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210913s000lbl.pdf

  23. Dry Eye Medications Cequa (cyclosporine ophthalmic solution 0.09%) Studies to note: OTX-101 in the treatment of dry eye disease. Tauber et al. OTX-101 in the treatment of dry eye disease. Clinical Ophthalmology 2018:12 https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210913s000lbl.pdf

  24. Dry Eye Medications Lumify(brimonidine tartrate ophthalmic solution 0.025%) What makes it different? OTC 0.025% vs Alphagan P 0.1% or 0.15% Venule vs arteriole constriction How is it prescribed? 1 drop into affected eye every 6-8 hours QID max Use: Treatment of ocular redness due to minor eye irritations Actually a red eye medication https://www.lumifydrops.com/professional

  25. Allergy Medications FDA Approvals Zerviate FDA approved May 2017

  26. Allergy Medications Zerviate (cetirizine ophthalmic solution 0.24%) What makes it different? First topical ophthalmic cetirizine How is it prescribed? 1 drop BID into each eye Separated by 8 hours Use: Ocular itching associated with allergic conjunctivitis https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208694s000lbl.pdf

  27. Other Medications FDA Approvals Oxervate FDA approved August 2018

  28. Other Medications Oxervate (cenegermin-bkbj ophthalmic solution 0.002%) What makes it different? First medication for neurotrophic keratitis Use of recombinant human nerve growth factor How is it prescribed? 1 drop 6x/day into affected eye One 8 week treatment course Use: Neurotrophic keratitis https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/761094s000lbl.pdf

  29. Other Medications Oxervate (cenegermin-bkbj ophthalmic solution 0.002%) Studies to note: REPARO BoniniS et al. Phase II Randomized, Double-Masked, Vehicle-Controlled Trial of Recombinant Human Nerve Growth Factor for Neurotrophic Keratitis. Ophthalmology. 2018;125:1332-43.

  30. Other Medications Oxervate (cenegermin-bkbj ophthalmic solution 0.002%) BoniniS et al. Phase II Randomized, Double-Masked, Vehicle-Controlled Trial of Recombinant Human Nerve Growth Factor for Neurotrophic Keratitis. Ophthalmology. 2018;125:1332-43.

  31. Thank you The future of ophthalmic pharmaceuticals looks bright! Email: Puccic@umsl.edu

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